StoneRiver Pharmacy Solutions, a provider of comprehensive cost management solutions and workers’ compensation prescription billing solutions to more than 55,000 pharmacies nationwide, has
announced that the company has leveraged an enhanced solution that enables carriers and employers to gain financial and clinical control of workers’ compensation prescriptions that are submitted online without a medication card, in collaboration with Progressive Medical, Inc., a provider of pharmacy management and ancillary solutions and offers cost management services and products to the workers’ compensation and auto no-fault insurance industries.
According to the new solution, both the companies will rely upon real-time connectivity between the two organizations in order to trigger the procedure. Whenever a pharmacy won’t be able to identify the appropriate payor, it will submit prescriptions associated with Progressive Medical clients’ workers’ compensation prescription claims to StoneRiver Pharmacy Solutions, which will promptly issue a real-time alert to Progressive Medical. Further, the company will review the prescriptions for eligibility and will return the results to StoneRiver Pharmacy Solutions after applying drug utilization review edits. Finally, StoneRiver will complete the adjudication process, and will issue the response back the pharmacy.
Both the companies hope that the innovative partnership will benefit them by enabling considerable cost cutting for workers’ compensation claims administered by Progressive Medical clients, which will further reduce the number of unmanaged out-of-network prescriptions.
One of the clients who have been leveraging the solution and have realized savings in their costs is Texas Association of School Boards Risk Management Fund. In the words of Herman Wilks, Department Director of Workers’ Compensation Claims, Texas Association of School Boards, the Fund handles a significant number of workers’ compensation claims every year, and the pharmacy expenses account for a significant portion of the medical costs on these claims. Wilks continued that the organization has demonstrated that this partnership enables it to dramatically reduce pharmacy costs by streamlining adjudication of what would traditionally have been out-of-network invoices.
Manual processing of the workers’ compensation invoices involves a very high cost as the companies have to handle a huge number of such claims every year. Apart from that, the paper invoices are not subject to payors’ real-time drug utilization review or formulary edits. The new solution by StoneRiver Pharmacy Solutions & Progressive Medical helps in electronic processing of huge piles of paper invoices, and also enables edit application within them in real-time, effectively streamlining the entire process and ensuring appropriate pharmaceutical utilization.
According to Tron Emptage, Chief Clinical and Compliance Officer for Progressive Medical, the company continually seeks new ways to help its clients contain costs and StoneRiver Pharmacy Solutions was the ideal partner for this program because of their unique relationship with pharmacies and their willingness and ability to co-develop this unique technology to bring about greater efficiency and cost savings. Emptage noted that this program will allow Progressive Medical to dramatically reduce out-of-network pharmacy expenses for its clients that choose this program.
In June 2010, Progressive Medical, Inc.
promoted Tron Emptage, RPh, to the status of Chief Clinical and Compliance Officer from the position of Executive Vice President of Business and Product Development. The company claimed that the newly created position that will help it in continuing to revolutionize the total workers' compensation claims management process.
Edited by
Juliana Kenny
