HCAA Executive Forum Sponsorship Guide - Spring 2023

SPONSORSHIP GUIDE SPRING 2023

Welcome to HCAA’s Annual Digital Sponsorship Guide. We at HCAA have had an amazing trajectory of successful conference events. We know this success could not have happened without the partnership of our sponsors. Since its inception in 2020, our Digital Guide has focused on providing another opportunity for our amazing Sponsor Partners to let you know about their very valuable products and services.

We invite you to please take time to use it to find out more about what they offer! Remember, here at HCAA, it is always about “the value of connection”!

Carol Berry, HCAA CEO

Susan Crolla, Executive Director

Powering Healthcare

Cost Management Solutions

Cost Containment Experience Impacting Savings

16+ years of experience and historical reimbursement data resulting in transparent pricing that’s fair for all.

Physician-led Medical Bill Review Confirming Accurate and Reasonable Pricing

30-member physician panel reviews claims at the line item level, resulting in an average of 10% savings on hospital and facility claims.

On-demand Insight Delivering True Transparency

Next-generation portal and analytics platform providing visibility into claims flow, performance metrics, real-time trends, claim-level data, and more.

Care Navigation Team Connecting Members with Healthcare Options

Healthcare resources offering a variety of care options to optimize savings, schedule procedures, and check eligibility.

Enriched Member Experience

AMPS Connect Enabling Smarter Healthcare Decisions

Mobile application allowing members to compare providers, schedule procedures, submit balance bills, and communicate with the AMPS’ Member Advocacy team.

Rapid Response Reducing Member Abrasion

Settlement early in the process once a balance bill is received, reducing member abrasion.

Enhanced Member Advocacy Providing Faster, More Frequent Communication

Accelerated contact with members by returning calls within 24 hours and more frequent communication throughout the process.

Additional Savings Opportunities

Pharmacy Solution Providing Honest Pricing and Better Benefits

A non-traditional PBM (Drexi) enabling savings with transparent pricing and pass-thru on prescription medications at more than 65,000 pharmacies.

Stop Loss Coverage Optimized for RBP Performance

Programs with some of the largest stop loss carriers in the industry, creating competitive pricing and tailored to AMPS’ RBP performance, historical data and enhanced analytics.

Centers of Excellence Improving Patient Care

Second opinion review allowing access to a high-quality network to address misdiagnosis, over utilization, sub-optimal treatment and overpricing.

2005

Year Founded

1+ BILLION Claims Managed Annually

600+

Number of Clients

73%

Average Facility Savings

Average Plan Savings Over PPO

146%

26% Average Medicare Reimbursement Rate

Make your healthcare dollars go further.

sales@amps.com

www.amps.com

WHAT MAKES US DIFFERENT

WHO WE ARE

Alaffia Health is a healthtech company that uses machine learning and AI to eliminate fraud, waste, and abuse in medical claims We review claims on a pre-payment basis to proactively prevent overpayments We’re on a mission to eradicate improper payments so that providers and payers can focus on what matters most – providing the highest quality of care to patients at the best prices.

b u r s e d f a s t e r

O U R C L A I M

R E V I E W

P L A T F O R M

O u r c l a i m r e v i e w p l a t f o r m p r o v i d e s t r a n s p a r e n c y a n d r e a l - t i m e i n s i g h t s o n y o u r c l a i m s w e a r e r e v i e w i n g . S t a y i n f o r m e d t h r o u g h o u t t h e e n t i r e r e v i e w p r o c e s s b y v i e w i n g l i n e - b y - l i n e r e v i e w s i n f u l l d e t a i l a l o n g w i t h d e n i a l r a t i o n a l e V i e w a l l s u p p o r t i n g d o c s a n d c l a i m r e p o r t s d i g i t a l l y o n o u r p l a t f o r m .

A U T O M A T E D

B I L L R E V I E W S

T h e A l a f f i a p r o p r i e t a r y O C R s y s t e m c o n v e r t s m e s s y i t e m i z e d c h a r g e s a n d m e d i c a l r e c o r d s i n t o d i g i t i z e d f o r m a t s u s e d t o a u t o m a t i c a l l y r e v i e w i n d i v i d u a l l i n e c h a r g e s a n d c l i n i c a l d e t a i l s

C O N S U L T A T I V E

P R O V I D E R

C O M M U N I C A T I O N

A l a f f i a e d u c a t e s p r o v i d e r s o n b e s t b i l l i n g p r a c t i c e s t o r e d u c e f u t u r e m i s b i l l i n g .

A l a f f i a u t i l i z e s P r o v i d e r S i g n - O f f

A g r e e m e n t s t o c o n f i r m t h e f i d e l i t y o f e a c h r e v i e w f i n d i n g

I N D U S T R Y L E A D I N G S A V I N G S

A l a f f i a d e l i v e r s a n a v e r a g e s a v i n g s o f 2 2 % a b o v e i n d u s t r y d i s c o u n t

All-in-one digital healthcare navigation platform

Amino Health empowers plan members and care coordinators to make informed healthcare decisions through an intuitive, integrated platform experience.

Leverage innovation to win and retain customers

Delight members with a digital navigation solution that supports nearly any network, plan design, or point-solution you or your customer can imagine.

