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Below is the transcript and demo from our on-demand MicroWebinar:  Road Testing the RJ Health Medical Drug Edits and API Platform RJ Health’s MDEs intake customer claim data and apply our best in class medically covered drug data and algorithms in order to improve reimbursement timeliness, drug coding, and payment accuracy, drug formulary adherence, and […]

INSIDE THIS ISSUE CMS News New, Revised, and Deleted HCPCS® Effective July 1, 2019 Upcoming in the June Update Drug Reimbursement Code Price Updates Drugs/Devices New Clinical and Billing Information Software Updates Data Enhancements Coming Soon CODE UPDATES Large Price Changes: We identify and report on the codes with the most substantial pricing increases or […]

In April there were four new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were five supplemental drug approvals. The FDA had acted on assignment of new PDUFA dates for six new products for review. Drugs included in this review are generally regarded by the industry as specialty […]

In Medical Drug Edit Blog Posts #1 & #2, we learned how Medical Drug Edits can enhance Medical Drug claim submission and reimbursement accuracy.  However, the utilization of an API (Application Programming Interface) to deliver Medical Drug Edits can further improve the Medical Drug pre-claim review process. Specifically, the use of an API can: Speed […]

Beginning April 29 and continuing to May 2, Asembia will be hosting its 15th annual Specialty Pharmacy Summit at Wynn & Encore in Las Vegas. RJ Health is excited to join the many pharmacies, health systems, pharmaceutical manufacturers, PBMs, health plans, technology companies, and consulting firms that will be in attendance. The agenda includes continued […]

RJ Health’s Saas provides data regarding the number of billable HCPCS code units that are associated with each NDC. Learn more: VIEW THE FULL WEBINAR   [TRANSCRIPT] Laura: First, we’d like to do a quick orientation to some of the applicable data. We will assume that you have some basic knowledge about medical claims, and we’ll […]

INSIDE THIS ISSUE CMS News New HCPCS® C-Codes Effective April 1, 2019 Now Available Quarterly ASP (Average Sales Price) Pricing File Revised for April 2019 April 2019 NOC (Not Otherwise Classified) Pricing File Hospital OPPS (Outpatient Prospective Payment System) Update Drug Reimbursement Code Price Updates Drugs/Devices New Clinical and Billing Information Software Updates Prioritize your […]

In March there were three new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were four supplemental drug approvals. The FDA had acted on the assignment of new PDUFA dates for ten new products for review. Finally, there was one product that had an extension of a PDUFA […]

Our latest white paper demonstrates the value and versatility of an automated medical drug claim edits solution. RJ Health’s system implements a rules-driven platform to reduce overall medical drug claims errors and improve overall efficiency. Appropriate reimbursement for drugs covered by the medical benefit increasingly requires more data and structure. Many of the billing systems […]

Increasing healthcare costs continue to outpace inflation in the United States. Specialty drug costs are the largest driver and component to healthcare spend. This surge has led to transformative patent care but has also given rise to a disproportionate total healthcare spend. Major drivers of medical drug spend are the complex processing of medical drug […]