Prescription History Profiling Tool Translates Rx Claims Information

by Lindsey Amaya on June 23, 2015

As an underwriter, wouldn’t it be great if you could gather greater insights into your applicants’ prescription history? What if there was a tool that helped facilitate precision underwriting?

In fall of 2014, ExamOne acquired MedPoint from OptumInsight. As part of ExamOne and Quest Diagnostics, our prescription database increased, providing you with a more in-depth review of your applicants’ prescription history. ScriptCheck® is now a more powerful tool aiding in the underwriting process.

Better data. More savings.

How does using ScriptCheck save you money? Underwriters tell us they only use three years of eligibility data to make decisions — anything more than that isn’t used. So while we receive the same seven years of eligibility as competitors do, we only provide the last three years to underwriters. This data is clean, accurate prescription data that allows you to make informed underwriting decisions about your applicants.

Additionally, as part of the new ownership ExamOne gained access to new data sources. Our database now provides access to over three billion new claims and eligibility records for clients. This provides our clients on average a 16 percent increase in hit rates.

Exclusive access to OptumRX

Quest Diagnostics has exclusive access to OptumRX claims information. OptumRX, owned by UnitedHealth Group is the third largest pharmacy benefit manager (PBM) in the country and is the preferred PBM of UnitedHealthcare. This data provides a more comprehensive review of your applicant’s prescription drug history.

Cleaner data, straight from the source

We currently access more than 70 percent of the PBM market. How does this affect you and your underwriting decisions? Through our PBM relationships we go directly to the source and collect the pharmacy claims regardless of where they fill their prescriptions. By using this strategy, you receive information on the drugs you care about for underwriting. It recognizes mail order maintenance as well as specialty drugs, in addition to any retail prescription purchases. This data approach provides you with the most complete and accurate picture of your applicant’s Rx claims history.

More intelligent design

With ScriptCheck’s new design, it will recognize when two names in the system are in fact the same individual. For example, a female fills a prescription, gets married a month later and changes her last name. The next time she fills a prescription her last name has changed. Our sophisticated algorithm will recognize this as the same individual and will combine all prescription history for both names. This same algorithm will also identify when two individuals who are on the same insurance plan, are not the same person.

Additionally, with this new infrastructure you will experience improved functionality. The new design will help you:

  • Identify potential diseases based on an individual’s prescription history
  • Determine if an applicant is following their maintenance drug plans as prescribed
  • Identify drug interactions that could be causing medical problems
  • Recognize specialties of all the doctors prescribing medication to your applicants
  • Uncover hidden health issues

We are excited about this new investment and the benefits it will provide to you. As a leader in the insurance industry, we are committed to helping our clients obtain the best and most accurate data, while also facilitating precision underwriting.

To find out more please contact our Strategic Product Owner, Stacy Steuart, at Stacy.R.Steuart@ExamOne.com.

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