Engage members for better outcomes

Plan sponsors with Amino guide members to top providers at 3x the rate of populations who rely on traditional provider directories, while also maintaining a 35% engagement rate across members.

Make compliance a strategic advantage

Amino is on the forefront of supporting plan sponsors in meeting Transparency in Coverage requirements - all within a consumer-friendly navigation experience.

Add functionality without sacrificing margin

Upselling premium features offsets the investment in new or improved core functionality.

"Amino has been a great partner every step of the way and our customers love them!" Amino Partner

everyone benefits.

Visual, Sharable Benefits Analytics

Cedar Gate Healthcare Benefits Analytics is an employee benefits analytics and reporting application for self-funded employers, their payers, and their broker/consultant advisory partners seeking to meet the plan sponsor’s clinical and financial performance goals. It enables benefits managers to tailor plan parameters and model performance based on the characteristics of the member population. Visual dashboards distill the data into prescribed actions, preventing clients from getting lost in the analysis. Focused reports track the efficacy and impact of care management activities and point solutions by monitoring performance indicators in member cohorts. Unlike the competition, the Healthcare Benefits Analytics tool is built for self-service plan design and reporting, reducing or eliminating the need for additional consultants or vendors. It pulls data from a common data lake that is shared by Cedar Gate’s Care Management application, ensuring the accurate translation of data to insights, and insights to action. The application is cloud-based and built on a next-generation NoSQL database for rapid interpretation of unstructured data. It enriches member data to identify savings recommendations and generates visual dashboards that communicate insights and key points to all stakeholders.

COST, QUALITY, TRENDS, & COMPARISONS

Monitor performance indicators and correct undesirable trends.

COHORT IDENTIFICATION

Conduct population risk stratification to identify specific cohorts that need to be monitored and reported on.

PRE - CONFIGURED DASHBOARDS & REPORTS

Render stunning visuals with over 100 out-of-the-box clinical and financial reports and dashboards that communicate key facts to an array of stakeholders.

MEMBER, PLAN & BENEFITS BENCHMARKING

MEMBER DATA ENRICHMENT

Augment member data with over 5,000 types of data enrichment.

DIY DASHBOARD & REPORT CREATION

Create custom reports and visualizations on the fly with an easy-to-use tool designed for the non-technical user.

PLAN & BENEFITS MODELING

Test changes to plan elements based on the member population profile to generate recommendations that will have the greatest clinical and financial impact.

Compare real-time performance against Cedar Gate’s proprietary commercial benchmark dataset of over 11 million members — by region, state, MSA and industry type.

CLAIMS ADJUDICATION

What makes us different? Well...you do.

Cervey’s Adjudicator is a next-gen plan management and claims adjudication platform designed for you, with you. We offer a solution as unique as the needs of your clients, empowering you to provide nimble support in an ever-changing industry.

We listen. You leverage.

From customized pricing based on NADAC, AWP, WAC, MAC, ACQ to rulesdriven engines, Cervey’s Adjudicator provides the innovative flexibility you’ve been waiting for. We’re not just software. We are your partner in building a solution to help you maximize your strategy.

Claims adjudication doesn’t come in one size fits all... and neither should your software.

• Infinite Flexibility: Never out of the box. Our team of in-house developers offer endless benefit configurations designed to meet your unique needs.

• Comprehensive Expertise: With two decades of experience in claims adjudication, 340B, specialty and patient assistance, let Cervey’s seasoned team tailor your total solution.

• Unmatched Service: When you need support, you need an expert. You call we answer. No outsourcing. No robots. It’s as simple as that.

• No Competing Interests: Cervey is a privately held company, independent from any PBM ownership. Your success is our success. No question.

• Industry Readiness: Cervey’s flexible model allows us to quickly adapt to any future industry changes and requirements, including NCPDP F6 and beyond.

• Interoperability: Our extensive API framework simplifies the data integration with your internal processes and external business partners.

Key Differentiators

Pave the Way®

Pave the Way® is ClaimDOC’s trademarked proactive healthcare provider outreach program, which begins up to 60 days prior to the effective date. Our Member Advocates create a one-on-one relationship with each member to help them navigate their new plan. As part of the onboarding process, our implementation team explains the reimbursement method and claims submission process to each provider to ensure a smooth transition between plans. On average, 90% of providers contacted through Pave the Way® accept our fair payment solution.

Pave the Way® is the most differentiating aspect of ClaimDOC’s reference based pricing plan (RBP). There’s nothing like it on the market today.

True, Fiduciary Protection

90% average provider participation

ClaimDOC bears costs for risk management for the plan as well as for member legal disputes related to RBP services.

FREE Physician Claims Processing

Unique to ClaimDOC, all provider/HCFA claims under $2,000 are repriced and defended at no cost to encourage and support complete network replacement.

Detailed, Line-by-Line Audits

Our proprietary claims management and audit system is custom engineered to allow for detailed line-by-line audits. Our in-house audit team is comprised of healthcare experts who conduct “eyes on” reviews of all UB-04 facility claims, ensuring maximum savings. Many RBP programs only review balance bills and appealed claims.

No Outsourcing

At ClaimDOC, we do everything in-house, including implementation, provider relations, balance bill support, clinical auditing, legal management, and member advocacy. Our highly responsive Member Advocates guide clients through our program to ensure a smooth experience for all.

