In all 100% copay situations, health care providers are currently able to unilaterally decide to circumvent claim adjudication by either electing to not submit or reversing the claim, thereby generating five significant problems.
Significance of the Problem
In all 100% health plan copay situations, consumers are vulnerable to being charged more than provider contracted rates without their knowledge or consent and this impacts:
Approximately 90% of members under CDHPs who never meet their deductible!
Approximately 50% of members under HDHPs who never meet their deductible!
Those with Pharmacy Cash Discount Cards experience claim reversals 4 to 10 times that of traditional, fully funded co-pay plans, with comparable experience expected under all other 100% copay situations.
MBRx eliminates this vulnerability and the five related problems under all 100% copay situations via two truly unique and comprehensive solutions, MedConfirmation℠ and Patient Driven Rx℠, specifically designed for the healthcare industry to provide real-time quality control solutions to the claim adjudication circumvention problem.
“The MBRx medical banking solution is the closest thing I've seen to the Holy Grail.”
B. Greg Buscetto, Former Segment President, Strategic Solutions, CatamaranRx, and Consultant, Leading Business Consultants
RFP Minimum Criterion:
How would you answer this question?
“Please explain the real-time, quality control measure that you can provide to prevent health care providers from either circumventing the adjudication process or reversing claims without the patient’s consent or knowledge when the patient bears the full financial responsibility for the cost of a product or service.”
(MBRx grants permission for any reader to use this question in any RFP/RFI)
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