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, VP of Events and Vendor Relationships
Jordan Lacer, Association Services Coordinator
Sponsorship Guide
A&G Healthcare has been in the payment integrity industry since the 90s–decades of experience, translating to millions of dollars in savings.
We’re dedicated to providing the best in class services within our tangled up healthcare system. With a mix of customizable backend tools and one-on-one personalized support, we’re developing client-driven solutions for:
• Health Plans
• Third Party Administrators
• Self-Insured Organizations
• Unions
• Health Share Organizations
• Re-insurers
The A&G Difference..
We’re more than just a partner in processing, but your advocate. All of our services are backed by customer service, reconciliation, and provider relations team to mitigate the typical headaches of provider pushback.
Adjudication System Integration
We’re partnered with most major adjudication systems such as Eldorado HEALTHpac & Javelina, Ebix Health LuminX, WLT, Cognizant TriZetto, VBA, and more. This means les can be turned around quickly to your own system with the format you expect, as well as minimal to no impact to your existing work ow.
Implementation
We customize each case, so you can be con dent that connectivity will be as smooth and e cient as possible. Leave the heavy-lifting to us so you can get back to what matters most.
The future is getting brighter...
Beacon is a trusted leader in providing health claims management technology solutions for Third Party Administrators. Our cloud-based SpyGlass software suite empowers our clients to process claims quickly and accurately, automate key operations, and administer a wide range of plans to stay ahead of competitive market demands. With Beacon, you benefit from the vision and expertise of a knowledgeable, experienced team managing industryleading technology. Let us help you transform your business and pave a path toward the future.
Rx Concierge
by Candesa Pharmacy Solutions SM
Rx Concierge is our innovative solution to reducing pharmacy claims costs. One that combines firsthand expertise of clinical pharmacists, the knowledge of a large health plan and the power of advanced data.
A brilliant approach to finding guaranteed pharmacy savings
We know how fast the pharmacy market changes with new brands, generics, price increases and the ever-changing pipeline. We also understand Carriers, TPAs, and PBMs have their own formularies and utilization management programs. That’s why we want to partner with you to identify additional savings opportunities. We’ll collaborate closely and can white label our solution to meet your needs and accommodate different funding arrangements.
Clinician-to-clinician approach
Our clinicians identify savings opportunities and provide voluntary treatment insights to providers.
We guarantee a minimum 2:1 return on investment and help improve patient outcomes.
No changes to benefits or formulary
We work with any Carrier, TPA, or PBM, layering on top of your pharmacy benefits.
No member disruption
The clinicians work directly with the patient’s prescriber for a seamless member experience, and all changes are voluntary.
CarelonRx
We’re putting the benefits back into pharmacy
You have a true partner in pharmacy benefits with CarelonRx. We combine new perspectives and deep expertise to create value through cost savings and better health outcomes.
CarelonRx is committed to partnering with you and your members
• Cost management strategies with an eye toward total cost-of-care savings
• Flexible network solutions that eliminate barriers and extend beyond traditional retail and home delivery channels
• New models of member engagement that focus on meaningful connections and patient-centered care
• Proactive programs, leveraging predictive analytics, for managing chronic conditions
• Real-time, self-service reporting and analytics, with actionable insights and product modeling
• Dedicated account management teams, backed by clinical and operational specialists
• Personalized care and best-in-class support for members taking specialty medications, including disease management programs and digital tools
$34B total revenue1
310M pharmacy claims annually2
16M+ members3
third-party administrators
TriZetto® solutions include end-to-end claims processing and administration capabilities to help third-party administrators (TPAs) optimize service, operations and costs. Built in and for the cloud and leveraging the benefits of artificial intelligence (AI), our platforms feature advanced functions, automated processes, integrated workflows and dashboards to help you manage diverse lines of business and their unique challenges while achieving optimal efficiency.
Full cloud-native functionality to transform your TPA business
Integrated automation
Streamlines claims, detects fraud, reduces overhead with AI
protection and compliance with cloud-native solutions
Flexibility and scalability
Supports growth and facilitates personalized service delivery
Healthcare Transparency in Quality & Pricing
The largest and most accurate data available on medical providers and negotiated prices in the USA.
We help payers, providers, plan sponsors, and members identify the best doctors at the best prices by procedure, location, network, or by provider (NPI) or health plan using actual, negotiated rates and unbiased, data-driven quality metrics through user-friendly B2B Web-based platforms or automation inside other applications (business systems or member portals).
Provider Ranking System (PRS)
Compare unbiased provider ranking and cost information by medical procedure or specialty by region or nationally, with individual physician and hospital rankings.
