About MBRx - Solutions

 

Medical Banking Rx services are integrated, but outsourced, components of a healthcare claims processor’s real-time claim adjudication process to meet the needs and objectives of plans, programs and the consumers they serve.  Medical Banking Rx provides two approaches to eliminate: 1) the ability of health care providers to “game” the system by circumventing the adjudication (re-pricing) process by either failing to submit claims or reversing submitted claims when they realize the responsibility for payments is entirely that of consumers at the point of service, and 2) the resulting five significant problems. 

 

1.  MedConfirmation℠ is a patent-pending, real-time messaging solution that enables consumers to audit health care providers for adjudicated charges at the point of service, and optionally, their claim reversal actions, if any, in order to prevent claim adjudication circumvention.  When health care providers receive their adjudicated pricing edit, consumers also receive it.  MedConfirmation℠ confirms the submission of their claim, provides price transparency, and alerts the consumer if the provider subsequently reverses their claim.

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Business Development Service (Optional)

Those healthcare claims processors utilizing a MBRx solution have the option to employ MBRx’s truly unique and comprehensive business development service.  The MBRx market strategy for its clients is unconventional and provides a true “win-win” scenario. It delivers a tremendous value proposition and enables significant product differentiation to effectively accomplish the growth objectives of all MBRx Channel Partners.

2.  Patient Driven Rx℠ enables healthcare claims processors to initiate payments to providers on behalf of consumers to prevent both health care provider claim adjudication circumvention and overcharges. Patient Driven Rx℠ is an award winning, real-time medical banking solution specifically designed for the healthcare industry to eliminate the deficiencies that currently exist when the patient bears the full financial responsibility for healthcare provider reimbursement.  Medical Banking Rx is a recipient of the Healthcare Information and Management Systems Society (HIMSS) Medical Banking Project “Disruptive Innovator” Award (best potential to transform healthcare using disruptive innovation) for creating a truly unique process, Patient Driven Rx℠, that provides a real-time solution to the deficiencies inherent in all 100% copay situations under High Deductible Health Plans, Consumer Driven Health Plans, and all Cash Discount Programs.

"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

MedConfirmation℠ and Patient Driven Rx℠ force health care providers to submit every claim for adjudication in all 100% copay situations.  Under cash discount programs, healthcare claims processors are able to diminish their typically high attrition rates and recoup previously lost revenue (20 – 50% for PBMs alone) caused by adjudication circumvention.  These solutions effectively transfer control of the claims submission decision from the health care provider to the consumer to prevent claim adjudication circumvention and preclude provider self-serving pricing.  

Additionally, Medical Banking Rx provides MedNotification℠, a service that enables health care claims processors to send real-time messages to consumers under all types of health plans and programs by using consumers’ preferred method of communication or notification to communicate relevant information to them.

 

Those healthcare claims processors that don’t have an ability to prevent adjudication circumvention and inappropriate reversals in real-time can expect to be severely disadvantaged.  The MBRx solutions can be expected to change the terms on which healthcare claims processors and health plans can win and retain business by altering the acceptable expectations of their clients and the consumers they serve.  There is reason to believe the following question will become a minimum standard criterion in every Request for Proposal:  “Please explain the real-time, quality control measure that you [healthcare claim processor] can provide to prevent health care providers from circumventing the adjudication process and reversing claims without the patient’s or your [healthcare claims processor’s] consent or knowledge when the patient bears the full financial responsibility for the cost of the product or service”.  The Medical Banking Rx solutions generate a significant value proposition that enhances not only health plans and cash discount programs, but also employers’ and consumers’ perception of provided value and satisfaction. 

 

The MBRx solutions enable healthcare claims processors providing cash discount programs to effectively combat their typically high attrition rates and significantly increase their revenue by preventing claim adjudication circumvention.  For example, claim reversals under the pharmacy cash discount card programs of numerous PBMs are four to ten times that experienced under traditional, fully funded (cost-sharing) programs.  Again, since both HDHPs and CDHPs are essentially cash discount programs until deductibles are met, and approximately 90% of CDHPs and 50% of HDHPs do not meet their deductibles, the preceding applies to all such programs.