Pave the Way® with ClaimDOC

If you are a healthcare claims payer…

You are almost certainly a healthcare claims over-payer.

ClaimReturn can help fix that…at no cost to you.

The ClaimReturn Solution

ClaimReturn’s proprietary artificial intelligence platform reviews and analyzes your claims in a matter of minutes, sending up flags that our team inspects individually. Then we get fast to work on recovery. Our exclusive reporting system lets you follow our progress every step of the way. And ClaimReturn’s exhaustive analytics makes it easier to recognize future overpayments, making our recovery process both retroactive and proactive.

ClaimReturn Offerings

Post-Pay: After the claim is paid, we identify billing anomalies on a technical component and coding basis review across hundreds of logic statements within our rulesbased engine. We then recover those overpayments and return them to you.

Our Promises

COB: We identify claims whereby the plan paid, but Medicare should have in fact been the primary payer. We correct the payment ledger with Medicare as the payer and return the amounts you paid back to you.

To-Pay: After claim adjudication but before the bill has been paid, ClaimReturn provides a “final check” and makes payment recommendations preventing overpayment before any funds are sent to providers.

ClaimReturn’s collaborative approach to recovery is professional and respectful. We will never damage your provider relationships, your contracts or your own brand in the name of recovery.

We are not a collection service; we are a correction service.

We also promise full transparency in our process and analytics. We believe that the more you know, the more confident you’ll be in our work and proprietary systems.

Inaccurate claim payments are flying everywhere. We catch them.

Michael Loprieno Director of Analytics

Our next generation rating manual, Actuarial Advisor, allows you to swiftly price plans for groups of any size with or without historical claims experience while accounting for customizations such as reference-based pricing. Trained on billions of dollars in claims data, Actuarial Advisor is the most accurate rating manual on the market.

PUBLISH YOUR OWN HEALTH AND WELLNESS MAGAZINE!

PUBLISH YOUR OWN

HEALTH AND WELLNESS MAGAZINE!

Want healthier employees?

Want healthier employees?

Need to lower the cost of benefits?

Need to lower the cost of benefits?

Community Health offers a full suite of customized services, magazines, websites, apps, and more. Improving engagement, controlling cost, and reducing administrative burden.

get real results!

Community Magazine Group creates custom health and wellness magazines for some of the largest employers in Western New York and Western Pennsylvania. We offer a full suite of print and digital publications, along with wellness survey and engagement tools.

GET REAL RESULTS!

In Western New York and Southwestern Pennsylvania, Community Health wellness engagement has led to:

In Western New York and Southwestern Pennsylvania, Community Magazine Group wellness engagement has led to

• Quadrupling of participation in employee wellness programs

• Quadrupling of participation in employee wellness programs

• Reduction in annualized cost increases from 13% to 3%

• Reduction in annualized cost increases from 13% to 3%

Learn how your organization can take control of employee wellness. Contact publisher MARK HORNUNG at (773) 573-9794 and mhornung@cmgms.com.

Learn how your organization can take control of employee wellness. Contact publisher MARK HORNUNG at (773) 573-9794 and mhornung@cmgms.com.

Get where you want to grow with DataPath solutions as your travel partner.

Technology? DataPath has the proven all-in-one cloud platform for comprehensive administration of CDH Accounts, HSAs and Investments, COBRA, Billing, and Well-Being benefits.

Productivity? Our extensive business process outsourcing (BPO) services provide the service expansion, staff supplementation, and cost savings you’re looking for.

Education and Marketing? DataPath offers the industry-experienced, professional marketing services that you won’t find anywhere else.

Where do you want to grow? Let’s start the journey. Contact DataPath today.

dpath.com/tpa-grow

echohealthinc.com

ECHO never stops innovating to save you time and money on payments

We’ve spent 25+ years building solutions that solve complex B2B payments challenges.

Networked scale

With 1M+ provider and vendor connections, we have the largest payment network, so you can hit the ground running from day one.

Compliance expertise

We’re compliance experts, processing HIPAA, OFAC, and IRS 1099 compliant transactions.

Seamless integration

Implementation and wirkflow designs are built around your unique needs for seamless integration, with minimal time commitment for staff training.

Flexible solution

ECHO advantage

Enjoy the simplicity of a single payment solution

Convert costly check paymens to a fully electronic platform

Eliminate the pain, risk, and timeinvolved in the 1099 process

Offer customized, consolodated family EOBs

No setup or implementation fees

ECHO is not one-size-fits all; our comprehensive end-to-end solution can be tailored to fit clent needs.

Tested credibility

We are trusted to process $10B+ in payments every year.

CoeoRx—A TPA’s Pharmacy Powerhouse

We arm you with powerful leverage, marketing and support. You deliver the value.

Win lives—and broker trust.

CoeoRx is an independent Rx benefits consultant—with the strongest and largest portfolio of PBM contracts and pharmacy expertise—providing TPAs with the tools and support to effectively market and move their groups into better deals, seamlessly.

Your Rx Success Starts with a Custom Reprice

We load your clients’ claims data into NueroSQL, customized to your PBM portfolio, to deliver a side-by-side assessment and ensure your clients have a single source of truth to choose the PBM option that’s right for them.

• One easily digestible view

• Effectively market and manage the movement of new and incumbent groups with a white-labeled reprice tool

We measure the metrics that matter. You deliver the savings. Clients, and brokers, keep coming back— year-after-year.