Help members find the best doctors & specialists
Data-driven local ranking offers targeted provider lists to optimize health outcomes, cost efficiency and manage referrals. Build or integrate your network to help members find your best doctors.
Healthcare Pricing Guide (HPG)
The first of its kind user friendly tool from the Transparency in Coverage files (TiC), revealing negotiated prices from all healthcare payers for all services to all medical providers.
Benchmark & negotiate prices or demonstrate value
Revealing massive variability in prices by procedure across different payers and providers, with options to drill down by location, plan, or NPI. Set and negotiate prices in feefor-service or value-based care.
www.DennistonData.com Austin, TX ~ New York, NY
Technology-Enhanced Solutions to Complement Your Dental Strategy
With 40 years of experience in PPO dental network management and advanced, client focused dental solutions, we will customize a plan that complements your dental strategy. Our expanded suite of technology enhanced products supported by our custom reporting, analytics and dentist recruitment will position you for success.
DenteMax’s Product Suite
Commercial Network Lease
One of the largest leasable dental PPO networks in the country.
Loyal dentists with nearly 95% retention rates annually.
Targeted custom recruitment to improve your access and savings.
Stringent credentialing and strong data integrity.
Claims Repricing Services
Automated provider matching and fee schedule assignment to your dental claims prior to adjudication.
Eliminates manual provider match and the need to load provider and fee schedules.
PPO, proprietary and out-of-network options.
Medicare Network Lease
One of the largest leasable dental Medicare networks in the country.
A perfect fit for Medicare Advantage and senior benefit plans.
Modeled after CMS standards.
Monitoring for Medicare sanctions and malpractice.
Front-End Mailroom Services
Let DenteMax electronically scan claims for you.
Eliminate the administrative burden of paper claims.
Secure handling, imaging and conversion.
HIPAA formatting.
A great companion product with our Claims Repricing Services.
Flexible Stacked Networks
DenteMax specializes in developing flexible stacked networks to best meet our clients’ needs.
Network administration and analytics managed by DenteMax.
Turn-Key Discount Card Program
Products designed for those without a traditional insured benefit.
Customizable for your business needs.
Ability to private label.
Negotiable pricing and margins.
Dental-only or Wellness Complete plans, which offer additional discounts on vision, hearing, prescriptions and wellness.
System and Organization Control
(SOC) Reporting
What is SOC?
System and Organization Controls (SOC) reporting options include valuable tools for service organizations. Reporting options include the SOC for Service Organizations (SOC 1, SOC 2, SOC 3), SOC for Cybersecurity and SOC for Supply Chain.
Why do you need a SOC Examination?
Provide trust and transparency for stakeholders. If you continuously receive questionnaires or must be in compliance with customer obligations, a SOC examination can help meet these demands.
Benefits of a SOC Examination:
Û Reduce time and money spent on customer questionnaires
Û Fulfill contractual obligations
Û Monitor your control environment
SOC 2
Do customers rely on my controls for some portion of their financial reporting?
Do customers rely on me to process and safeguard their sensitive data?
Audits of financial statements
Û Provide trust and transparency to stakeholders.
Û Competitive advantage
SOC 3
Û Define scope
Would a simplified SOC 2 report that can be readily shared with others be valuable?
Û Describe system
Û Assess gaps
GRC programs, vendor due diligence
Marketing purposes
Business process and IT general controls related to user’s financial reporting (ICFR)
Personalized solutions for your members’ healthcare journey.
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.
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 Payers, Plans, and Members.
We o er:
• Provider Open Access Program (POAP)
• Curated medical management
• In-depth risk analysis with predictive modeling
• 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!
The Turnkey Solution for Claims Administration
Hi-Tech Health builds claims administration systems that serve TPAs, Carriers, Provider Sponsored Plans, Medicare Advantage, and more.
Series 3000 Features
Auto-adjudicate claims
Make modifications in real time
Load benefits without limitation
Cloud-based software
Perform one screen claims processing
Convert and pay claims in various currencies
Generate reports on demand
Complete Cobra administration And more
Our systems run on the latest technologies and hardware to ensure supportability and speed and to keep our software up-to-date with System Critical Support from all of our vendors.
As a strategic partner, we’re dedicated to scaling our platforms to continue to meet our clients’ evolving needs now – and in the future.
Disaster Recovery Plans
Data Center with Highest Level of On-site Security
people when it matters most
HKM partners with TPAs to build brand and communication strategies that make care solutions more visible, more understood, and more used by members.
