The State of West Virginia Partners with HDM to Audit Pharmacy Benefit Programs
HDM is pleased to announce it has entered into a partnership in pharmacy expense management with the State of West Virginia. Partnering with HDM will allow three of the State’s payors – the West Virginia Public Employees Insurance Agency (PEIA), the West Virginia Children’s Health Insurance Program (WVCHIP), and Access West Virginia (AccessWV) – to effectively implement industry leading practices focused on PBM administration, overpayment recovery and fraud, waste, and abuse detection.
King of Prussia, PA, February 27, 2008 --(PR.com)-- Healthcare Data Management, Inc. (HDM), a leading source of cost reduction, expense management, and compliance services for self-insured employers, is pleased to announce it has entered into a partnership in pharmacy expense management with the State of West Virginia. Partnering with HDM will allow three of the State’s payors – the West Virginia Public Employees Insurance Agency (PEIA), the West Virginia Children’s Health Insurance Program (WVCHIP), and Access West Virginia (AccessWV) – to effectively implement industry leading practices focused on Pharmacy Benefits Manager (PBM) administration, overpayment recovery and fraud, waste, and abuse detection.
HDM will provide auditing services to the State’s Employee and Retiree Health Program from a clinical, administrative and operational perspective. The audits will include: administrative/ operational procedures, claims, performance guarantees, compliance with contract terms, and a review of the vendor’s internal audits. Involved in these audits will be a review of the adequacy of the internal programs and assurance that all applicable credits have been applied to the State’s accounts. Under the prescription audit a review of retail pharmacy contracts, data management, and pharmaceutical manufacturer, contracts will be included to assure pass-through pricing, rebates and discounts. The contract runs through July 31, 2011.
“We are excited to partner with the State of West Virginia and authenticate that their prescription drug claims are paid accurately and appropriately according to formulary and terms of their administrative agreements,” said William Conlan, President and founder of HDM. “With a pharmacy plan audit, we will be able to assist West Virginia in reducing the cost of their prescription drug expenses, identify overpayments, and discover opportunities for improvement.”
HDM will provide auditing of the Pharmacy Benefit Manager through ongoing re-adjudication of all retail, mail order and the PBM specialty prescription claims. HDM will conduct re-pricing audits to confirm that the PBM is processing prescription drug claims accurately and appropriately according to benefit design and the terms of the contract; to identify overpayment; and to detect outliers that may indicate potential fraud, waste and abuse.
About the New Clients
The West Virginia Public Employees Insurance Agency (PEIA) provides prescription drug coverage for its employees, non-Medicare eligible retirees and their covered dependents. PEIA has 154,343 covered lives and spent $124,335,927 on prescription drugs last year. The covered populations include state employees, county and municipal employees as well as school and university faculty, teachers and other employees. PEIA’s Medicare-primary retirees’ plan, Advantra Freedom, has 33,550 covered lives and spent $79,252,844 on prescription drugs last year.
The West Virginia Children’s Health Insurance Program (WVCHIP) is a low-cost health care plan for children and teenagers of working families.
The West Virginia Health Insurance Plan, now called AccessWV, provides health insurance to West Virginians who have been unable to find or who have been denied health insurance in the private market because of a medical condition. It also provides coverage to people who are eligible under the Federal Portability Act or under the IRS Health Coverage Tax Credit Program.
About HDM
Founded in 1992, Healthcare Data Management, Inc. (HDM) is a leading independent provider of fully-integrated benefits analysis and financial reporting solutions for leading employer groups with self-insured health plans, including Fortune 500 companies, government agencies, and labor groups. HDM offers a partnership in healthcare expense management and provides pioneering solutions – customized by an employer’s data, procedures, and contracts – to reduce their cost, manage expense risks, and comply with Sarbanes-Oxley or government audit requirements. To learn more, call 800-859-51190.
###
HDM will provide auditing services to the State’s Employee and Retiree Health Program from a clinical, administrative and operational perspective. The audits will include: administrative/ operational procedures, claims, performance guarantees, compliance with contract terms, and a review of the vendor’s internal audits. Involved in these audits will be a review of the adequacy of the internal programs and assurance that all applicable credits have been applied to the State’s accounts. Under the prescription audit a review of retail pharmacy contracts, data management, and pharmaceutical manufacturer, contracts will be included to assure pass-through pricing, rebates and discounts. The contract runs through July 31, 2011.
“We are excited to partner with the State of West Virginia and authenticate that their prescription drug claims are paid accurately and appropriately according to formulary and terms of their administrative agreements,” said William Conlan, President and founder of HDM. “With a pharmacy plan audit, we will be able to assist West Virginia in reducing the cost of their prescription drug expenses, identify overpayments, and discover opportunities for improvement.”
HDM will provide auditing of the Pharmacy Benefit Manager through ongoing re-adjudication of all retail, mail order and the PBM specialty prescription claims. HDM will conduct re-pricing audits to confirm that the PBM is processing prescription drug claims accurately and appropriately according to benefit design and the terms of the contract; to identify overpayment; and to detect outliers that may indicate potential fraud, waste and abuse.
About the New Clients
The West Virginia Public Employees Insurance Agency (PEIA) provides prescription drug coverage for its employees, non-Medicare eligible retirees and their covered dependents. PEIA has 154,343 covered lives and spent $124,335,927 on prescription drugs last year. The covered populations include state employees, county and municipal employees as well as school and university faculty, teachers and other employees. PEIA’s Medicare-primary retirees’ plan, Advantra Freedom, has 33,550 covered lives and spent $79,252,844 on prescription drugs last year.
The West Virginia Children’s Health Insurance Program (WVCHIP) is a low-cost health care plan for children and teenagers of working families.
The West Virginia Health Insurance Plan, now called AccessWV, provides health insurance to West Virginians who have been unable to find or who have been denied health insurance in the private market because of a medical condition. It also provides coverage to people who are eligible under the Federal Portability Act or under the IRS Health Coverage Tax Credit Program.
About HDM
Founded in 1992, Healthcare Data Management, Inc. (HDM) is a leading independent provider of fully-integrated benefits analysis and financial reporting solutions for leading employer groups with self-insured health plans, including Fortune 500 companies, government agencies, and labor groups. HDM offers a partnership in healthcare expense management and provides pioneering solutions – customized by an employer’s data, procedures, and contracts – to reduce their cost, manage expense risks, and comply with Sarbanes-Oxley or government audit requirements. To learn more, call 800-859-51190.
###
Contact
Healthcare Data Management, Inc.
Adriana Falco
800-859-5119
www.hdminc.com/
Adriana Falco
800-859-5119
www.hdminc.com/
Contact
Categories