Conversion from Multiple Platforms to a New Claims Processing System

IndustryDrug Compendia
ProblemA growing PBM needed to coordinate several books of business under a single claims processing software system using a service bureau arrangement. Previously, the claims processor used First Databank (FDB) as their drug compendia, but the new processor uses Wolters Kluwer’s Medi-Span drug compendia. Plan edits and formularies using FDB identifiers needed to be converted to Medi-Span GPI (Generic Product Identifier) codes.
PHSI SolutionPHSI analyzed the formulary and plan edits to isolate FDB codes that required conversion to Medi-Span codes. PHSI created a one-time compendia crosswalk based on NDC matches. GCN (Generic Code Number), and GSN (GCN Sequence Number) codes were converted to Medi-Span GPI codes. PHSI also converted therapeutic class GC3 codes to GPI codes.
ResultsThe client leveraged PHSI expertise to meet the aggressive conversion schedule and experienced a smooth transition. In the process, the client consolidated several high maintenance formularies and plan edits into more efficient GPI wildcard lists that reduced ongoing maintenance efforts, while understanding the limitations of this one-time crosswalk file.