PHSI Tracks PBM Rebates

IndustryManaged Care/ PBM
ProblemAn employer group contracting with a PBM wished to track their rebate receivables to determine outstanding balances for each fiscal quarter and to ensure the PBM’s client guarantees were being met.
PHSI SolutionPHSI created a tracking spreadsheet and provided quarterly updates to the employer group by balancing the remittance reports against the monthly claims adjudication reports. PHSI was able to identify a large number of claims that had been excluded from the rebate remittance.
ResultsPHSI was able to work with the PBM to identify the cause of the claims discrepancy and ensure that the client received their full pay amount. PHSI continues to monitor to ensure that rebate guarantees are being met.