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Overview

Healthcare markets, regulatory and compliance controls, brand/generic conversions, payer sheet and carrier guide specifications, formulary management, shifts in consumer behavior, complex product distribution chains, and sophisticated, dynamic services are accelerating the rate of change in the pharmacy business environment. To remain competitive, organizations are challenged to rapidly identify revenue opportunities
100% of claims and fields in the adjudication can be reviewed
and threats, and execute swifter actions to increase or protect this revenue. For example: Pharmacies that process millions of transactions a month have no possible way to review every claim for errors, margin improvement, reimbursement, contract management compliance, and denial management by hand or with an arm of professionals. Through technology the live analytical program 100% of claims and fields in the adjudication can be reviewed for errors and opportunity for improvement.

Unlike legacy Pre/Post Editing (PPE) systems that have 5-10 basic rules, The Next Generational platform has over thousands of advanced business rules that may be customized to meet the needs of the customer. By deploying and leveraging complex event processing and a sophisticated business analytic platform with an integrated dashboard Veridikal has changed the way that both individual pharmacy locations and corporate chains use their data to drive performance improvement and decision making. Event processing is a method of tracking and analyzing (processing) streams of information (data) and transactions (events), and deriving a conclusion from them. Complex Event Processing (CEP) is the event processing that combined data from multiple sources to infer event or patterns that suggest more complicated circumstances. The goal of CEP is to identify meaningful events (such as opportunities or threats) and respond to them as quickly as possible.

Corporate pharmacy Clients utilize this program to integrate their existing workflow, reporting, and business intelligence (BI). There are a couple of critical decisions that are required with this solution for this Work Order, for example, electing the best approach for integration with the right Pre/Post Editing Package:
Approach 1 - Veridikal PPE Program – Used when Clients are not currently using any existing PPE package or when they are using a limited legacy service with only 1-15 basic edits. Veridikal allows for a simple conversion to our PPE Sponsored Pre/Post Editing Package and advanced business rules engine.

Approach 2 - Client Sponsored PPE Program – Used when Corporate Clients have already heavily customized their PPE program through the switch. Client will grant Veridikal access to a direct data feed from the switch of editing package in a flat or custom file format to integrate with BI Reporting and Pharmacy Business Solutions. This approach supports the “Root-Cause” hierarchy analytics, automation or workflow and BI Reporting and allows the use of the Veridikal Integrated Dashboard and contract management systems.

Approach 3 - Hybrid/Combination PPE Program – Allowing Corporate Clients to leverage Approach 2 for Pre-Edit business rules with the Veridikal Post Editing Business Rules, Reference Databases and Support Services. The Veridikal package includes key post editing business rules that support payer sheet preferences, formulary management, reimbursement analytics, contract management, financial impact reporting/monitoring, policy and procedures, educational materials, and other monitoring tools.

Database Sources

Additional key decisions will require Client to determine the number of integrated databases or sources of information that will be streamlined into the BI Reporting Tools. The following databases are recommended for the “Best Practice” approach:
  • Advanced Pre/Post Editing Data Feed
  • Transactional Database [Historical Claim Sets] –Switch sponsored Database or Veridikal will create a database for the client based on granted permission and request for data from the switch. Recommended minimum for contract and financial modeling is 12 months
  • Raw 835 Source [835 in 4010/5010 format or database of all segments] – Used for analytics in 835 segments for Fees/Adjustments, Transaction Fees, Audit, Take-backs, PB1 Segments, etc. Recommended minimum for contract and financial modeling is 12 months
  • Audit Data - Existing tracking of audit requests etc. Recommended minimum for contract and financial modeling is 12 months
  • Cost/Wholesaler/Rebate Data [8020 Report from wholesaler or custom data feed for true-cost and purchasing history]
  • Contract Terms, Assumptions and Parameters [Custom Contracting or PSAO]
  • Manual/Direct Billing Transactions

Cross-Functional Team Access Levels

Multiple cross-functional team members utilize the BI/Reporting Tools for this program. Client will be required to determine the number of users and level that they will have access to the BI Reporting Tools and System. BI Reporting has a separate one time only charge for assigned users to the system. For example:
  • MySubscription –Pushed Report Distribution
  • Integrated Dashboard - Consumer Base User – Static Reporting
  • Integrated Dashboard - Business Analytics (BA) User – Custom Reporting
  • Integrated Dashboard - Power User – Database and BI Specialist for Custom Dashboard capabilities

Traditional Approaches

To date, delivering faster, actionable analytics has presented a tremendous challenge. When Business Intelligence (BI) and data management teams explore building live analytic applications, they encounter daunting problems in the following areas:
  • Gathering large volumes of constantly changing data from various customer or operational touch-points;
  • Integrating this high volume data with existing customer and operational information to provide full situational context;
  • Continuously analyzing the rapidly changing information to identify problems and opportunities and deriving the proper course of action.

Advantages of Approach

Live analytics provide pharmacies the equivalent of multiple systems. Management gains the benefit of all functionality in one revenue cycle solution, including but not limited to:
  • Advanced Editing Systems
  • Claim Scrubber
  • Contract Management System
  • Denial Management System
  • Supply Chain Optimization
  • Clinical Formulary/CPOE
  • Rebate and Supply Management
  • Business Strategic Services
  • Trending & Strategic Planning

Support Packages

Veridikal Support Services ensure that success of your investment in our technology and programs. We provide superior customer services to our clients and partners through commitment to customer satisfaction and dedication to personal support. Veridikal understands that our Client’s technical and operational support needs vary and may evolve over time, which is why we offer five Support Plans designed to suite a wide variant of Client requirements. Each of these support packages is building and inclusive.