We manage the fulfillment, whether it’s 1:1 mailers, onboarding kits, or population - targeted outreach, so your solutions reach the people who need them.
strategy & planning
tailored communication plans
messaging architecture
data planning & activation
data - driven optimization
data integration & tagging
kpi definition & measurement
creative services
brand development campaign tool kits
audience segmentation
data - informed content
trigger - based campaigns campaign reporting
execution at scale
diverse print & mail solutions
precise, compliant processing
rapid, reliable turnaround
peak period capacity
secure production
1:1 personalization
HKM is the behind - the - scenes engine that amplifies your offering. Whether it’s a new virtual care service, a behavioral health partner, or a specialty program, we help you communicate it, promote it, and get people to use it.
Let’s tailor a solution for you!
SCO TT DURHAM CEO
strategic communications from concept thru delivery
CARA BRUCE VP, CLIENT SUCCESS
Subrogation: Solved
Identify every subrogation opportunity.
Intellivo uncovers ALL reimbursement sources for accident-related medical claims to help you secure and increase payments from third parties. Intellivo lets you experience greater peace of mind — and more reimbursements —without the administrative pain.
INTELLIVO IS RELIED UPON BY: 4
largest U.S. Airlines, (including the world’s largest carrier) of America’s Largest Health Plans of the 100 Largest U.S. Employers out of
“You guys find things we never could.”
“This is going to be a game changer.”
“One less thing I have to think about.”
Mphasis Platform++ Transformation Playbook
Accelerating Healthcare Digital Transformation
Mphasis Platform++ drives healthcare digital transformation by modernizing legacy systems, enhancing ef ciency, and improving user experiences across the value chain.
Scope
• Javelina Platform Implementation
• Legacy/Mainframe Modernization
• Cloud Migration & Implementation
• Interoperability Integrations
Outcomes
• Optimized Processes & Improvements
• Auto-Scalable with Cloud Options
• Improved Data Access & Reporting
• API Management for Web & Mobile
• Flexible Pricing: PEPM, PMPM, Per Claim
Scope
• Portals/Mobile App
• Gen AI – Chat/IVR/Telephony
• Fax Digitization – OCR/ICR/NLP
• CRM Implementation
Outcomes
• Self-Service Enablement –Up to 30% Savings
• Faster Resolution Times & Higher Satisfaction
• Evidence-Based Design for Better Adoption
• Reduced Manual Efforts
• Zero-Cost Pricing Models
Experience Digitization
Platform Modernization & Transformation
Transformation
Data, Analytics & IT Value Stream Acceleration
Scope
• KPI-Driven Data Pipelines (Data Lake/Mesh/Fabric)
• AI/ML Analytics
• Cloud-Based Third-Party Integrations
• AI-Driven DevSecOps/SRE Outcomes
• Enhanced Data Liquidity & Access
• Real-Time Cost & Quality KPI Tracking with AI/ML
• Faster External Analytics Sharing
• Zero Downtime Operations
• Business-Driven SLAs
Scope
• RPA-Enabled Back-Of ce (Claims, Billing, Plan Setup)
Manual processes, lack of error tracking, and inconsistent training lead to missed auditing opportunities and prolonged claims settlement times. These inefficiencies reduce provider satisfaction and result in costly delays, highlighting the need for streamlined processes.
Strategic Solutions Elevating Accuracy in Claims Processing
Healthcare payers can significantly enhance claims accuracy through targeted solutions:
Automated Sampling Tools:
Ensure precise, targeted auditing and regulatory compliance.
Structured Training Programs:
Equip processors with the skills to reduce errors and boost accuracy.
Real-Time Feedback Mechanisms:
Facilitate immediate error correction and proactive adjustments.
Streamlined Query Resolution:
Expedite query handling, improving provider satisfaction and operational flow.
Transformational Outcomes for Healthcare Payers
Automation and feedback systems dramatically improve accuracy and minimize costly errors. 20% Boost in Claims Accuracy:
Comprehensive training leads to fewer mistakes, ensuring claims are processed with precision. 15% Fewer Errors:
Processors work faster and more effectively with realtime error corrections. 10% Surge in Productivity:
Discover how operational excellence can transform your claims processing. Visit www.insightpro.ai or call 410-760-2700 to learn how InsightPro.ai can help you achieve higher accuracy, reduce errors, and optimize efficiency.
55 million lives 35 years experience 95% client retention 1,200+ employees
$10.62 PMPM
Savings by clients that switched to MedImpact from other PBMs and implemented our clinical trend management.
88% of clients rated us 9+ on implementation satisfaction
32 years
Our longest client relationship, and still going
25% Of clients have been with us for 10+ years
50% Of clients have been with us for 5+ years
92% of clients rated us 7+ when asked about overall satisfaction
100% scalable
Our claims adjudication platform is infinitely scalable.
