NextLogical's unique approach will improve the health status of your plan members, as well as, your bottom line.

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Outsourced Services (Optional)

  1. Implementation and Management of MedIntelligence Prescriber Advisor Program.
  2. Implementation of NextLogical's Medical Director Program Utilizing MD Hawkeye Analytical and Predictive Modeling Software Supported by a Team of Physicians, Pharmacists, Pharmacy Benefit Experts and Other Clinical Staff:
    • Acquire Monthly Medical and Pharmacy Claims Data from TPA / Carrier and Pharmacy Benefit Manager (PBM).
    • Cross-map Data for Data Point Correlation and File within the Medical Director Data Warehouse.
    • Analyze The Data as follows:
      1. Qualitatively Evaluate and Quantitatively Assess the Medical Risk within the Member Population,
      2. Target Health Plan Resources (Utilization/Case/Disease and Network Management) on Specific Cases where Intervention is Indicated.
    • Generate Written Quarterly Reports for the Plan:
      1. Summarize Identified Areas and Specific Instances of Medical Risk that have been Identified,
      2. Demonstrate Trends for Risk Within the Health Plan,
      3. Demonstrate the Effectiveness and Outcomes of Past Interventions within the Member Population, and
      4. For TPA / PBM Auditing Purposes, Identify Any Administrative Issues (both Medical and Pharmaceutical) Related to: Claims Paid Out Of Eligibility, Claims Paid Not In Eligibility and Duplicate Claims Paid.
    • Generate a Written Annual Report of all Risk Interventions and Outcomes and Present an Oral Presentation of Findings to the Client.
    • Clinical Advice and Support as Requested.
  3. Consolidated Enrollment, Eligibility Management and Billing for all Lines of Coverage, including but not limited to:
    • Medical,
    • Dental,
    • Vision,
    • Section 125, Flexible Spending Accounts (FSAs) and Non-Discrimination Testing,
    • Life / AD&D Insurance,
    • Disability Insurance,
    • Employee Assistance Program (EAP),
    • COBRA / HIPAA Administration,
    • Toll-free Call Center Operation,
    • Electronic Enrollment Management System,
    • Integration with Payroll System for Automated Deduction Feeds, and
    • Tax Form 5500 Preparation and Filing.
  4. Third-Party Administrator (TPA)/Carrier and Pharmacy Benefit Manager (PBM) Auditing.
  5. Actuarial Consulting.

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