We’ll help move your clients, and broker partners, into fewer and stronger pharmacy deals through our custom reprice, branded with your logo.

The best part? You pay us nothing. Our transparent fees are built into the power of the PBM contracts we deliver.

GET YOUR TIME BACK WITH THE FUTURE OF SELF-FUNDING.

Waiting to quote and underwrite a group often takes days, sometimes weeks. The process of traditional self-funding is complex and overly complicated for everyone involved, costing both time and money.

What if you could underwrite hundreds of groups a day?

It’s simple—just Power On with Health in Tech.

OUR SOLUTIONS—YOUR PROGRAM

At Health in Tech, our end-to-end solutions are designed to give you full autonomy, so you have the power to create whatever you want. We help you build your system, designed specifically for your needs and your market, so you can run with it.

BEST OF ALL!

You can go from WEEKS to MINUTES to quote and bind small to medium-sized groups. Produce a firm proposal that has 12 plans with 4 tier rates in only 2 minutes!

The industrys most advanced underwriting and quoting platform.

Creative risk-mitigating and stop-loss solutions.

Member benefit utilization and accessible, transparent data.

Accessible reference-based pricing networks.

POWER ON THE FUTURE OF SELF-FUNDING

Get started today and learn more about what Health in Tech can do for you.

Comprehensive Provider Access and Healthcare Services to Payers, Plans and Members.

Cost Containment, Utilization Management & Disease Management.

Hines accompanies your members through every step of their healthcare journey by coordinating integrated Care, Cost & Risk Management solutions. Our industry-leading suite of health management services is entirely customizable for Payors, Plans, and Members.

We o er:

• Provider Open Access Program (POAP)

• Curated medical management

• In-depth risk analysis with predictive modeling

Hines provides fully integrated health management programs that deliver optimal clinical outcomes with superior financial results. For every stage along the continuum of care, Hines o ers custom solutions.

Led by talented, experienced and knowledgeable team of registered nurses, medical specialists, financial review professionals backed by AI driven technology.

Personalized solutions for your members’ healthcare journey. ACCREDITED

• Prevention and wellness engagement

• Early and continuous patient intervention

• ClaimChexTM cost management platform for optimal negotiated savings

With Hines, you're in good hands.

Designed to return control of healthcare back to the patient and plan. Opus one integrates Care, Cost and Risk Management in a single bundled package superior to a Primary PPO network or a reference-based pricing alternative solution.

With Hines, gain end-to-end health and wellness services personalized services for better care, better outcomes.

We’ll be there for you every step of the way!

800-735-1200

A nationwide leader delivering Care, Cost and Risk Management solutions and services that matter to you and your members.

It’s about time you found out about

As the workloads of TPAs continue to grow and evolve, it’s about time you had some help.

Presenting Claim Watcher – a powerful and efficient costcontainment tool that addresses the growing challenges and expectations faced by TPAs and their clients.

Our solution works on a few different levels:

For our TPA partners, we seamlessly integrate into your workflows as we take a closer look at claims to correct any billing or coding issues.

For the clients you serve, we provide significant savings – typically 20-30% on their health benefits spend.

And for members, our premier concierge service is on hand to assist with provider appointments and any general questions. And, if a member receives a surprise balance bill, we’re there too – with full and free legal defense, and timely, proactive outreach to update the member so they feel supported while also being protected.

Reach out today to learn more about how Claim Watcher can benefit you, your clients, and their members.

Too many TPAs limit their own revenue, their value to their customers, and their ability to di erentiate their services by not taking advantage of innovation opportunities. Every employer client represents an opportunity to establish a special relationship between you and each employer by presenting opportunities for additional value, quality improvements, and cost savings that your competitors can not or are not doing.

Ikigai Growth Partners evaluates hundreds of early-stage firms, looking for the few hidden gems that add value to your relationships. Current hot deliverables include:

• Digital direct contracting, DPC networks, vendor management, and bundled services

• Surgical optimization; faster recovery with almost no opioid utilization

• Caregiver support services for employees supporting aging loved ones

• Musculoskeletal (MSK) true digital front door, allowing immediate access to care triage and virtual expert support

• Virtual group mental health therapy

Don’t limit your organization to only those standard services and o erings that mimic your competitors. Add value to your relationships through innovation.

Come explore with us.

Michael Brouthers Founder/Principal Ikigai Growth Partners

mbrouthers@ikigaigrowthpartners.com

ikigaigrowthpartners.com

Tomorrow’s Solutions for Today’s TPAs

Access the industry’s most powerful, flexible, secure platform and stand-alone transparency solution with Integrated Payor Solutions.

Encompass

is the transformational cloud-based solution that powers your business.

Full-stack technology solution

Scalable

you grow

is the most efficient and inexpensive solution to meet all current and future regulations of the No Surprises Act (NSA).

Unparalleled scalability and reliability powered by Salesforce™

that No additional IT investment Built on Salesforce™

solution Compliant and secure Easy to use Low barrier to entry

can

Meets All Requirements for Machine Readable Files, Price Comparison Tools, Advanced EOBs, Qualifying Payment Amounts, & More.

a Demo Today

sevans@integratedpayorsolutions.com

Liberty Mutual | Employer Stop Loss

Our mission is to be a leader in the excess loss industry through outstanding services, relationship building and innovative products.

