Virtual Benefits Administrator (VBA) Integrations

As pioneers in specialized drug management and frontrunners in Medicaid pharmacy initiatives, we are transforming pharmacy benefit management through strong partnerships with our clients and members to deliver an outstanding healthcare experience. Our dedication centers on the belief that every individual should have access to the essential tools for a healthy and rewarding life. By crafting solutions that emphasize personalization and improvement of the healthcare experience, we strive to achieve optimal outcomes for both our clients and members, while also nurturing a sense of community and support that extends beyond the individual. This holistic approach not only enhances health results but also fosters lasting relationships built on trust and collaboration.

Southern Scripts simplifies the intricate world of Pharmacy Benefit Managers (PBMs) by offering employer groups remarkable freedom, authority, and adaptability in shaping their benefits plans. Founded by pharmacists, Southern Scripts distinguishes itself as an innovative PBM aiming to revolutionize the traditional PBM approach. Through our distinctive pass-through PBM model and customizable solutions, we empower plan sponsors to increase savings, reduce risk, and enhance flexibility in their plan designs, all while supporting authentic patient-centered clinical care at the most budget-friendly net cost. The plan sponsor only pays the precise amount that the pharmacy receives, and we guarantee that all discounts and rebates acquired are completely passed on to the plan sponsor at 100%. There are absolutely no concealed fees for vital PBM services, which include prior authorizations, step therapy, and data reporting. Our extensive clinical management programs and premium drug formularies are crafted to ensure the lowest net costs, protecting plans from unnecessary expenses while enhancing patient health outcomes. Ultimately, our commitment is to provide exceptional value, ensuring that plans are not only effective but also efficient in achieving their objectives. By prioritizing transparency and collaboration, we aim to foster stronger partnerships with our clients.

Revamp the design and production methods to create clearer and more effective materials for members, ensuring they are more engaging and relevant. Combine and oversee both digital and printed communication channels to guarantee that each interaction leaves a lasting impression on members. Streamline the process for setting up provider payment preferences, ensuring that payments are made promptly and meet their needs. By adopting this holistic strategy, the organization can cultivate a more robust relationship with its members, ultimately enhancing overall satisfaction and loyalty.

Ensure the dependability of your health plan while identifying precise pricing through the Context4 Health Plans Suite, our adaptable and cloud-based technological solution. Gain immediate and actionable insights for identifying Fraud, Waste, and Abuse (FWA), crafted by our team of certified experts proficient in clinical, dental, and health benefits. By utilizing reliable data along with cutting-edge cloud technology, we provide a strong and justifiable Medicare reference-based pricing (RBP) solution. Our platform integrates over 100 healthcare data sets, further enhanced by expert guidance to improve operational efficiency and maintain regulatory compliance. Moreover, our advanced medical coding software is designed to facilitate claim submissions and minimize the chances of denials. In addition, our cloud-based Payment Integrity Platform employs a distinctive analytics engine to detect coding errors, evaluate medical necessity, tackle unbundling, and identify fraud, waste, and abuse, while also assessing audit risks and uncovering pricing inconsistencies that could greatly impact your organization’s overall performance. This all-encompassing strategy not only protects your financial stability but also equips you for lasting success in the dynamic healthcare environment. With our commitment to innovation, you can navigate challenges with confidence and ensure a future of continued growth.