Seeking to Grow Market Share?

Get a FREE assessment of your CDH products —
a $3,000 value.

XpandPBM™: Real-time Integration of Pharmacy and Medical Benefits.

XpandPBM is an easy-to-implement, robust technology solution that enables health plans to offer real-time integration of pharmacy and medical benefits for CDH, PPO, POS or EPO plans. Real-time synchronization between a pharmacy benefit management provider and a core benefit plan reduces — if not eliminates —administrative time and effort related to claims that were improperly processed using inaccurate accumulators.

A Closer Look at XpandPBM's Advantages

Featuring enhanced service and operational support, XpandPBM reduces costs for handling claims and consumer service calls by eliminating many of the overpayment and underpayment problems that can result from a lack of synchronization. In addition, this advanced technology solution provides both your consumers and customer service staff with a single, consistent view of timely information.

Furthermore, because of its close integration with your core claims system, XpandPBM minimizes the time and effort needed to design and configure new products, subject to the limitations of the PBM. Integration also allows for synchronized adjudication and adjustment of claims. This means no need to request that IT spend hours setting up new parameters or conducting extensive testing. Products can be defined using existing or new templates — or by allowing the plan’s core processing system to dynamically define products. At the same time, its Service-Oriented Architecture (SOA) design eliminates technology integration barriers.

XpandPBM's Bottom-Line Impact

  • Integrated
    Closely coordinates payments for pharmacy and medical benefits, synchronizing the data and lowering the number of claim adjustments caused by timing issues

  • Scalable
    Expedites product development and eliminates bandwidth constraints, thanks to SOA and user-friendly admin console for managing technical services

  • Enabling
    Combines pharmacy and medical benefit accumulators and deductibles for faster and more accurate processing and customer service

  • Real-Time
    Allows claim adjudication to occur in tandem with core claim system, with real-time accumulator updates that eliminate payment delays and reduce claim adjustments and consumer calls

  • Synchronized
    Supports coordinated processing of pharmacy and medical claims, more accurate calculations (completed in milliseconds) and fewer claim adjustments and service calls

XpandPBM Features

  • Integrated Product Design and Configuration
  • Coordinated Enrollment and Eligibility Management
  • Consolidated Financial Information
  • Simplified Customer Service Support
  • Administrative Console for Easy, Efficient Platform Management
  • Integrated, Sophisticated Client Reporting
  • Messaging-based Platform for Flexibility and Scalability

Please contact us to learn more.