Trusted, reliable Independent Medical Review because
medlitix is a URAC-accredited, comprehensive Independent Review Organization that partners with Payers and TPAs to deliver tailored, evidence -based clinical and utilization reviews. Our advanced AI technology and flexible solutions support seamless compliance with regulatory standards while ensuring accuracy, consistency, and quality in every review helping ensure appropriate care is delivered.
With a combination of innovative AI technology and a deep bench of clinical expertise, medlitix enhances operational efficiency, reduces administrative costs and equips your team with accurate, timely, actionable insights for faster and more defensible decision -making.
Solutions for Payers & TPAs
medlitix supports your utilization management and appeals operations with a robust panel of specialists across 100+ medical and allied health disciplines. Clinical & Utilization Review Services include:
Utilization Management
• Prior Authorization – End-to-end services for procedures, medications, and pre -certifications.
• Physician Generalist Reviews – Independent clinical reviews to ensure medical necessity and reduce inappropriate utilization.
• Specialist Reviews / Quality of Care Assessments – Subspecialty insights across areas such as Behavioral Health, Radiology, Orthopedics, and Oncology to identify risks and optimize outcomes.
Appeals Support
• Independent Clinical Appeals – First and second-level appeals with defensible, evidence -based determinations.
• Federal & State External Review Services – Regulatory expertise and clinical rigor for navigating complex appeals landscapes.
• Additional Capabilities – SIU support, DRG Clinical Validation, Pharmacy Reviews, and Gold Card program support to streamline high-quality care delivery.
Contact: Steve Keresztes, M.D. | Vice President Client Services
724.294.8797 | skeresztes@mlxiro.com
Customize Your Ideal Management Solutions
MedVision is a proud partner of multiple provider organizations and networks with nearly three decades of continuous collaboration with key industry leaders.
Our mission is to make your business even better with healthcare solutions strategically designed to maximize every aspect of your workflow. QuickCap 7 (QC7), our proprietary healthcare administrative software, simplifies your complex business processes with powerful and innovative modules.
Let’s Build Something Great Together
QC7 brings together all essential tools into a single comprehensive healthcare administrative solution essential for you and your business. Discover how you can benefit from ingeniously-developed, integrated, and value-based healthcare administration solutions.
Streamline Your Operations with Structured Systems
QC7 brings together all the necessary tools you need to manage your business effectively.
Easily customizable and adaptable to multiple business needs, QC7 enhances your healthcare workflows from start to finish.
Produce consolidated billing statements and invoices across your client base
Set up multiple contracting rates, modified fee schedules, and payment and bonus arrangements
Minimize the under or over-utilization of benefits with a comprehensive referral management system
Empower your members to manage their care better with end-to-end high-risk and high-cost stratification tools
Track and manage provider data your way with customizable credentialing and provider network management tools
Ensure bank transfer accuracy with a fully customizable ACH file generation and prevalidation process
Harness the power of data and make betterinformed decisions with critical cost avoidance, quality, risk, and predictive analytics
A smarter TPA for a healthier tomorrow
Your Voice. Your Rx Benefits. Amplified.
At Phoenix PBM, we focus on amplifying your voice by tailoring personalized pharmacy benefits to meet you and your clients’ unique needs.
Open-Architecture Benefits
Phoenix PBM’s Open-Architecture Approach puts you in control, giving you the voice to design customized pharmacy benefits plans. We listen to your needs and innovate with flexibility to ensure savings, coverage, and satisfaction.
What That Means for You
Brokers:
Get clearer data and solutions tailored to your clients’ goals.
Employers:
Offer employees cost-saving benefits with easy access to affordable medications.
TPAs:
Partner with an experienced team for seamless claims processing and auditing.
TPA Reporting Assistance:
We deliver clear, timely, and actionable reporting to help optimize pharmacy benefits and make informed decisions— without the complexity.
We Helped Clients Save $514M in One Year
Phoenix delivers unmatched savings, with an average plan savings of 22%. We prioritize your needs with customizable solutions and hands-on care, ensuring every dollar works for you.
What Sets Us Apart
Cost: No hidden fees—100% of pharmacy-generated revenue passed to you.
Concern: Proactive data analysis and clinical stopgaps to control spend.
Customization: Open-architecture approach to tailor benefits to your goals.
Customer Care: Personalized, hands-on service for long-term success.
Ready to Use Your Voice?
When we say we’re a different kind of PBM, we mean it. Our dedicated team is here to listen, inform, and ensure your benefits plan reflects your needs— loud and clear.
