{"id":6986,"date":"2014-11-18T12:00:21","date_gmt":"2014-11-18T17:00:21","guid":{"rendered":"http:\/\/www.rxedo.com\/?page_id=6986"},"modified":"2015-01-30T19:03:37","modified_gmt":"2015-01-31T00:03:37","slug":"health-plan","status":"publish","type":"page","link":"https:\/\/www.rxedo.com\/?page_id=6986","title":{"rendered":"Health Plan"},"content":{"rendered":"[vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;0px&#8221; padding_bottom=&#8221;0px&#8221; border=&#8221;none&#8221;][vc_column width=&#8221;1\/1&#8243;]<hr  class=\"x-gap\" style=\"margin: 3.313em 0 0 0;\"><h1  class=\"h-custom-headline center-text h1\" ><span>Discover how we are the partner that delivers<\/span><\/h1><hr  class=\"x-gap\" style=\"margin: 3.313em 0 0 0;\"><p style=\"text-align: justify;\"><span class=\"s1\">R<\/span><span class=\"s2\"><sub>x<\/sub><\/span><span class=\"s1\">EDO<\/span>\u00a0works closely with our MCO clients to define \u201cbest practices\u201d. We work together to understand the benefits for each group, within each block of business, for each client. We believe that understanding the benefits is important, but understanding the client\u2019s approach to handling and supporting their business is even more important.<\/p>\n<p style=\"text-align: justify;\">Our goal is to allow our MCO clients to focus on their specific objectives by striving to provide the highest levels of service and support in the industry. At\u00a0<span class=\"s1\">R<\/span><span class=\"s2\"><sub>x<\/sub><\/span><span class=\"s1\">EDO<\/span>, our clients are truly our #1 priority.<\/p>\n[\/vc_column][\/vc_row][vc_row][vc_column width=&#8221;1\/1&#8243;]<div  class=\"x-container max width\" ><ul  class=\"x-block-grid four-up\" ><li  class=\"x-block-grid-item\" >\n<h4 style=\"text-align: center;\"><a href=\"#medsolutions\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-7113\" src=\"https:\/\/www.rxedo.com\/wp-content\/uploads\/2014\/11\/medDbutton.png\" alt=\"medDbutton\" width=\"98\" height=\"109\" \/><\/a><\/h4>\n<h4 style=\"text-align: center;\"><a href=\"#medsolutions\">Medicare Part D Solutions<\/a><\/h4>\n<\/li><li  class=\"x-block-grid-item\" >\n<h4 style=\"text-align: center;\"><a href=\"#cms\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-7111\" src=\"https:\/\/www.rxedo.com\/wp-content\/uploads\/2014\/11\/cmsbutton.png\" alt=\"cmsbutton\" width=\"98\" height=\"109\" \/><\/a><\/h4>\n<h4 style=\"text-align: center;\"><a href=\"#cms\">CMS Compliance<\/a><\/h4>\n<\/li><li  class=\"x-block-grid-item\" >\n<h4 style=\"text-align: center;\"><a href=\"#preauth\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-7112\" src=\"https:\/\/www.rxedo.com\/wp-content\/uploads\/2014\/11\/preauthbutton1.png\" alt=\"preauthbutton\" width=\"98\" height=\"109\" \/><\/a><\/h4>\n<h4 style=\"text-align: center;\"><a href=\"#preauth\">Preauthorization<\/a><\/h4>\n<\/li><li  class=\"x-block-grid-item\" >\n<h4 style=\"text-align: center;\"><a href=\"#mail\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-7137\" src=\"https:\/\/www.rxedo.com\/wp-content\/uploads\/2014\/11\/HIMSbutton.png\" alt=\"HIMSbutton\" width=\"98\" height=\"109\" \/><\/a><\/h4>\n<h4 style=\"text-align: center;\"><a href=\"#mail\">HIM Solutions<\/a><\/h4>\n<\/li><\/ul><\/div>[\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;0px&#8221; padding_bottom=&#8221;0px&#8221; border=&#8221;none&#8221;][vc_column width=&#8221;1\/1&#8243;]<hr  