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Provide Professional Pharmacy Billing Auditing


Location
Alaska
Publication Date
01/10/2020 07:05 AM EST
Closing Date
01/15/2020 09:00 PM EST
Issuing Organization
Municipality of Anchorage
Solicitation Number
Description

Specifications include, but are not limited to: 3.1 Pharmacy benefit management program must include: • The ability to receive electronic requests for pharmacy benefits through the Municipality’s computerized claim system, Claim Pilot. • Describe the process by which you will provide each claimant with a retail drug card. The card must list an effective date. Retail drug cards must be provided for new claimants and replacement cards must be provided to existing claimants on an ongoing basis. Please describe any capabilities you might have to supply such information in a digital format, e.g., to a claimant’s cell phone via an app. • The pharmacy ID cards will provide eligible claimants with access to prescription medications at a large national network of preferred providers. • Claimants enrolled in the pharmacy benefit program will be entitled to receive eligible medications via home delivery order. • Generic medications should be substituted in compliance with Alaska statutes. • Contractor shall employ medication plans and formularies specific to body part and nature of injury. • The contractor shall review prescriptions to identify those not related to the claimant’s medical treatment. • Medications that are temporarily blocked at point of sale should be immediately routed to the Municipality’s claims adjusters for review. • Contractor is required to follow Municipality’s escalation of approvals process – 24 hours after initial fill request is received by Contractor, if initial authorized approver has not responded, Contractor will contact next senior Municipality adjuster for approval, and so forth. • The contractor shall review prescriptions to identify duplications, early refills, and possible abuse. MOA must be alerted to any such findings. • The contractor shall track opioid prescription usage for potential abuse and notify the prescribing physician of potential problems in writing. • The contractor shall maintain a clinical staff capable of performing medication utilization review accompanied by recommendations for therapy, considering available medical records and prescription history. • The contractor shall have a staff of clinical pharmacists available to provide customized support for medication-related decisions. • The contractor shall provide invoices for services on a daily basis as the services are incurred via electronic means compatible with the claim system employed by MOA, Claim Pilot.

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