Payors

We offer Payors a full suite of solutions to manage medical drug spend across their organization and obtain cost containment and savings.

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Providers

When submitting a claim, the goal is to always get it right the first time. Coding, pricing and units are a challenge when it comes to submitting for administered drugs on medical claims.

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Pharma

RJ Health Systems provides guidance to Pharmaceutical companies to ensure that drugs are billed and coded accurately.

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Service Organizations

We partner with multiple service organizations to provide solutions to manage medical drug spend in many different ways.

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What We Offer

Our solutions can guide you in establishing pricing and reimbursement policy, analyze overspending, target outlier claims, educate and build provider compliance using the industry standard in medical drug data.

Finance/Analytics

Finance and Analytics teams use RJHS products and services to establish pricing and reimbursement policy, and analyze potential opportunities for cost containment.

Clinical/Pharma Ops

Clinical / Pharmacy Operations teams source our data and software as a service application to establish clinical edits in support of case management programs designed to improve outcomes and minimize costs.

Claims

Claims adjudication teams use RJHS data and software as a service application to review and target outlier claims, increase payment accuracy and reduce risk of appeals.

Network

Network Management sources our data to manage medical specialty drug pricing included in fee schedules.

Methodology

Our Methodology

Our reimbursement methodology is based on the expectation that every episode of care starts with a clinical diagnosis. From this foundation, we dedicate ourselves to delivering a transparent analysis of appropriate care that balances lowest cost alternatives with positive outcomes for the patient.

RJ Health Systems’ data combines clinical diagnosis and procedural coding matched to the right drug and dosage, as well as the most cost efficient specialty drug price.

Thanks to this proven approach, we stand at the intersection of Medical drug reimbursement and count the nation’s leading Payors, thousands of Providers and most major Pharmaceutical manufacturers as our customers.

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