See How Phoenix Delivered a Client $450k in Savings in One Year
Read the Case Study
Precision Analytics for Health Plan Management
“When every penny counts, we count every penny”
Optimized for TPAs, Healthplans, and Brokers
In-Depth Data Analytics: Uncover deep insights into health plan data to drive informed decision-making
Claim Re-Analysis: Delve into past claims for a thorough understanding and better future strategies
Individual and Multi-tier Modeling: Tailor your approach with versatile modeling options for individual and multi-tier plans
Integrated Medical and Prescription Data: Connect the dots between medical services and prescriptions for a holistic view
Cost Illustration: Visualize expenses many ways, enabling clearer financial planning
Product Services
Analysis Reporting: Comprehensive analysis for a deeper understanding of claim patterns as well as convenient summaries of enrollment and claims
Disclosure Reporting: Essential for TPAs needing detailed stop-loss underwriting data
Plan Modeler: Simulate changes in plans, assessing impact and efficiency
Scheduling: automatically generate reports at specified intervals
Custom Reporting: Build a custom report based on specific needs
Highlights & Features
•Developed in 2005 and maintained in the USA •Fully customizable reporting
•40+ years of collective expertise in self-funded sectors •Unlimited user access
Your Ideal Analytics Partner
Whether you're a TPA seeking comprehensive analytics, a broker in need of indepth insights into health plans, an HMO navigating complex healthcare landscapes, or a Medicare/Medicaid payor aiming for efficiency and compliance, Planwatch is your go-to solution for efficient, data-driven decision-making.
Planwatch
Reimagining pharmacy solutions to provide the care we would want for our loved ones
Prime Therapeutics (Prime) values our mid-market partner relationships and focuses on creating exceptional experiences for those we serve. With Prime, you get targeted, innovative solutions that are designed for your unique needs and built on our Save, Simplify, Support™ approach.
Save: Make medications more affordable
We improve affordability for you and your members through market-leading solutions like trend and pipeline forecasting, innovative clinical programs and customized low-cost formularies.
Simplify: Deliver an easy, transparent experience
We create connections to deliver more efficient care experiences, no matter where your members are in their care journey. Our new PrimeCentral™ mobile app simplifies the experience, delivering timely alerts and allowing your members to easily compare prices — and understand exactly what they’ll spend on their meds.
Support:
Help people achieve better health
We offer a suite of solutions and products designed to serve you and your members across the health care continuum. MyRxView delivers actionable insights and predictive analytics through comprehensive, on-demand online reporting, helping you make a meaningful difference in member outcomes.
Learn more about how we’re uniquely positioned to support you at
Take Control of Your Health Plan Costs
The high-performance, low-noise alternative to PPO medical claims pricing for self-funded health plans.
Model
Reliant Model for Health Plan Savings
While Reference-Based Pricing (RBP) is a good alternative to PPO pricing, for most employers it comes with challenges. With our advanced technology of Intelligent Allowable, combined with the Fair Market Pricing model pioneered in 2010, Reliant provides a comprehensive set of real-world data points, analyzed by both dynamic algorithms and human oversight, supported by adaptive learning and configurable precision. That allows a more nuanced, betterinformed repricing strategy, for consistently fair and defensible pricing. All with a guaranteed 48-hour maximum claims turnaround.
Reliant offers the most sophisticated, flexible medical claims repricing solution in the market for self-funded health plans. Engage us as an open-access network alternative, for all the safety of a network… but with deeper discounts and fewer strings. Or wrap us around your existing network, for out-of-network (OON) and casualty medical bill repricing with a streamlined experience.
Comprehensive Appeals Management
Over 99% of our repriced claims are accepted because of our proprietary methodology. When an appeal does occur, we defend our pricing. 70% of appealed claims are resolved with our original pricing. For the remainder, we facilitate an agreement that works for all parties.
With payers seeking better ways to comply with The No Surprises Act, Reliant offers solutions that simplify NSA navigation. Our automated QPA calculator and comprehensive provider communication assist payers in navigating NSA compliance, backed by experts dedicated to understanding the regulation.
Moving Mountains one claim at a time...
Who We Serve
-Third Party Administrators
-Stoploss Carriers/MGUs
-Self-Insured Companies
Produ cts We Defend
-Code Compliance Reviews
-Single Case Agreements
-Group Wide Contracting
-Clinical Standards of Care Eval
-Specialty Drug Therapy Contracts
-Medical Record Retreival
Wit h Focu ses On
-Large Dollar Claims
-In Network/Out of Network -Inpatient/Outpatient
-CAR- T Therapy
-NICU/ICU
-Trauma Centers
-Burn Unit
-Oncology and Radiation
-Durable Medical Equipment
-Rehabilitation
-Air Flight/Ambulance
-DRG and fee-schedule Validation
-QPA Data Analytics
Jason Nau Vice President -(307) 431-5612www.jason.nau@rm-review.com
We are stronger together...
