FLORHAM PARK, N.J. – Conduent Incorporated (NYSE: CNDT) an industry leading business process services company, today announced its Pharmacy Benefit Management (PBM) module, Conduent™ Flexible Rx System, has received federal certification in the state of Montana. This is the first instance of federal certification for Flexible Rx and the first time that certification has been granted to an individual Medicaid management module.
Flexible Rx is a comprehensive Pharmacy Benefit Management system, built on a web-based platform. It was designed to help states improve care while controlling costs. Its agile design can easily plug into modular frameworks or work in conjunction with existing legacy platforms. Flexible Rx enables states to quickly adapt to changes in federal regulations and updates to state policy.
The system provides:
Pharmacy Claims Processing Flexible Rx streamlines the claims adjudication process through the electronic submission, transmission, and payment of prescription information for Medicaid, federal and commercial clients.
Prospective Drug Utilization Review (ProDUR)To promote positive outcomes, Flexible Rx evaluates claims against comprehensive ProDUR edits (including drug-drug interactions, therapeutic duplication, and incorrect dosage) which promotes prescribing compliance with evidence-based criteria. Our solution instantly alerts providers to potentially adverse interactions, ensuring members receive the safest and most cost-effective therapies.
Automated Prior Authorization processing: Combined with the Conduent™ SmartPA Pharmacy Application, Flexible Rx automates up to 90 percent of claims requiring prior authorization. This expedites medication dispensing and reduces the administrative burden on providers while reducing costs.
In 2016, the Centers for Medicare & Medicaid Services (CMS) developed a process for vendors to obtain modular certification. The certification was granted based on a complete virtual review of the systems capabilities – a first for CMS – and the latest federal checklists for modular solutions in the Medicaid Enterprise Certification Toolkit.
“CMS’ certification of Flexible Rx provides validation that a modular approach to these systems can work,” said David Hamilton, general manager, Government Healthcare Solutions, Conduent. “As a precedent, the certification will enable us to speed the process in other states.”
Flexible Rx is being used in Montana to support the state’s growing Medicaid population, which has added over 75,000 members since Medicaid Expansion took effect on January 1, 2016. Since its go-live date, Flexible Rx has processed millions of dollars in claims for the state.
Conduent is a leading provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.
We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.
Whether it’s digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning – Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at www.conduent.com.