GxCare™

Medical & Pharmacy Benefits Management Application

The management, maintenance, and migration of Benefit Plans are a time consuming, potentially error-prone task that has a direct impact on a PBMs performance. GxCare™ provides key opportunities to automate a majority of the analytical, management, migration, and testing activities associated with Benefit Management and has proven to be 67% faster with an 85% reduction in errors.

75%

Increase in efficiency through the use of Automation

80%

Reduction in errors decreasing performance penalties

50%

Reduction in production errors

Globally Implemented at Fortune 20 Organizations

Product and Managed Services for
  • Automated parsing and building of dependency maps in a database
  • Automated impact report generation for each of SDLC e.g. requirements, code, and QA
  • Integration with tools such as McCabe to generate test cases and provide objective data on code coverage
  • Provides different views for business analysists, dev team. and QA
  • Provides impact in terms of areas such as Medicare and Medicaid
  • Import claim history
  • Create, save, copy, and merge selection scenarios
  • Targeted drug lists with wildcarding
  • Targeted member lists with include/exclude
  • Targeted plan parameters
  • Add random selections for additional breadth
  • D.O adjudication ready output
  • Automated analysis of claim outcomes
  • Direct drill down to root cause claim components
  • Traceability to plan configuration and plan requirements
  • Organize, tag, and track claims by deficit ID
  • Pricing threshold settings limit false positives
  • Pricing comparison/analysis
  • GxCare™ integration
  • Typically a 4-8 week process depending on complexity of claim and benefit data sources
  • Alignment of claim history format
  • Integration with adjudication system
  • Linkage or import of plan data (GxCare™ recommended)
  • Linkage or import of eligibility data (optional)
  • Hosted option available
Claim Selection – Key Features
  • Selection summary
  • Claims by member
  • Claims by drug or category
  • Claims by client or group
  • Formulary coverage
Claim Analysis – Key Features
  • Paid/reject analysis
  • Reject frequency
  • Pricing analysis
  • Claims by defect tag
  • Threshold analysis
Learn More About GxCare™