Systems Xcellence Introduces New Product for Pre and Post Adjudication Software for Pharmacies and Managed Care Organizations 

The new system, to be called HX-Compliance®, will be part of Systems Xcellence's growing Healthcare Xcellence (HX) suite of healthcare automation products. HX-Compliance provides pre and post-adjudication capabilities that allow retail pharmacies to optimize and manage the contracts they have with Pharmacy Benefit Managers (PBMs). With HX-Compliance, retail pharmacies take a proactive approach to managing PBM contracts, ensuring that claim submissions result in maximized reimbursement according to the terms of their contract. Claim pre-adjudication minimizes rejections from PBMs, reducing pharmacy administrative costs. In addition, HX-Compliance allows pharmacies to streamline claim submissions and create a more efficient prescription fulfillment process. The post-adjudication provides pharmacies with an audit tool that identifies discrepancies in the pre-adjudicated reimbursement amount and what was actually paid by the PBM.

"Pharmacies using HX-Compliance will find greater workflow efficiencies with this new product." said Systems Xcellence President and CEO Gordon Glenn. "By increasing the accuracy and compliance rate of the claims submission process, HX-Compliance enables pharmacists to concentrate on what they do best, taking care of patients."

The system includes a flexible set of rules for such factors as ingredient costs and dispensing fees, ensuring the pre-adjudication process is completed in accordance with PBM contract guidelines. Although the focus of the software functionality is on the claim, HX-Compliance also allows pharmacies to register negative eligibility records if an individual's coverage is rejected - ensuring procedural efficiencies, and preventing future claim submissions for patients previously determined to be ineligible.

HX-Compliance is the latest product in Systems Xcellence's growing line of Healthcare Xcellence products for the healthcare benefits management industry. HX-PBS® (Pharmacy Benefits System), its flagship product, combines full-functionality with a patient-centric design. Targeting Pharmacy Benefit Managers and Managed Care Organizations, HX-PBS is used to manage all aspects of pharmacy benefits, such as membership identification and enrollment, drug Interaction and utilization, billing and payments, eligibility and claims adjudication.