Reveal - Claim Rejections Monitoring and Analytics
How often do you review denied pharmacy claims?
Few health plans have the capacity to review all their pharmacy claims. The result is often sampling from spreadsheets, relying on summary reports that don’t tell the whole story, or not even reviewing them at all. Reveal solves this by analyzing 100% of your claims and showing you only those claims that put you at risk.
Real Time Analysis
Too many plans wait for the CMS auditor to show up before realizing they are rejecting pharmacy claims incorrectly. This is an expensive way to learn a lesson! Reveal loads your data daily, so you can see the problems immediately after they occur and take action right away, potentially saving your plan thousands of dollars while improving patient outcomes in the process!
CMS Best Practices
Get a clear look at how you’re handling CMS’ best practices. See your performance down to the individual best practice to easily identify which claims put your plan at the greatest risk and take action on them. View your plan’s performance over time to identify trends and spikes in the data and identify areas for process improvement.
Find That Needle
With more than 30 separate filters, Reveal allows you to zero in on the signal you’re looking for while removing the noise. Match rejections to paid claims, find out which transition patients have already received their transition fill and much more!
Reveal's incorporated workflow management ensures that claim issues are tracked and worked to completion. It's easy to contact the pharmacy, allow others to see progress and ensure there's a resolution to the rejected claim.