class=\"x-gap\" style=\"margin: 15.313em 0 0 0;\"><h1 id=\"medsolutions\" class=\"h-custom-headline medsolutions center-text h1\" ><span>Medicare Part D Solutions<\/span><\/h1>[\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;8%&#8221; padding_bottom=&#8221;8%&#8221; border=&#8221;none&#8221; bg_image=&#8221;7063&#8243; parallax=&#8221;true&#8221;][vc_column width=&#8221;1\/1&#8243;]<hr  class=\"x-gap\" style=\"margin: 3.313em 0 0 0;\"><div  class=\"x-container max width\" ><p style=\"text-align: justify;\"><span class=\"s1\">R<\/span><span class=\"s2\"><sub>x<\/sub><\/span><span class=\"s1\">EDO<\/span>\u00a0diligently focuses on strengthening your Medicare Part D program through expert guidance, oversight and leadership. We\u00a0partner with Plan sponsors to monitor and improve your Star Ratings.<\/p>\n<p class=\"p1\"><span class=\"s1\">R<\/span><span class=\"s2\"><sub>x<\/sub><\/span><span class=\"s1\">EDO<\/span>\u00a0partners with Plan Sponsors to ensure CMS guidance and regulations are adhered to in all aspects of Medicare Part D programs.\u00a0<span class=\"s1\">R<\/span><span class=\"s2\"><sub>x<\/sub><\/span><span class=\"s1\">EDO<\/span>\u00a0offers proven midyear implementation strategies as well as new benefit year implementation strategies based on years of Medicare Part D knowledge.<\/p>\n<p><strong>Medicare Part D Services<\/strong><\/p>\n<ul>\n<li>Part D Formulary Support<\/li>\n<li>Medication Therapy Management (MTM)\/Drug Utilization Review (DUR)<\/li>\n<li>Explanation of Benefit (EOB) Processing<\/li>\n<li>E-Prescribing Formulary Management<\/li>\n<li>Pharmacy Network Administration<\/li>\n<li>Coverage Determinations (Prior Authorizations)<\/li>\n<li>Rebate Contracting and Management<\/li>\n<li>CMS Reporting &amp; Support<\/li>\n<li>Prescription Drug Event (PDE) Processing<\/li>\n<li>PDE Error Resolution<\/li>\n<li>CMS Audit Support<\/li>\n<li>Pharmacy Member Services<\/li>\n<li>Network Pharmacy Audits<\/li>\n<li>Quality Assurance<\/li>\n<li>Part D Reporting Submission<\/li>\n<li>Health Plan Management System (HPMS) Support<\/li>\n<li>CMS Guidance Updates<\/li>\n<li>GeoAccess Reports<\/li>\n<li>Part B Processing<\/li>\n<li>Mid-Year Implementation<\/li>\n<li>Plan Finder Submission<\/li>\n<li>Medicare\/Medicaid Dual Coverage<\/li>\n<li>Transition Letters<\/li>\n<li>DMR Approval\/Denial Letters<\/li>\n<li>MIPPA Compliant<\/li>\n<\/ul>\n<\/div>[\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;0px&#8221; padding_bottom=&#8221;0px&#8221; border=&#8221;none&#8221;][vc_column width=&#8221;1\/1&#8243;]<hr  class=\"x-gap\" style=\"margin: 8.313em 0 0 0;\"><h1 id=\"cms\" class=\"h-custom-headline cms center-text h1\" ><span>CMS Compliance<\/span><\/h1>[\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;8%&#8221; padding_bottom=&#8221;8%&#8221; border=&#8221;none&#8221; bg_image=&#8221;7064&#8243; parallax=&#8221;true&#8221;][vc_column width=&#8221;1\/1&#8243;]<div  class=\"x-container max width\" ><p style=\"text-align: justify;\">The combination of clinical and operational Medicare Part D expertise enhances compliance with CMS requirements.<\/p>\n<ul>\n<li style=\"text-align: justify;\"><strong>Integrated Review Approach<\/strong>&#8211; Determining the potential impact of benefit changes specific to your Part D program aligned with federal and state legislative reviews.