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.
Something is wrong....
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.
Solution...
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.
-(803) 322-1748www.shana.boley @rm-review.com
At Serve You Rx®, the success of you brings out the serve in us.
As a full-service, independently owned pharmacy benefit manager (PBM) with nearly 40 years of experience, we offer unquestionable flexibility, unwavering quality, and an unrelenting commitment to our clients’ needs. Through our exceptional service and tailored, costeffective benefit solutions, we empower plan sponsors to overcome three critical industry challenges:
Aligning PBM incentives with plan goals for better outcomes
Controlling specialty drug spend through proactive trend management solutions
Delivering unparalleled satisfaction through exceptional, client-centric service
The Serve You Rx Difference
Flexibility
• We are independent and nimble, empowered to say “Yes”
• Our transparent contracts align with your plan objectives
• We work with you to design creative, tailored solutions
Quality
• Our integrated assets, including our call center, home delivery, and specialty pharmacies, are all domestically located, ensuring accountability and savings.
• Proactive trend management contains costs while improving outcomes
• We can effectively implement some plans in 30 days
32%
The average amount that new groups save on their total drug spend by switching to Serve You Rx.
We outperform industry averages 6% overall trend vs 13.5% industry 1 7.8% specialty trend vs 12.4% industry 1
Large enough to deliver savings, small enough to personalize service.
You Centricity
• Service isn’t just in our name –it’s our promise and purpose
• We put you first in everything we do, from plan design to client support
• We integrate with your preferred point solutions
PHARMACY DONE DIFFERENTLY
Our Commitment to Value, Transparency, and Trust
SlateRx is the industry’s first PBX™—pharmacy benefit experience—combining the financial value of a traditional pharmacy benefit manager (PBM) with the concierge service of a pharmacy benefit administrator (PBA). Our clients realize immediate savings that average 15%+ on unit costs alone, and also receive seamless service and seasoned implementation and account teams. Our offering is fully backed by performance guarantees and contractual fiduciary language that gives our clients true peace of mind.
by SlateRx
SlateRx’s unique value begins with the leverage of our partnership with HealthTrust, the industry’s largest sole- source coalition of plan sponsors, then bolstered by truly innovative programs and independent clinical oversight operated by our URAC-accredited Pharmacy and Therapeutics (P&T) Committee. We help your plan optimize the true cost of drugs, the volume and mix of drugs used, and any underlying volatility, leading to a total pharmacy experience you can measure and trust.
Three Distinct Ways
Our Full-Service Model is Different
1 Buying Power –Plain and Simple
In partnership with HealthTrust, your plan gets the buying power of millions of lives, and unique contract terms and protections.
2 Fiduciary Protections Via Contract
Our model provides real risk protection through contractual commitments, aligned incentives, and full disclosure.
3 Custom Clinical Model
True management of utilization through innovative programs and edits, separate from the PBM, under the watchful eye of our URAC-accredited P&T Committee.
Corporate Solutions
corporatesolutions.swissre.com/esl
® Industry-Renowned Protection Against Fiduciary Liability Arising from Final Level Appeals.
Next Level Reference-Based Pricing with Quality Care and Fair Pricing Done Your Way.
STOP LOSS INSURANCE FOR EMPLOYERS SELF-FUNDING
MEDICAL
PLANS
Get the benefits of self-funding medical while managing your risk
Fulfilling promises is what we do. We’re here to help employers fulfill theirs.
Catastrophic claims have continued to rise and we understand the risk this can raise for self-funded medical plans. By mitigating the risk from catastrophic claims with Stop Loss Insurance, employers can focus on funding their plan while giving employees the coverage they deserve.
Why Prudential?
As a direct writing carrier, we hold underwriting discretion and claims reimbursement authority. We are offering Stop Loss Insurance to provide self-funded employers coverage they can count on from a leading financial services company. So you can benefit from our:
Experience
Work with a partner you can trust— for nearly 150 years, the Prudential brand has stood for strength, stability, and innovation.
Security
Rated:
•AA- by S&P
•Aa3 by Moody’s
•AA- by Fitch
•A+ by A.M. Best
Efficient, responsive service
Take advantage of streamlined processes across quoting, onboarding, and reimbursements.
Dedicated distribution team
Benefit from our consultative approach for both new and existing Prudential clients, as we work hand-in-hand with your existing relationships.