We understand that relationships are one of the driving forces in our industry today. We are committed to meeting the special needs of our broker partners and, most importantly, our self-funded employers. Through every step of the way, we pay great attention to details and respond promptly to all different aspects of the industry.

Partner with Liberty Mutual, and you benefit from the financial strength, security, and capacity of a Fortune 100 carrier. Go beyond business as usual.

To learn more, please contact:

Karthik Mohan

Vice President, Sales & Distribution

Liberty Mutual Medical Stop Loss 860-408-7896

Karthik.Mohan@ironshore.com

Services offered:

Specific excess loss coverage

•Incurred and paid, run-in and run-out contracts

•Specific attachment points available from $20,000 (per state regulations) to $1,000,000

•Eligible groups down to 50 covered lives (Per state regulations)

•Aggregating specific deductibles available

• Coverage available in all states except WA

Aggregating excess loss coverage

•Incurred and paid, run-in and run-out contracts

•Monthly aggregate accommodation available

• Terminal liability option available

•Non-experience aggregates are available on existing full insured employers

In-house clinical team and ProAct Care Solutions

• The Liberty Mutual ProAct program engages select vendors that provide the leading expertise in catastrophic claim management and clinical consulting services. In many cases, fees for services are considered eligible expenses under the Stop Loss Policy for members that exceed the specific deductible.

• Provide access to our robust in-house clinical review team offering expert guidance to producer partners and informed risk assessments.

A Brighter Future

Magellan Rx Management is a next-generation pharmacy benefit manager on a quest to evolve and inspire the pharmacy industry and lead our customers and members toward a brighter, healthier future.

Connect with us at HCAA and see how we can help you solve complex pharmacy challenges through:

Patient and copay assistance programs for specialty medications with multiple competitive pricing options available—savings averaging 70% of specialty drug costs

Experienced pharmacists to help you make more informed decisions to bring down the total cost of care for your members

State-of-the-art reporting and analytic tools to help you unlock the power of your data

Want to learn more? Connect with us!

magellanrx.com

mrxinquiries@magellanhealth.com

Magellan Rx Management Magellan Rx Magellan Rx

30+ Programs & Services > One Partner Solution

At MedWatch, we know that the job of containing medical costs while improving the health of members isn’t easy. You can build the perfect mix of services, support and care, but if members don’t engage – your results could be disappointing.

We’ve intentionally added services that work in tandem with a single point of access and provide resources and tools to help guide them every step of the way.

Compassionately Built – Seamlessly Integrated

We’ve carefully constructed 30+ programs and services that fit together seamlessly to meet members where they are in their health journeys.

With 35+ years in the industry, MedWatch’s continued innovation and growth, proprietary technology, depth of staffing, experience, and expertise provides clients with the best solutions and partner available.

“Because no one should have to walk their healthcare journey alone.”

Sally-Ann Polson | President & CEO

ANNIVERSARY 35th

Optimize your healthcare benefits experience now

Are you a self-funded employer, TPA or broker looking for a better solution for today’s workforce?

Medxoom dramatically improves the healthcare benefits experience for your members By unifying all key components of your health benefits Medxoom helps match members with the best price vs quality provid driving greater member satisfaction and cost savings. Medxoom does th hard work of integrating all the disparate pieces of the benefits ecosyste into one member-optimized experience

The Problem

Healthcare coverage is too expensive. Employers are finding it

• 8% Y0Y increases in premiums

• 250% increase in deductibles

WHAT YOU GET?

Ocozzio’s team of self-funded experts use industry knowledge and experience to identify opportunities, solve

problems and generate business. From marketing intelligence and strategy to messaging, execution and reporting,

A complete marketing team working for you. Ready to meet your marketing team? Connect with Ocozzio today. Zach

| 706.922.1912 | zswenson@ocozzio.com

Ocozzio is the marketing department you’ve always dreamed of but never thought you could afford.

A Collaborative Model

That Rises To Meet Your Needs

Phoenix is a modern pharmacy benefits management (PBM) company that provides brokers, TPAs, and self-funded organizations with scalable, individualized pharmacy plans that save money on prescription medications for both the plan and its members.

What Sets Us above the rest?

Open-Architecture Approach

Phoenix uses an “open-architecture” approach to plan design and management. This means you can choose the elements that work best for your needs, and nothing that you don’t. Plus, we’ll implement it in a seamless way that allows for limited member disruption.

Exclusive Pharmacy Network Contracts

We are completely independent and own 100% of our contracts, which means more flexible plan design options and better overall plan management whether you choose an Open, Preferred, or Limited Network.

Honest Rebate Opportunities

Our goal is to eliminate the questions—what drugs are included, when, and how much? With Phoenix, it’s simple: every rebatable drug, every time. Whatever arrangement best suits your needs, we’ll do rebates your way. And we pay out faster than the competition.

Customized, Comprehensive Pricing

Whether it’s a passthrough or a traditional model, Phoenix finds a way to meet your needs and save you money while offering strong plan benefits to members. We take a comprehensive approach to pricing, completely customizing a model that works for you.

Above & Beyond Customer Service

From Implementation to Account Management and Member Services, customer service excellence is integral to our culture. When you partner with Phoenix, you benefit from a relationship that grows your business.

