Payors

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Our Customers

What We Do For Payors

Our industry standard medical drug data can guide you in establishing pricing and reimbursement policy, analyze overspending, target outlier claims, educate and build provider compliance.

Our platform of data and software-as-a-service applications gives payors the capability to drive improvements related to medical drug spend. Establishing and enforcing policies through the operational processing of medical claims with administered drugs, is most effective with ReimbursementCodes.

Additionally, RJ Analytics’s goal is to partner with payors to create insight into specialty drug trend and develop methods to effectively manage medical drug spend across their organization.

Finance/Analytics

Finance and Analytics teams use RJHS products and services to establish pricing and reimbursement policy, and analyze potential opportunities for cost containment.

Clinical/Pharma Ops

Clinical / Pharmacy Operations teams source our data and software as a service application to establish clinical edits in support of case management programs designed to improve outcomes and minimize costs.

Claims

Claims adjudication teams use RJHS data and software as a service application to review and target outlier claims, increase payment accuracy and reduce risk of appeals.

Network

Network Management sources our data to manage medical specialty drug pricing included in fee schedules.

Learn More

To learn more about our products and solutions we offer to manage specialty drug spend, contact us.

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