Comprehensive Conversion Solutions

PMSI has introduced a comprehensive suite of innovative solutions that significantly increase network penetration throughout the life of the injured worker’s claim. These best-in-class, end-to-end solutions to convert out-of-network transactions include:

• Compliance – Driving compliance within our network is at the core of PMSI’s Pharmacy conversion programs. Our flexible card and cardless programs promote initial compliance while offering payors flexibility and choice. In addition, PMSI actively works with network pharmacies to identify claims earlier in their lifecycle and process them through PMSI's retail network. These proprietary techniques strengthen program penetration and enrollment, while producing demonstrated savings on future prescription fills.
• Automated Re-Indexing – Since 2007, PMSI has delivered an automated re-indexing program with one of the largest pharmacy chains in the country, Walgreens. Through this program, PMSI performs an automated, retroactive adjudication of transactions that were not identified at point of sale as belonging to a PMSI client. This seamless adjudication applies all edits as if transactions were processed at the time of dispensing and ensures almost complete network compliance.
• Third-Party Billers – Recognizing the significant need to mitigate the impact of third-party billers for our clients, PMSI has partnered with one of the nation’s largest third-party billing services to utilize our existing eBilling processes. This partnership lowers clients' out-of-network costs and reduces administrative costs by significantly reducing out-of-network paper bills.
• Clinics – As part of our conversion initiatives, PMSI joined with two of the country's largest clinic networks to provide comprehensive pharmacy benefit management services, clinical programs, and real-time claims management technology. Clients will achieve reduced costs and improved efficiencies by capturing first fill opportunities in these frequently used workers' compensation settings.
• Direct Mail Pharmacies – Recognizing that direct mail pharmacies represent another rapidly growing out-of-network distribution point, PMSI has entered into a partnership with several direct mail pharmacy providers that are among the largest out-of-network billers for PMSI clients. PMSI will process these transactions online, provide pharmacy benefit management review for these claims and be able to provide additional information regarding claimants and treating physicians.