Reinventing pharmacy benefits management

A better way to empower your employees and reduce costs

Prescryptive Health delivers the clinical, operational and customer service you value from a PBM, plus we offer transparent pricing and a health intelligence platform that puts the focus back on what matters most: you and your members.

We believe:

The system is fundamentally broken and the solution must empower patients with transparency, choice and control.

A better pharmacy experience begins in the prescriber’s office – and a prescription is the natural gateway to the care cycle.

The pharmacy ecosystem needs to be rewritten so that incentives are aligned with better financial outcomes for plans and better health outcomes for patients.

What’s different about Prescryptive Benefits?

TRANSFORMATIVE PRICING MODEL

The best partnerships are built on trust. We offer fully transparent pricing, 100% pass-through of rebates, and no hidden fees.

HEALTH INTELLIGENCE PLATFORM

Our secure, HIPAA-compliant platform connects benefit plan information, the patient, and the provider, all at the point of care, enabling better, more informed health decisions.

GUARANTEES AND ACCOUNTABILITY

We act in the best interest of our clients and their members by serving as a named fiduciary for the client’s benefit plan in the areas of formulary management, pharmacy network contracting and management, rebate contracting and payment administration, and adjudicating charges to the benefit plan. We put our fees at risk to hit aggressive financial guarantees for our clients. Contact us to get a member experience demo and free savings

76% of unidentified or unfamiliar calls go unanswered.1 Meanwhile, 90% of text messages are read within three minutes.2

81% of consumers want shopping for healthcare to be as easy as shopping for other services.3

As consumers shoulder more and more of the healthcare costs, the ability to shop will become imperative.

Unstoppable trends and behaviors that demand a better experience

Great teams build great products for those in need. We combine team member expertise and experience to secure advantages for our Clients. RMR provides access to credentialed and certified professionals. - CPC,CIC, RN, MD, & Ph.D, AHIMA, HIT, Nurse Auditors, and Veteran Contracting Officers.

Receiving Healthcare should not bankrupt an individual nor plan. Even more so if the cost of that healthcare is consistently inaccurate and left unchecked. Cost Containment should help, but it needs to become more comprehensive and impactful. We work tirelessly, from all corners of our industry, to increase your CLEAN CLAIM CONFIDENCE to the highest risk areas of your plans. LARGE DOLLAR CLAIMS.

At RMR we understand that our Clients have specific needs. Let’s talk. Now more than ever, it is necessary to stay on top of the changes weaving their way into our industry. In turn, it is our belief that Cost Containment efforts must also evolve to maintain relevance and effectiveness. RMR’s products strive to be dynamic. This ensures both product compliance and relevant results are delivered.

R OCK Y M OUN TA IN R EVIEW

Welcome to Prescription Savings

When you switch to Scripius, you get a full-service Pharmacy Benefits Manager (PBM) that provides cost savings, superior service, and complete access to claim-level data. Plus, we’re so confident your switch will be easy, we give you a first-year savings guarantee and a money-back satisfaction guarantee.

You get the least expensive price tag.

Our five-year average Per Member Per Month (PMPM) cost from 2016-2020 was $66.65, and we haven’t found a lower PMPM in the market.1 PMPM is the most accurate price tag because it includes all your costs: administrative fees, clinical programs, network discounts, rebates, maximum allowable cost lists, and ingredient costs. It’s the real price tag you’re paying.

You get clinical programs that work.

Beyond achieving a high generic utilization rate, our pharmacist team works to save you money in all aspects of your drug spend. Our team secures enhanced rebates and renegotiates network contracts, and they implement clinical programs like our medication management, biosimilars, and opioid management programs. All in all, our programs equated to MORE THAN $54 MILLION IN SAVINGS.

Million

$2.9 Million

$11 Million

Million

$18 Million

$54.7 MILLION

You get agile customizations with speedy market adjustments.

It’s a volatile marketplace and you need a PBM that can make dynamic reactions to surprise price increases and new pipeline medications. While some take 45 days to react to marketplace changes (the time lost can cost clients thousands of dollars), we can often make changes on day one.

You get guaranteed savings in year one.

We are so confident we can save you money that we guarantee it. If you share your data and let us reprice your claims, we will give you a first-year savings amount that we will guarantee. Email GetSavingsNow@Scripius.org to start the conversation.

1 Source: The 2021 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, Adam J. Fein, Ph.D., Drug Channels Institute (March 2021) and Scripius internal data.

Empowering Healthcare Companies

Smart Data Solutions is a strategic partner in healthcare process automation and interoperability that utilizes data and intelligent automation to digitally transform operations and deliver outcomes for our clients which reduce costs, streamline workflows, and improve overall customer experience.

3 BENEFITS FOR TPAS WHEN PARTNERING WITH SMART DATA SOLUTIONS

MAILROOM & DOCUMENT CAPTURE AUTOMATION

INTELLIGENT DOCUMENT MANAGEMENT

A strategic partner to help you better utilize your resources

WORKFLOW MANAGEMENT

Utilize our OneStream Managed Gateway for easier processing of all document types

APPEALS

Our Capabilities CONTACT

MEDICAL RECORDS ENROLLMENT

An industry expert in process automation to help reduce common errors for TPAs

CLEARINGHOUSE

A

A Different Kind Of Pharmacy Benefit Manager

Southern Scripts is a leading pharmacy bene ts manager (PBM) founded by pharmacists to reinvent the traditional PBM approach. Our innovative pass-through PBM model and exible solutions empower plan sponsors to achieve maximum cost savings, decreased risk, and optimum versatility in plan design to achieve true patient-centered clinical care at the lowest net cost.