<\/li>\n<li style=\"text-align: justify;\"><strong>Positive Regulatory Relationships- <\/strong>Working closely with Plan sponsors\u00a0to interpret\u00a0\u00a0CMS regulations and guidance.<\/li>\n<li style=\"text-align: justify;\"><strong>Proactive\u00a0Process-<\/strong> Staying up to date with CMS changes and provide proactive consultative services to assist clients in managing their program to exceed compliance.<\/li>\n<li style=\"text-align: justify;\"><strong>Expert Prescription Drug Event (PDE) Error Analysis &amp; Resolution-<\/strong> Proficiency in PDE management results in positive financial outcomes.<\/li>\n<li style=\"text-align: justify;\"><strong>Audit Support- <\/strong>Expert support of CMS audits and the various operational compliance focus areas.<\/li>\n<\/ul>\n<\/div>[\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;0px&#8221; padding_bottom=&#8221;0px&#8221; border=&#8221;none&#8221;][vc_column width=&#8221;1\/1&#8243;]<hr  class=\"x-gap\" style=\"margin: 8.313em 0 0 0;\"><h1 id=\"preauth\" class=\"h-custom-headline preauth center-text h1\" ><span>Preauthorization<\/span><\/h1>[\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;8%&#8221; padding_bottom=&#8221;8%&#8221; border=&#8221;none&#8221; bg_image=&#8221;7065&#8243; parallax=&#8221;true&#8221;][vc_column width=&#8221;1\/1&#8243;]<div  class=\"x-container max width\" ><ul>\n<li>Seamless PA management for our customers<\/li>\n<li>Web-based, real-time fully integrated PAHub rules engine and connectivity\n<ul>\n<li>Eligibility<\/li>\n<li>Authorizations and Pre-Adjudication<\/li>\n<li>CMS and URAC accredited clinical criteria<\/li>\n<\/ul>\n<\/li>\n<li>E-prescribing connectivity and network access to over 400,000 physicians EHR and 43,000 pharmacies\n<ul>\n<li>Prospective prior auth using eligibility<\/li>\n<li>Increase automated PA adjudication<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>[\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;0px&#8221; padding_bottom=&#8221;0px&#8221; border=&#8221;none&#8221;][vc_column width=&#8221;1\/1&#8243;]<hr  class=\"x-gap\" style=\"margin: 8.313em 0 0 0;\"><h1 id=\"mail\" class=\"h-custom-headline mail center-text h1\" ><span>HIM Solutions<\/span><\/h1>[\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;8%&#8221; padding_bottom=&#8221;8%&#8221; border=&#8221;none&#8221; bg_image=&#8221;7148&#8243; parallax=&#8221;true&#8221;][vc_column width=&#8221;1\/1&#8243;]<div  class=\"x-container max width\" ><p class=\"p1\"><span class=\"s1\">The Health Exchange Marketplace (HIM) is an online marketplace that provides \u201caffordable\u201d health care coverage for Americans.\u00a0 HIM\u2019s offer income subsidies for those members that meet poverty level income, and household size restrictions.\u00a0 The Exchange offers different metal levels of coverage Bronze, Silver, Gold, and Platinum. These levels are based on the coverage or qualities that are offered by the insurance company.\u00a0 All Exchange providers no matter the level must meet the\u00a0following requirements:<\/span><\/p>\n<ul>\n<li>Ambulatory patient services<\/li>\n<li><span style=\"line-height: 1.5;\">Emergency services<\/span><\/li>\n<li>Hospitalization<\/li>\n<li><span class=\"s1\">Maternity and newborn care<\/span><\/li>\n<li><span class=\"s1\">Mental health and substance use disorder services, including behavioral health treatment<br \/>\n<\/span><\/li>\n<li><span class=\"s1\">Prescription drugs<\/span><\/li>\n<li><span class=\"s1\">Rehabilitation