Pharmacy Claim Processing
Pharmacy Claim Processing is custom proprietary system which provides a wide array of customized pharmacy benefit design and processing. Secure, dependable systems process claims quickly – the claims are at your fingertips real time, when you need them via client web portal. That means no expensive software or special licensing to purchase.
Flexible Benefit Plan
Flexible Benefit Plan design based on your unique needs. We work collaboratively, focusing on your plan design and what's important to you. Customized logic and edits support all types of copays, co-ordination of benefits and subrogation along with customized point of service messaging. Eligibility options include real time access at your fingertips.
Formulary management and expertise focuses on balancing the most appropriate drug options. Our standard formularies are designed to meet client objectives whether it's lowest cost or maximizing rebates. PDMI also supports custom formularies. Choose the options that best meet your needs.
Rebate Management services have no hidden income and therefore no hidden agenda. 100% of the rebate monies received are passed on to our clients less a fully disclosed rebate management fee.
Nationwide Pharmacy Network
Nationwide Pharmacy Network consisting of more than 64,000 pharmacies including independents, regional and national chains. We create the network that best meets your needs because we are pass through and transparent – there is no hidden income from network contracts. You can use your pharmacy network, wrap our pharmacy network with yours, or have a customized network.
Mail Order and Specialty Pharmacy Services
Mail Order and Specialty Pharmacy Services by the provider of YOUR choice. Independently and privately owned, PDMI has no ties and no hidden income from mail order and specialty pharmacy contracts.
Clinical Solutions are available on an a la carte basis giving our clients the flexibility to provide clinical services in house if that best meets their needs. PDMI Clinical Solutions help promote the use of safe, effective, lower cost medications and educate and empower members. Services include: Concurrent Drug Utilization Review, Retrospective Drug Utilization Review, Polypharmacy Monitoring and Alerts, Fraud, Waste and Abuse, Compliance and Monitoring Programs, and Utilization Management Tools (Prior Authorization, Step Therapy, etc.).
Analytics and Reporting Services
Analytics and Reporting Services provide a wide array of options giving you the timely, detailed information you need to manage your plan and control costs. Our standard report library as well as customized reports and analytics are available via web services or on a subscription basis. Quarterly Management Reports can be customized to focus on your unique requirements. Quarterly Management Reports include drug utilization and spend trend analysis.
Customized Client Dashboard
Customized Client Dashboard provides snapshots of your Key Performance Indicators at your fingertips – anywhere, anytime. Your dashboard is a powerful management tool to help you measure, monitor and manage your business. The details behind the overview are easily accessible with a simple click. Drill down as far as you need. Better decisions. Faster decisions. Better performance. It's all there at your fingertips.
Member Services are determined at the plan level giving you the flexibility to provide the services desired. Whether it's a simple pharmacy look up tool or a client branded web accessible member portal providing pharmacy claims history, plan coverage, pharmacy and price location, medication lookup…… You choose what best suits you and your member needs. PDMI can also provide member welcome kits and member cards – customized to meet your needs.
Call Center Services
Call Center Services provides timely, expert, accurate assistance to members and pharmacies via toll free numbers. Our call center agents can enter overrides, prior authorizations, direct member reimbursements and universal claim forms according to client specifications. PDMI is flexible; use your call center, our call center or our call center for after hour coverage.
Administrative Services include flexible billing cycles to meet your needs for pharmacy payments, private labeled billing to your clients on your behalf and comprehensive reporting to support billing and invoices.