100% Transparent, Pass-Through Pricing & Rebates

Plan sponsor is charged the exact price the pharmacy is paid. We pass all discounts and rebates that we secure at 100% to the plan sponsor.

All-Inclusive Administration Fee

No additional fees for prior authorizations, step therapy, reporting, ID cards, or any other plan feature/bene t for standard PBM services.

Lowest Net-Cost Approach

Our robust clinical management program and high-performance drug formularies deliver the lowest net cost to protect plans from unnecessary expenses.

Southern Scripts is a proven partner to a growing number of plan sponsors across the nation. We’re helping them drive dramatic results. We can do the same for you.

customer-focused transparent and pass-through approach. A full suite of innovative tools and programs. Significant savings. This is a better way to manage your pharmacy benefits.

Corporate Solutions

You want unparalleled customer service. Employers need the right stop loss coverage. At Swiss Re Corporate Solutions, we deliver both. We combine cutting-edge risk knowledge with tech-driven solutions and a commitment to put our customers first. We make it easy to do business with us and relentlessly go above and beyond to make stop loss simpler, smarter, faster and better. We’re addressing industry inefficiencies and customer pain points, moving the industry forward – rethinking employer stop loss coverage with you in mind.

corporatesolutions.swissre.com/esl

Employer Stop Loss: Limit Health Care Exposure. Advancing Self-funding

SOLUTIONS for Third-Party Administrators

The Transparency in Coverage Rule and No Surprises Act didn’t just create a need for a scalable technology solution that ensures compliance with the mandates, it has manifested a new participant-driven healthcare ecosystem through which your clients and their covered members can greatly benefit.

Are your groups protected today AND equipped for long-term success? TALON’s suite of software services is designed to fulfill ALL transparency requirements, while also capitalizing on the opportunities presented by a rapidly evolving industry.

ASK YOURSELF the Following Questions:

1 Are we providing the appropriate protections and guidance to our clients?

2 Can our system deliver the required shopping experience, including accurate estimates of encounter costs both at plan-level and subscriber level?

3 Are eligibility updates, plan design feeds, consumption accumulators, QPA and Advanced EOBs fully automated?

4 Have we protected ourselves and our clients from costs for accessing and downloading publicly accessible files?

5 Have we architected a compliance solution that scales and will work long-term?

WHY TALON?

Our dynamic platform goes far beyond JUST compliance—providing a streamlined, end-to-end solution for lowering healthcare spend and fostering a happier, healthier, more productive workforce.

Our system creates free-market dynamics, starting with subscriber engagement through alignment of incentives, providing true ROI.

The unmatched digital experience provided by our innovative MyMedicalShopper™ platform EMPOWERS employees to be informed and make smart, economical decisions about their own care.

As an added incentive for choosing low cost, high-quality care, TALON’s patented and intuitive MyMedicalRewards™ program rewards employees through HSA/HRA contributions or gift cards.

TALON seamlessly integrates with any existing system with no distraction or disruption.

TALON protects your clients from overpaying for care, lowering healthcare spend by 20-40%!

THE PHIA GROUP’S SERVICES

Learn Plan Save Protect

The Phia Group is Empowering Plans to Contain Costs Through Comprehensive Consulting, Legal Expertise, Innovative Plan Design, Superior Claim Negotiation & Unrivaled Recovery Services

Learn: Plan: Protect:

Independent Consultation & Evaluation (ICE)

General Consulting & Third-Party Agreement Review

Family & Medical Leave Act - Policy Review & Drafting

Phia Document Management® (PDM) & The Flagship Template

Plan Drafting Services - Including Wraps & SBCs

Gap Free Review® - Including Stop-Loss & Employee Handbooks

Save:

Subrogation & Reimbursement

Overpayment Recovery

Claim Negotiation & Sign-Off (CNS)

Phia Unwrapped - Out of Network Solution

Plan Appointed Claim Evaluator® (PACE)

Balance Bill Resolution & Reference -Based Pricing Support

Patient Defender

Balance Bill SafeGuard

Phone: 781-535-5600

Email: info@phiagroup.com

Website: phiagroup.com

A Trusted PBM Partner with Proven Solutions

Customized Pharmacy Benefit Plans

We create and manage customized pharmacy benefit plans that fit the unique needs of each client. Tell us about your employers’ greatest benefit challenges, and our strategists will design solutions that optimize medications, lower costs, enhance employee health, and minimize disruption.

Exceptional Service Creates Satisfied Clients

Our focus on client communication and patient care helps you retain and gain more clients by delivering an exceptional pharmacy benefits management experience.

ROI Visibility with Quarterly Plan Reviews

Each client has quarterly reviews that show how we fulfilled our savings promise, how many members we assisted, and patient satisfaction scores.

One Team of Experts for All Needs

Every client and TPA has one team for implementation, reporting, monitoring, and ongoing consulting. You’ll have access to the same team for every call and question.

