RxShield

About

As pharmacy expenditures rise, pharmacy FWA continues to be a prevalent issue for both commercial and government payers. RxShield is fully integrated with PreShield, PostShield, QueryShield, and CaseShield empowering Healthcare Fraud Shield customers to be able to:

-Identify prescription drugs improperly billed based on company policies and guidelines.
-Demonstrate abusive patterns of prescription use by members; such as obtaining early refills, pharmacy and doctor shopping and more.
-Detect prescribers providing medications outside the standard of care.
-Peer comparison of pharmacies for aberrancies such as excessive use of override codes, high volume of brand drugs, suspect number of controlled substances and more.
-Conduct cross-claim analysis between pharmacy and medical claims to identify potential double billing as well as diagnoses that do not support the medications prescribed.
-Easily create detailed customized analysis reports using both pharmacy and medical data.

This product is intended for

• Claims Clerk
• Special Investigator
• Data Analyst