and habilitation services and devices<\/span><\/li>\n<li><span class=\"s1\">Laboratory services<\/span><\/li>\n<li><span class=\"s1\">Preventive and wellness services and chronic disease management<\/span><\/li>\n<li><span class=\"s1\">Pediatric services, including oral and vision care<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">At\u00a0<span class=\"s1\">R<\/span><span class=\"s2\"><sub>x<\/sub><\/span><span class=\"s1\">EDO<\/span>\u00a0we offer solutions to keep our clients compliant with all Federal and State Regulations.\u00a0 We continually research and stay in front of any forthcoming amendments to the Federal or State regulations or requirements.<\/span><\/p>\n<\/div>[\/vc_column][\/vc_row]\n","protected":false},"excerpt":{"rendered":"<p>[vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;0px&#8221; padding_bottom=&#8221;0px&#8221; border=&#8221;none&#8221;][vc_column width=&#8221;1\/1&#8243;][\/vc_column][\/vc_row][vc_row][vc_column width=&#8221;1\/1&#8243;][\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;0px&#8221; padding_bottom=&#8221;0px&#8221; border=&#8221;none&#8221;][vc_column width=&#8221;1\/1&#8243;][\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;8%&#8221; padding_bottom=&#8221;8%&#8221; border=&#8221;none&#8221; bg_image=&#8221;7063&#8243; parallax=&#8221;true&#8221;][vc_column width=&#8221;1\/1&#8243;][\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;0px&#8221; padding_bottom=&#8221;0px&#8221; border=&#8221;none&#8221;][vc_column width=&#8221;1\/1&#8243;][\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;8%&#8221; padding_bottom=&#8221;8%&#8221; border=&#8221;none&#8221; bg_image=&#8221;7064&#8243; parallax=&#8221;true&#8221;][vc_column width=&#8221;1\/1&#8243;][\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;0px&#8221; padding_bottom=&#8221;0px&#8221; border=&#8221;none&#8221;][vc_column width=&#8221;1\/1&#8243;][\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;8%&#8221; padding_bottom=&#8221;8%&#8221; border=&#8221;none&#8221; bg_image=&#8221;7065&#8243; parallax=&#8221;true&#8221;][vc_column width=&#8221;1\/1&#8243;][\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;0px&#8221; padding_bottom=&#8221;0px&#8221; border=&#8221;none&#8221;][vc_column width=&#8221;1\/1&#8243;][\/vc_column][\/vc_row][vc_row inner_container=&#8221;true&#8221; no_margin=&#8221;true&#8221; padding_top=&#8221;8%&#8221; padding_bottom=&#8221;8%&#8221; &#8230; <\/p>\n<div><a href=\"https:\/\/www.rxedo.com\/?page_id=6986\" class=\"more-link\">Read More<\/a><\/div>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-blank-4.php","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/www.rxedo.com\/index.php?rest_route=\/wp\/v2\/pages\/6986"}],"collection":[{"href":"https:\/\/www.rxedo.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.rxedo.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.rxedo.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.rxedo.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=6986"}],"version-history":[{"count":84,"href":"https:\/\/www.rxedo.com\/index.php?rest_route=\/wp\/v2\/pages\/6986\/revisions"}],"predecessor-version":[{"id":7269,"href":"https:\/\/www.rxedo.com\/index.php?rest_route=\/wp\/v2\/pages\/6986\/revisions\/7269"}],"wp:attachment":[{"href":"https:\/\/www.rxedo.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=6986"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}