Unbundled approach
Choose from flexible policy options to build a coverage plan that works to address the financial needs of each self-funded plan and unique requirements of the business and employees.
Reassurance
When you submit claims for Stop Loss reimbursement, we help ensure you are paying the right amount to serve your employees.
Vālenz Health®
Configurable Solutions
Vālenz Health® is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality and elevate the healthcare experience. The Valenz Health mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz Health engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification.
Featured Solutions
Imaging and Surgical Bundles:
Provide intuitive navigation that ensures the right imaging and surgical care at the right time, allowing members to seek care close to where they live and work, with average travel of 15–60 miles. Achieve an average savings of 55% across 400 procedures with the nation’s largest bundled solution covering all 50 states.
Infusion Therapy:
With the largest covered infusion list, 80% of infusion therapies can be delivered in-home at a savings of 30%–70%. Provide cost-effective, convenient care with in-home delivery nationwide and 65+ infusion centers in 16 states.
Payment Integrity Solutions:
Our clinical bill review solution identifies erroneous in-network charges and achieves significant savings after network discounts. For out-of-network claims, leverage Valenz Market-Sensitive (VMS®) repricing to reduce billed charges an average of 60% with appeal rates of less than 1%.
VativoRx’s proprietary rebate platform enables
Don’t leave rebate dollars unclaimed! Contact
At VBA, we deliver cutting-edge, personalized technology tailored to meet the evolving needs of healthcare payers. Our intelligent solutions provide actionable insights and efficient processes, enabling confident decision-making and seamless operations. With faster, more accurate claims processing and enhanced scalability, VBA is transforming the healthcare landscape—driving meaningful outcomes for your business and the members you serve. Claims and Benefits Administration
VBA
AI VOICE AGENTS FOR TPAS & HEALTH PLANS
Discover the Power of Universal Solutions OUR SYSTEMS
As the health space and government regulations continue evolving every day, turnkey solutions that are comprehensive, proven, and future-facing are not only valuable – they’re necessary.
With WLT Software’s exclusive and proprietary suite of services, our clients are instantly connected – and stay connected – to the industry’s most comprehensive, compliant, and automated benefits administration solutions.
MediClaims
CLAIMS AND BENEFIT ADMINISTRATION SOFTWARE
MediClaims’ administration and processing capabilities encompass a range of benefit and claim types, from Standard Medical, Dental, Vision, and Prescription Drug, to FSA, HSA, HRA, COBRA, Disability, and HMO Capitation.
MediConnX
BENEFITS PORTAL
WLT’s MediConnX web portal provides employers, providers, payers, and brokers with on-demand access to the data and services they need, reducing customer service costs and allowing for dynamic automation of enrollment, member registration, call tracking, and more.
MediConnX360 2.0
MEMBER ENGAGEMENT PORTAL
MediConnX360 2.0 is our advanced web portal, providing the same services found in MediConnX, but with increased performance, benefits, and features, including comprehensive transparency compliance and a price comparison tool. MediConnX360 2.0 is powered by Healthee, an industry leader in providing healthcare solutions.
WLTlytiX
ADVANCED DATA ANALYTICS TECHNOLOGY
WLTlytiX is a powerful analytics platform that helps track trends, predict claims costs, and enhance cost containment strategies. With real-time data access, customizable reports, and seamless integration, it’s built to transform how you manage benefits.
Scale your Business with a Unified Member Experience
zAnalytics Unlocks Insights for Action
Our visual dashboard offers actionable strategies for informed decision-making for TPAs like you. The zAnalytics Reporting Suite provides personalized insights through customizable reports and enhances heathcare management choices
Pain Points Solved
• Cost Containment
• Technology Integration
• Client Retention & Acquisition
• Boosting Operational Efficiency
zAnalytics Reporting Suite Highlights
• Claims data reports
• Plan use analysis
• HIPAA compliance reports
zAnalytics Highlights
• Identification of cost and risk drivers
• Dynamic cohort building
• ROI tracking to measure intervention effectiveness
zAnalytics Case
Study Results
• $20 Million savings in Rx
• 67% members increased PCP visit
• 13% decrease in ER usage
zConnect: Unified Member Experience
Predictive analytics and algorithms to identify gaps in care, cost drivers, risk drivers, etc.
Use data driven technology & CRM to personalize member experience and interactions
Digital assistant available 24/7 to support members in their day to day queries, issues and easily connect to human touch
Intelligence
Pro-actively promote appropriate behaviour e.g. close gaps in care, make PCP appointments, use alternative places of care
Predictive analytics and algorithms to identify gaps in care, cost drivers, risk drivers, etc. Nudges
zConnect Cost Estimator Tool Solution
• zConnect is a dynamic, embedded multi-touch mobile provider search tool configurable to any plan design and network design
• zConnect allows members to search and compare the prices for healthcare services at different places of care based on contracted network negotiated rates
Modernizing the Healthcare Financial Journey
Why Zelis?
