WORKS
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REVERIFY
A simple 4-step process that provides deep, electronically-generated patient insurance verification that compares end of year coverage to new year coverage, which then pushes those patients with changes to the top of the list for completing appropriate approvals, as necessary.
UBC PATHWAYS
HOW IT
UBC Pathways Reverify will help prevent your patients from having a lapse in therapy due to an insurance coverage change that may occur during typical re-enrollment periods.
BEGIN
1
STEP
A listing of all patients is extracted from your patient support program (a.k.a. hub)
2
STEP
All patients will have an electronic benefit verification completed that will identify aspects of the patient’s coverage near the end of the calendar year.
3
STEP
As the calendar year changes, PBMs load the eligibility files and benefits from their customers (payers).
UBC Pathways Reverify will run benefit verifications on all patients and will pull the same information as shown previously in step 2.
Our unique algorithms will then do an appropriate comparison of the pre/post calendar year information, looking for specific changes in eligibility and coverage.
When a specific change (for example, change in member ID) has occurred, this then triggers the specific patient to be pushed to the top of the list for additional review. Patients with no change are moved to the bottom of the list.
Reverify 13,000 patients at the beginning of the year to avoid abandonment / withdrawals
Determine if the patient has federally-funded or commercial insurance coverage
Reduce number of bridge / temporary free goods
4
STEP
STUDY
CASE
RESTART
UBC Pathways Reverify
Yields Efficient and Effective Annual Reverification Results
Needs
1
Challenges
2
Historical processes would have taken:
Client was asking for a significant improvement in time and cost to execute
Solution
3
UBC Pathways Reverify delivered a 60% improvement
Prioritize ~3% of patients with known coverage changes to enable PA work to be completed first
Reduce number bridge/ temporary shipments by 57%
Reverification effort completed in 2 weeks total time
PBM name, plan and/or group name, member ID, coverage type, payer type
Eligibility Information
Pay amount, PA required, coverage alerts
Drug Specific Benefit Information
Assemble Patient Database
Electronic Benefit Verification 1
Electronic Benefit Verification 2
Automated Identification
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60 Resources
6 Weeks
Instead of 60 FTEs only 20 were needed
Reduced time to complete the reverification by 4 weeks
TM
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Restart
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RETURN
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UBC PATHWAYS
TM
REVERIFY
|
Efficient and Effective
Annual Reverification Results
for more information
Connect with UBC to Learn More
Connect with UBC to Learn More