Conversion from Multiple Platforms to a New Claims Processing System

IndustryManaged Care/ PBM
ProblemA growing PBM wanted 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 database, but the new processor uses Wolters Kluwer’s Medi-Span drug database. FDB plan edits and formularies 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. 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 a number of high maintenance formularies and plan edits into more efficient GPI wildcard lists that reduced ongoing maintenance efforts.