Fair Issac Announces Pharmacy PPO Integration Designed to Deliver Savings on Medical Claims

California-based Fair Isaac Corporation, a provider of analytics
and decision technology, announced the availability of the Interplan PharmacyComp Preferred Provider Organization (PPO) in the company’s CompAdvisor(r) medical bill review software. The new pharmacy PPO agreement with Interplan will enable Fair Isaac’s licensed and ASP clients, as well as its outsourced bill review customers, to significantly reduce pharmaceutical costs beyond what state fee schedules currently permit.

By retrospectively applying the Interplan Pharmacy network’s contracted fees to medical bills processed through Fair Isaac’s CompAdvisor and AutoAdvisor(r) software, Fair Isaac can now offer its clients access to discounted pricing on more than 100,000 prescription drugs. Retrospective pharmacy pricing can provide substantial savings in many short-term medical claims in which pharmaceutical savings are typically lost in more common prospective pharmacy claimant card programs.

Pharmacy costs reportedly constitute approximately 7 percent of the total expense in medical bills for workers’ compensation and automobile liability medical injuries.

“Adding the Interplan Pharmacy PPO network is an exciting development for customers of our CompAdvisor and AutoAdvisor bill review software and outsourced services,” said Sean Downs, vice president of Healthcare and Insurance Solutions at Fair Isaac. “For the first time, Fair Isaac can offer access to savings on pharmacy bills that go beyond what has been allowed until now on state fee schedules. Our agreement with Interplan is another way that Fair Isaac is providing unmatched savings and value to help our customers better manage the costs of workers’ compensation and automobile medical injuries.”

Available in licensed client/server and ASP versions, as well as through the company’s Insurance Service Bureau, Fair Isaac’s CompAdvisor and AutoAdvisor software utilizes an array of Fair Isaac software technologies to automate the review of a significant percentage of medical bills without human intervention.

The systems automate the review and repricing of workers’ compensation and automobile injury medical bills to the lowest commonly acceptable amount possible and provides additional preferred provider organization (PPO) medical discounts.

Featuring intelligent scanning and optical character recognition (OCR), and automated decision management through the company’s Capstone(r) workflow software, the combination of Fair Isaac’s advanced imaging, workflow and decision management tools allows for significantly faster, consistent and more accurate bill review.