ServicesStandardExtendedManagedPremiumDedicated
Implementation Planning & Kick-off Call
Basic Edit Training Classes [Over 1,200 Rules to select from]
Orientation Classes [i.e., DAW, DUR, Denial Management, etc.]
Report Configuration, Workflow, Distribution, & Modeling Recommendations
Shared “Standard” User Group Meeting and Support Package
Shared Support Liaison [i.e., Claim/Edits modification]
Shared Standard After Hours Support 24/7/365 Access
Quarterly Performance Reviews [Web-based Meeting]
New Software Releases & Updated
Integrated Dashboard Reporting [Consumer License Required]
Priority Involvement in Enhancement Requests & Rule Development/Deployment
Semi-Annual Onsite Visit ROI, Operational Maximization, & 4 Custom BA Sessions or Custom Reporting Sessions
Custom Reporting & Configured Dashboard Filtering [BA License Required]
Extended Dedicated Help Desk/Production Management Liaisons
Personalized Monthly Client/User Group Meetings Monthly
Quarter Onsite Visit ROI, Operational Maximization, & 6 Custom BA Sessions or Custom Reporting Sessions
Monthly Onsite Visits to Optimize Performance (1 day)
Custom Rule Assistance with Business Optimization & Prioritization
Critical Issue Notification & Escalation Notification
Dedicated Support Engineer/Business Analyst/Financial Analyst (3 for price of 1 [Without Taxes])
Environment Replication – A copy of your entire system
Monthly Onsite Visit (2-day) ROI, Operational Maximization, & 12 Custom BA Sessions or Custom Reporting Sessions
Weekend Expert Assistance


Client Testimonials


Jeff L. Moreland

CEO/Chief Patient Officer

"Veridikal has been a strategic business partner with Patient Engagement Advisors (PEA) for over three years. We have had the privilege of working on several health system engagements together. The Veridikal professional team and Solution Set is second to none and is absolutely critical to any pharmacy organization to effectively manage their Revenue Cycle activities. Veridikal has been instrumental in chaining behavior, driving performance improvement, margin optimization, and ROI for our collective clients."

Chris Mayer

Pharmacy Manager, Boulder Creek Pharmacy

"I would like to provide some feedback on one of your employees. Several days ago I contacted Jeff Maxwell for help understanding and handling some of the issues concerning my reports. I explained to him that we've been short staffed lately. The state of the economy had already forced us to cut back on labor costs. I told him I had little time left to fully utilize the services you provide. His answer to me was "that's why I'm here". His positive attitude and confidence in a solution exhibit qualities that myself as a customer and a pharmacist for 35 years, are hard to find in an employee. He helped customize my reports and gave me a better understanding of what to look for to better operate our handling of claims. A follow-up call the next day answered my remaining questions. I commend you for employing Jeff and will direct future contacts to him when I need help. Thank you for your time."

Veridikal Client

"We were very fortunate to find Veridikal two years ago. At the time, we were struggling to make one of their competitors provide exactly what Veridikal does. Veridikal instinctively knows what the pharmacies are trying to accomplish and provides the tools they're looking for in a way that's easy to understand. Veridikal has helped us restore credibility in the field for the pre & post edit process and business analytic with a solid return on investment, necessary reporting, and proactive business edits for our class of trade and customization by state."

Veridikal Client

"I am one of Veridikal's biggest fans from two completely opposite ends of the spectrum. As a Pharmacist who developed new Closed Door Pharmacies for 18 years, from the ground up for several companies and managed them as well I can tell you first hand that one of the greatest burdens/challenges we had was 1) knowing we were not getting paid as much as we could on most claims and 2) not having any time to drill down to see why we weren't getting our full reimbursement on each claim. Why? If you know anything about CDP's we spend 24/7 doing our best to ensure quality care to our nursing home patients and their caregivers. There is absolutely no time to look into reimbursements like we need to therefore operating on very thin margins. If someone would have come to me ten years ago with the services Veridikal has to offer I wouldn't have blinked an eye and say "sign me up"!!

Veridikal Client

"Why? there is nothing to lose, I get a minimum of 5 to 1 ROI...what's there to think about. Veridikal can alleviate my burden, I can maximize my reimbursements day in and day out, increase my profit margins and to top it off Veridikal goes the distance to automate my processes making me more efficient. As a DOP what more is there to ask for??"

Veridikal Client

"Now remember I said I am Veridikal's biggest fan from two opposite ends of the spectrum, the flip side, I am now building a new GPO for the CDPs! And you can bet my differentiator in the market place that I will offer our members will be the services Veridikal has to offer from Pre and Post Edits (PPE), 4 point reconciliation, maximum recovery services to Audits!"

Meena Rupani

Vice President, TempestMed, LLC.

"I can not emphasize enough the importance and the impact Veridikal will have on any CDP business. It all adds up to substantial revenue and increased profit margins with minimal costs, there isn't a business around that doesn't need that!!"

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New York, NY 10022
P: 480.636.1830

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