03/27/2008
RegenceRx® selects new claims processing vendor
RegenceRx recently made the decision to partner with a new claims processing vendor. RegenceRx is our in-house Pharmacy Benefit Manager (PBM). It performs all PBM functions, but it does not own the software and hardware required to process prescription claims. Instead, RegenceRx works with a claims processing vendor that follows our direction and requirements.
In March 2007 RegenceRx began compiling an extensive list of requirements for a claims processing vendor, based on our book of business and potential market-forward changes. RegenceRx then sent a request for proposal to six vendors. In the end, the chosen vendor was Prospective Health Services (PHS), a division of RelayHealth®, which is itself a division of McKesson.
PHS will provide us with increased flexibility in the coding of complex pharmacy benefit designs, such as with the complexity of Medicare accumulators. In addition, we will gain improved interface potential related to banking relationships (such as with FSAs, HRAs, etc.). PHS will also allow us to improve our coding and configuration to-market time for new benefit designs, as that functionality will come back in-house.
We are currently working on an implementation plan and schedule, which we will share in the near future. We expect the first group of plan designs (most likely RegenceRx's PBM-only business) to move over to PHS in August 2008. The target is to have all business moved over by first quarter of 2009. This change should be invisible to all parties and will not require the need to print new member cards.
If you have questions, please talk to your Regence Sales contact.
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