As your partner, Zelis isn’t just a solution—it’s your edge. With deep expertise in healthcare financial solutions, we bring innovation and expertise to transform complexity into clarity, costs into savings, and clients into champions. With Zelis, you’ll deliver holistic healthcare solutions that don’t just work. They shine.
But it’s not just about results. It’s about establishing yourself as the trusted solution clients rely on time and time again. And that’s exactly what we’re here to help you do.
Unlock Simplicity, Savings, and Seamless Operations
We empower you with tools and strategies to help simplify operations, optimize resources, and elevate member engagement—strengthening our value as a trusted partner.again. And that’s exactly what we’re here to help you do.
Build Better Networks
• Network Design, Analytics and Pricing
• Contract Modeling
• Open Access Pricing
Engage Members
• Care Concierge
• Price Transparency Tools
• Enrollment Materials and ID Cards
• Providers Directory
• Incentive-Based Care Programs
Send and Receive Seamless Payments
• Provider (B2B) Payments and EFT
• Provider Enrollment and Verification
• Data Recovery Services
• Member Disbursements (B2C)
• Premium Payments (C2B)
Optimize Claims Management
• Market-Based, In-Network, and Out-of-Networking Pricing Payment Integrity Services
• Expert Claims Review and Editing
• Negotiations and Settlement`
• No Surprises Act (NSA) Compliance
Orchestrate Communications
• Claims Communications
• Letters, Annual Notices and Invoices
Additional 2025 Sponsors
P-n-T Data Corp.
Sponsorship Guide
– A –
Audit/Actuarial/Financial
GBQ Partners LLC 24
– C –
Claim System Development/Management/Support
4L Data Intelligence 4
AbsenceSoft 94
Beacon Technologies Group 10
Cognizant 18
Hi-Tech Health 28
MDI NetworX 38
MedVision Inc. 44
P-n-T Data Corp. 95
Smart Data Solutions 64
WLT Software 86
Zelis 92
Cost Containment/Large Claims/Catastrophic
Claims Management
4L Data Intelligence 4
AMPS 94
Amwins Group Benefits 8
Cognizant 18
Hines & Associates 26
HPC 32
Intellivo 34
Javelina from Mphasis 36
MedWatch, LLC 46
Reliant Health Partners 56
Rocky Mountain Review 58
TALON 68
The Phia Group, LLC 70
Valenz® Health 74
Vativis 76
VativoRx 78
VBA 80
zakipoint Health 90
Zelis 92
– D –
Data Analytics
AbsenceSoft 94
AMPS 94
Denniston Data Inc (DDI) 20
Hines & Associates 26
Javelina from Mphasis 36
MedVision Inc. 44
mPulse 95
Planwatch 52
P-n-T Data Corp. 95
Rocky Mountain Review 58
TALON 68
VBA 80
Xevant 88
zakipoint Health 90
– M –
Marketing
HKM Direct Market Communications 30
Medical Management/UR/IRO/Disease Management
A&G Healthcare 6
medlitix 42
MedWatch, LLC 46
Personify Health 48
ProPeer 95
Valenz® Health 74
Sponsorship Guide
– P –
Pharmacy (PBM/Consulting/Audit/Services)
Agadia 94
AMPS 94
Amwins Group Benefits 8
Candesa Pharmacy Solutions 12
CarelonRx 14
MedImpact 40
Phoenix Benefits Management 50
Prime Therapeutics 54
Serve You Rx 60
SlateRx 62
Vativis 76
VativoRx 78
VytlOne 95
PPO/Network Provider
DenteMax 22
Hines & Associates 26
– R –
Referenced Based Pricing
Denniston Data Inc (DDI) 20
HPC 32
Personify Health 48
The Phia Group, LLC 70
Valenz® Health 74
Zelis 92
– S –
Software Development/Support
4L Data Intelligence 4
AbsenceSoft 94
Agadia 94
Beacon Technologies Group 10
ClearCost Health 16
Cognizant 18
Hi-Tech Health 28
MDI NetworX 38
MedVision Inc. 44
Office Ally 95
Planwatch 52
P-n-T Data Corp. 95
Smart Data Solutions 64
VBA 80
Voicegain 84
WLT Software 86
zakipoint Health 90
Specialized PPO Networks: Chemo, Dialysis, Premie Baby, Transplant, etc.
