Company Overview

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RJ Health Systems offers a proprietary methodology and related solutions for reducing medical drug spend. We provide industry standard pricing, coding, dosing, weight, age, and diagnosis information for those drugs administered in professional settings. Using our uniform product suite of tools, analyses and data, we help you save time and money.

Why Choose Us

Specialty drug trend outpaces inflation and general healthcare costs significantly. Organizations need greater transparency, data and tools to effectively manage this trend. Whether it’s targeting outlier claims, analyzing therapeutic class costs, educating and building provider compliance or establishing reimbursement policy, RJ Health Systems provides trusted solutions to the vast majority of US healthcare organizations, such as Health Plans, PBMs, Providers and Service organizations. RJ Health Systems’solutions help better control medical specialty drugs by cost, route of delivery, and therapeutic class, putting you ahead of specialty drug trend.
Clients receive greater transparency, more effective cost controls, and increased rebate income from their medical drug spend.

Our Mission

To provide transparency through industry standard specialty drug data that supports Payor / Provider alignment on Medical benefit drug reimbursement policy, claims analysis, care management and network management decisions.

We offer solutions that guide our clients’ management of drug trend in the most efficient way.

  • Software as a Service (SaaS) applications for pharmacy, claims and finance staff.
  • Customizable data that clients can integrate into operational systems for strategic enterprise initiatives.
  • Analytics on unit cost (fees/costs/pricing) and clinical utilization to analyze, forecast and manage upward drug spend trends.
  • Services for pharmaceutical manufacturers connecting them to our vast coverage of the payor market which ultimately improves reimbursement accuracy and relationships.

Testimonials

“As a Specialty Pharmacy provider, it is imperative that we have the correct information at our fingertips, in order to calculate and submit claims to medical plans. ReimbursementCodes is a wonderful resource that my team uses every single day to obtain HCPCS codes, billable units and pricing. I believe every Specialty Pharmacy should be using this product.”

Medical Billing Manager / Specialty Pharmacy Organization

“RJ Health Systems’ Data resulted in our organization having fewer disputes, it denied a ton of claims where the providers were submitting NDC’s that don’t actually link to the HCPCS code. This is the biggest savings – instead of just letting providers submit any NDC and then invoicing for those NDCs, we are preventing false claims and increasing the number of accurately invoiced NDCs.”

Pharm D, Administrator, Pharmacy Services / State Medicaid Plan

“Working with RJ Health Systems was great. The service is fast with quality info. Patients’ formulary restrictions are managed for accuracy from pharmacy to provider.”

Rod Marriott / Pharmacy Manager Charter Oak Health Center
Hartford, CT

“RJ Health Systems’ Customer Service Representatives treated all my requests with respect and professionalism. They are friendly, professional and collaborative.”

Dr. Sergio Mejia / Director, AOPC Institute of Living/Hartford Hospital
Hartford, CT