Auditing
   Vender Management

          PBM Procurement
          PBM Contract Review & Negotiations
          Escalated Issue Resolution
          FWA Training
          Specialty Drug Management
          Eligibility Management

             Reporting
             Clinical Services
             Medicare Specific Services
Vender Management

PBM Procurement

IPC/EvergreenRx has developed a sophisticated and efficient Request for Proposal (RFP) and proposal review process during the twenty years of working with our clients in PBM procurement. The RFP process is a complete re-pricing of a client’s 12 month claim data to determine actual pricing benefits and/or shortcomings of vendor pricing arrangements. This also includes, pricing elements such as Maximum Allowable Cost (MAC), preferred network arrangements, pass-through pricing arrangements and Specialty Pharmacy pricing arrangements.

IPC/EvergreenRx’s Procurement Questionnaire includes client specific elements that are tailored to each client’s requirements and measures the PBM’s flexibility to conform to the specific needs of the client.

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PBM Contract Review & Negotiations

IPC/EvergreenRx has over twenty years’ experience in PBM management and intense auditing of claims. This capability has allowed us to develop a wealth of knowledge on contract language which empowers our clients to effectively enforce the intent of various contract provisions and performance guarantees.

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Escalated Issue Resolution

IPC/EvergreenRx reviews any issues or unresolved complaints a participant encounters with their prescription drug benefit and the Prescription Benefit Administrator’s (PBA) Member Services.Issue Resolution includes a review of the member’s history and claim in question. This review will reveal if the issue is global in nature or a one-off situation. We will then provide a recommended solution, correct and address the matters to avoid the impact on multiple members.

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FWA Training

IPC/ EvergreenRx assist Plans to assure their staff receives Fraud Waste and Abuse (FWA) detection training. The Centers for Medicare and Medicaid Services requires Plans to provide FWA training and continuing education to all staff members that are actively engaged in activities related to Medicare and Medicaid services subsidies as well as reimbursements from these Governmental entities. IPC/EvergreenRx develops effective training programs that can be easily conducted by webinar or onsite to maintain the Plan’s compliance requirements. These programs are customized to fit each Plan’s obligations and services. IPC/EvergreenRx regularly attends CMS conferences to stay apprised of any new or revised compliance requirements and reviews all CMS issued guidance related to these requirements.

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Specialty Drug Management

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Eligibility Management

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