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Data Integration

Manage medical drug spend across your organization with our suite of data products.

We provide health care organizations with data products necessary to effectively manage and ensure appropriate reimbursement. Our data, at various levels across healthcare organizations, can help manage medical drug spend while adapting to the constantly changing specialty drug landscape.

Our data is designed for direct integration with various healthcare systems, such as financial and analytic platforms, pharmacy operations, network contracting, and claims management.

Data for accurate adjudication, reimbursement, and pricing

  • Finance and Analytics can establish policy, formulary and rebate program development.
  • Clinical and Pharmacy operations can effectively establish methods to create edits for case management.
  • Network management can effectively manage and create fee schedules, educate on policy and create clarity on medical drug reimbursement.
  • Claims operations can enhance claim payment accuracy and reduce risk of appeals.

Pricing Data Available

  • Pricing – Accurate AWP, WAC, ASP and APC pricing information for each HCPCS/CPT® drug code, including NOC codes
  • NDC Crosswalk– Links NDC to appropriate HCPCS/CPT® billing code, determines appropriate units of the code to bill when using specific NDC
  • NDC Conversion – Convert HCPCS/CPT® units to NDC units and calculate NDC level reimbursement and market share for rebates
  • Customizable Maximum Allowable Cost – MAC pricing for medically covered drugs

Clinical Data Available

  • Drug Diagnosis Coding 10 – Links FDA and Compendia listed ICD-10-CM codes to HCPCS/CPT® Drug Codes.

  • Min/Max Plus – Minimum and maximum FDA and Compendia dose ranges for adults and pediatric patients in billable units.

  • Age/Gender – Minimum and maximum ages for male and female patients for HCPCS/CPT® drug codes.

  • Part B or Part D – Determine coverage under Medicare Part B or Part D benefits structure.

  • Administration Codes – Links Admin code(s) to specific HCPCS/CPT® drug code.

Learn More

We offer customizable data files designed for direct integration with enterprise systems such as pharmacy operations, financial and analytic platforms, network contracting and claims management.

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