Health Plan & Payer solutions that reduce your costs and improve member health.

Specialized care management services that focus on members with complex conditions, bringing a personal touch to specialty drug management.

• Integrated pharmacy and medical specialty drug management (claims processing, utilization management, prior authorization, retail and 340B networks)
• State-of-the-art technology and analytics, including real-time data analysis and reporting
• IV and injectable drug therapy training
• National specialty pharmacy - 9th largest in the U.S.
• Proven medication adherence programs, including monitoring and support
• URAC Specialty Pharmacy Accreditation

Learn more about Specialty Pharmacy

Cutting-edge technology and clinical expertise provide a total drug management solution that improves outcomes while maximizing savings.

• Comprehensive reporting options, including real-time client access to data
• Formulary management
• Home delivery services
• 24/7/365 live customer service help, staffed with licensed pharmacy technicians
• 7th largest PBM in the U.S.
• URAC Pharmacy Benefit Management Accreditation and NCQA Utilization Management Certification

Learn more about PBM

Delivering the right intervention at the right time while reducing waste and removing barriers to member engagement.

• Educates and helps members manage their diabetes in their home
• Supply kits include program introduction, cellular glucometer, test strips, and how-to guide
• Monthly reports contain biometric readings, member engagement, and compliance levels
• Interventions boost compliance and drive behavior change
• Achieved 22% reduction in ER spend and 15% fewer ER visits per member per month
• Delivered 28% increase in compliance and 6% decrease in average glucose levels

Learn more about Diabetes Management

A 100% live-answer nurse advice line delivers an optimal experience and educates members on appropriate care and service levels.

• 24/7/365 resource providing clinical support immediately from the comfort of home
• Single-call resolution model
• Nurse triage teams across the country linked via HIPAA-compliant software systems
• 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
• RNs licensed in all 50 states and Washington, D.C., Puerto Rico and the U.S. Virgin Islands
• Proven methods get members to the right place the first time, reducing ER and other medical costs

Learn more about Nurse Advice Line

Eye care services that integrate evidence-based medicine and best practices to decrease exam and diagnostic claim costs.

• Routine and medical eye care coverage
• Board-certified ophthalmologists, optometrists, medical directors and staff
• Extensive network of independent providers and popular retail chains across the U.S., including Puerto Rico
• NCQA Certification in Utilization Management/Credentialing
• Innovative HEDIS/Star rating enhancement services
• Performance guarantees

Learn more about Vision

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
• High-quality dental services
• Cost-effective dental care management through a network of dental providers
• URAC Health Utilization Management Accreditation

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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
• Claims processing/payment engine: accurate adjudication for complex plans and multiple reimbursement models
• Two datacenters secure core applications and data with redundant networking systems and backups
• Production applications backed up daily to off-site storage facility that complies with HIPAA and HITECH rules

Learn more about Healthcare Management Services Organization (MSO) Solutions