Standard Management Reports. Report Category Potential Uses and Application Pharmacies (continued) and/or drug(s). Within the report results can be re-ranked, drilled into the top members and/or physicians associated with those pharmacies. Use to identify potential fraud and abuse, monitor trends in your network, and examine outliers Pharmacy Affiliations Provides key statistics on top utilized pharmacies. Data includes chain/association name, ID, total cost, plan paid, patient paid, % of plan paid, generic % of plan paid, total claims, % of total claims, generic % of total claims, plan paid per claim, and PMPM, by pharmacy chain/association. The number of top affiliations can displayed as specified and several different ranking methods are available: PMPM, % of total claims, Total Claims, Plan paid per claim, Total Cost, Total Patient Paid, Generic % of plan paid, Total Plan Paid, and Generic % of total claims. The report results can be optionally constrained by disease, prescriber, pharmacy, and/or drug(s). Within the report results can be re-ranked. Use to identify potential fraud and abuse, monitor trends in the network, and examine outliers. Prior Authorization Provides detailed tracking on therapeutic prior authorizations. By prior authorization, data includes the PA #, drug name, member information, and key status and status dates associated with the prior authorization workflow. The level within the plan hierarchy can be specified based on data and sort desired. The report results can also be optionally constrained by the entry source of the PA (either CONTRACTOR or the BHS Program), and/or by PA status. Use to monitor therapeutic PA volume, track PA process duration and turnaround time, and identify PA approvals/denials. BHS Formulary Report Provides a list of BHS Formulary approved medications in a portable format that can be printed and shared by County staff. When the BHS Formulary is updated, this report will be modified by CONTRACTOR to include the most current BHS Formulary information and conform to all BHS Program report standards for formatting, portability and any detail as necessary. CONTRACTOR agrees to customize performance report packages according to the needs and 24 goals of the BHS Program and in a format mutually agreed upon by ADMINISTRATOR and
Standard Management Reports. Based upon Claims submitted by and paid to Pharmacies, Pharmacy BenefitDirect shall prepare and deliver to CLIENT at no additional charge to CLIENT, one set of reports as selected by CLIENT from the “Management Reports” listed in Exhibit A. The Parties shall agree on the media (e.g., magnetic tape, electronic data interchange, etc.) on which such reports will be contained.
Standard Management Reports. AdvancePCS will provide Customer with AdvancePCS' standard management reports in connection with the Services provided hereunder, which reports may change from time to time at AdvancePCS' discretion. Customer may elect to receive some or all of the standard management reports made available by AdvancePCS.
