Claims Processing:

Implementation & Customization

Since 1983, PDM has encountered many unique situations, and we've developed an implementation procedure that is flexible enough to anticipate and prevent the problems that could plague a transition.

To ensure proper communication during a system implementation, we concentrate on the following pertinent areas:

•	Card Production
•	Claims Processing
•	Eligibility
•	Pharmacy Networks
•	Client Network Connectivity
•	Cash Management
•	Administrative Fees
•	Reporting
•	Plan Design

The time frame of the system start-up is dependent upon the complexity of these requirements. An ample time frame can range anywhere from 30 days to 90 days. Specific components such as card production, eligibility, and plan design can all have an effect on this timeline.

During past conversions, PDM has met with the following common issues:

•	Members not having correct cards.
•	Late - or incorrect - pharmacy notification, so chains have their systems configured incorrectly.
•	Pharmacies not submitting the claims to the new processor.
•	Pharmacies not submitting correct group numbers or PCN numbers,
•	Absence of claims history, which affects (among other issues) maximum/deductible information.

Our special implementation team comes armed with solutions learned over the years to combat these debilitating problems. The team also interactively reviews all claim activity as the claims are being processed during the first month of the conversion. If problems arise in claim adjudication, a team member will contact the pharmacist and/or your programming staff to correct the problem while the claim is being processed.