HealthTrans' flexible claims management services ensure accurate, reliable, and real time processing and support is readily available to respond to needs. Features include:

   Multi-tiered plan options - allowing for increased generic utilization, step therapy, and cost-containment measures

   Multi-domain rules - providing clients with the ability to structure sophisticated plans that can be both generic and also very specific, enabling extensive plan flexibility and profitability modeling options

   Member enrollment and identification - accommodating member enrollment changes from one up to tens-of-thousands of exchanges at a time, instantaneously

   Co-pay determination - allows for multi-tiered copays, and percentage copays encompassing varying enrollee situations

   Claims adjudication - ensuring all billing and payments are tracked in real time. Clients have the ability to instantly see the results of a transaction, including the cost paid to pharmacy

   Concurrent drug utilization review/drug interaction screening - ensuring maximum patient safety utilizing the time-tested First Data Bank clinical content

   Refill cautions - posting red flags for both early and delayed refills, ensuring appropriate drug regimen compliance

   Prior authorization - tracking exceptions that can be handled by automation or with manual controls

   Minimum/maximum dosing guidelines - flagging concerns that fall out of predetermined safety range, to enhance patient safety

   Customized messaging to pharmacy providers - ensuring appropriate messages and communication are delivered to the pharmacist before prescription is dispensed

   Pharmacy savings accounts - tracking and automated billing of flexible spending accounts

   Rules-based, table-driven functionality - enabling complex plan variations or simplified modifications without programming delays

   ID card production - facilitating card production for clients who wish to outsource this piece of their business