OUR ACCOUNT MANAGERS RETURN CALLS PROMPTLY

97% FIRST CALL RESOLUTION

4.7/5 PATIENT CARE SATISFACTION

Transparent Pricing and Rebates

Our model is designed around integrity. That means no spread in medication pricing and clients receive 100% of manufacturer rebates.

Working With Us is Simple

You’ll have clear contracts, a clinical pharmacist on your team, no-hassle integration, and innovative, proven solutions.

SCHEDULE A MEETING WITH SARAH HOWLETT, MBA, BUSINESS DEVELOPMENT DIRECTOR SARAHH@TRUERX.COM

Make better decisions and reduce costs through data transparency

Vālenz® Health is reimagining what a health plan should be. With our fully integrated Healthcare Ecosystem Optimization Platform and its single point of entry for unparalleled data transparency, we offer deep insights into claim payment precision and a better member experience.

Under the Claim Cost Arc SM , we engage with data early and often, empowering you to make better program decisions that focus on care quality and coordination. The results are reduced costs and the alignment of administrators, providers, payers and members. Together, let’s simplify the complexity of self-insurance and flatten the trajectory of health plan costs for smarter, better, faster healthcare.

WITH VBA’S HEALTHCARE

VBA’s integrated suite of solutions helps payers manage costs, improve population health and respond to changing regulations. When you partner with VBA, your business can run more efficiently so you can stay one step ahead of the competition and be the trusted advisor your clients are looking for.

Technology Solutions for Healthcare Payers

Meet Walmart Health Virtual Care

We

Through

Empowered Members, Lower Plan Costs, Satisfied Clients

At No Cost to TPAs

Approximately 15 million Americans have surgery every year,1 and as many as 50% of those surgical procedures are medically inappropriate.2

Advantages for

TPAs

( No cost (billed to group as a claim)

( Value add

The truth is, when patients hear the word surgery, most never take the time to consider all their options, often leading to avoidable medical expenses. Welvie is changing that.

Welvie My Surgery® is a proprietary six-step online program designed to educate and empower plan members who are considering surgery, arming them with the information needed to make the best decision for their health and well-being. When surgery is necessary, they are guided though the process every step of the way to drive better outcomes and ensure that the benefits outweigh the risks.

Step 1: Get the Right Diagnosis

Step 2: Find the Right Doctor

Step 3: Make a Decision

Step 4: Learn About Hospitals

Step 5: Prepare for Surgery

Step 6: Recover at Home

( Engaged population

( Reduced claims

( Informed decisions

( Happy clients

Proven Results

Savings of $15.00 PEPM on surgery spend.

93% of participants said they were better prepared for their surgery.

95% of participants said they were better informed when speaking to their doctor.

Simplifying benefits for everyone.

We offer the broadest range of healthcare benefits solutions built on the industry’s most modern and reliable technology and supported by our accountable and empathetic service experts.

Our benefits technology supports:

• 33 million consumers

• 408,000 employer groups

• Over 6.5 million HSAs

• Almost 60% of the Fortune 1000

Our service stands apart:

• All customer support centers located in the United States

• Over 94% of our clients renew with us annually

• 90% of employers choose us when looking for better service

• Our proactive approach to service resulted in a decline in customer service support inquiries despite a 23% growth of participants in 2020

We’re recognized as:

• A certified Great Place to Work®

• Winners of the Mobile Star Award

payments innovation

WEX has more than 5,000 associates in 10 countries

WEX is led by Melissa Smith, Chair and CEO of WEX

Web Portal 2.0

MediConnX360, Powered by TALON, is an identically operating native app for iOS and Android, and a web portal unlike any other, providing patients, payers, employers, providers, and brokers with ondemand, all-inclusive access to the data and services they need. That means members are instantly connected – and stay connected – to the industry’s most comprehensive, compliant, and automated benefits administration solutions.

o With MediConnX360 you can:

• Grant on-demand access of machine-readable files and reports to administrative and employer users.

• Distribute information to a large audience, using the integrated announcement feature

Provide directed selling methodologies

o And your members will be able to:

• Utilize price comparison shopping, including quality metrics and innetwork guidance.

• Verify claim payments.

• Access ID cards, Explanation of Benefits (EOBs), and Advanced Explanation of Benefits (AEOBs).

Search physicians linking members with providers.

Securely send messages and attachments.

Manage enrollment, family status changes, and ID card requests.

…and much, much more!

About Us

We believe in a better way to price, explain, and pay for healthcare on behalf of insurers and their members.

As the leading payments company in healthcare, we price, pay and explain healthcare for payers, providers, and healthcare consumers. Zelis was founded on a belief there is a better way to determine the cost of a healthcare claim, manage payment-related data, and make the payment because more affordable and transparent care is good for all of us.

Why Zelis?

We partner with more than 700 payers, including the top-5 national health plans, Blues plans, regional health plans, TPAs and self-insured employers, 1.5 million providers and millions of members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and an integrated pre-payment through payments platform to manage the complete payment process.

Zelis brings efficient, purpose-built solutions backed by a passionate team and agile technology to harmonize the complete payment process in healthcare.

Zelis has been recognized as an INC 5000 Fastest Growing Company annually for the past 11 years, and is a certified Great Place to Work.

REINSURANCE