Cutting-edge technology and clinical expertise provide a total drug management solution that improves outcomes while maximizing savings. Our services are designed to help you improve your financial, clinical and operational performance.

• State-of-the-art technology, reporting, and analytics
• Customized formulary management
• Coordinated home delivery services
• Innovative clinical programs
• 24/7/365 live customer service help, staffed with licensed pharmacy technicians
• Secure online member portal
• Robust member education and outreach strategies
• URAC Pharmacy Benefit Management Accreditation and NCQA Utilization Management Certification

Specialized care management services focus on members with complex conditions, bringing a personal touch to specialty drug management. As a combined provider of PBM solutions and specialty drug management services, Envolve can deliver an integrated, personalized drug management program to the individuals you serve.

• Integrated pharmacy and medical specialty drug management including; claims processing, utilization management, prior authorization, retail and 340B networks
• State-of-the-art technology, reporting, and analytics
• Comprehensive IV and injectable drug therapy training
• Nationwide, U.S.-based specialty pharmacy with 14 locations
• Proven medication adherence programs, including monitoring and support
• URAC Specialty Pharmacy Accreditation

A 100% live-answer nurse advice line delivers a personal experience that takes care of your members on the first call. Our nurse advice line solutions including 24/7/365 medical triage and clinical advice, telemedicine integration, and after-hours support deliver appropriate care with superior service levels.

• U.S.-based URAC-accredited and HIPAA-compliant clincal call centers
• 24/7/365 resource providing clinical support immediately from the comfort of home
• Single-call resolution model to get members the care they need on first outreach
• Culturally and linguistically sensitive staff
• Multilingual accessibility, including:
  • 90% Bi-lingual Non-clinical Staff
  • 35% Bi-lingual Clinical Staff
  • Services are provided in more than 200 languages via live interpretation
• Licensed RNs in all 50 states and Washington, D.C., Puerto Rico and the U.S. Virgin Islands

Our vision plan solutions help organizations reduce costs by better managing claims, improving quality performance metrics, and providing comprehensive vision benefits to your members. Our eye care services use evidence-based medical and best practices to reduce exam and diagnostic claim costs.

• Customizable plans including routine and medical eye care coverage
• Extensive network of independent providers and popular retail chains across the U.S., including Puerto Rico
• Robust provider communications and education
• In-depth analysis of claims data to identify overpayments, monitor frequently abused codes, and interrupt at the first sign of plan abuse
• NCQA Certification in Utilization Management/Credentialing
• Innovative HEDIS/Star rating enhancement services
• Performance guarantees

Comprehensive dental care through customized programs to deliver positive member outcomes and reduce administrative burden.

• Innovative education and outreach programs for those you serve
• Individualized provider support
• In-depth evaluation of the cost-effectiveness of dental claims and member outcomes
• Cost-effective dental care management through a network of dental providers
• NCQA Accreditation in Utilization Management/Credentialing

Enabling better healthcare and efficiency through best-in-class business administration services, data utilization, clinical excellence and operational support.

• Innovative benefit designs improve member health and comply with state/federal laws
• Complete claims processing/payment engine provides accurate adjudication designed for complex plans and multiple reimbursement models
• Established data and analytics infrastructure capable of providing both qualitative and quantitative outcome measures to determine the effectiveness of your organization’s interventions
• Efficient, comprehensive provider network management including contracting, service inquiry, documentation, and data management
• Comprehensive utilization management program to improve coordination of care while managing costs