Prescription Benefit Management
Prescription Drug Card Program — Administration & Reporting

Administrative Services and Billing

Administrative Services

Universal Rx's provides customized Administrative and Financial support for all of our Clients; Employers, TPAs, Brokers or Consultants.

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General Administration


Claims Processing

Claims Processing Office and Pharmacy Help Desk

Below are the Universal Rx procedures for processing and payment of prescription claims:

  • The member goes to the pharmacy to fill a prescription.
  • The pharmacy submits the claim to Universal Rx through one of the major switching companies.
  • The system processes the claim in accordance with the client’s benefit parameters.
  • The system immediately informs the pharmacy of prescription approval, co-pay amounts required to be collected from the member at the point of sale, and the amount of the pharmacy reimbursement.
    • The claims adjudication process takes approximately 0.41 seconds to complete
  • Once the system notifies the pharmacy of this information, the pharmacy fills the prescription and collects the member’s co-pay amount.

Account Management Teams

Account Management

Universal Rx provides each client with Account Management Teams comprised of Managers in the areas of Accounting, Customer Service, Plan Design, Contracting and Business Development are assigned to oversee each account.

Our Account Management Teams maintain a 99.8% success rate of incoming calls answered before a call goes into wait mode. This means only 0.2% of incoming calls experience a waiting time before their call was answered. The average wait time for this 0.2% of incoming calls is 14 seconds.




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Third Party Adminstrators (TPAs)

In today’s industry, it is common for groups to have third party involvement. Universal Rx is accustomed to coordinating and providing data such as eligibility, claims utilization data and reporting to other sources assisting in the administration of the group’s plan.


Third Party Administrators

Eligibility

Universal Rx offers access to real time eligibility lists through an online reporting warehouse to TPAs and their Clients.


Plan Design

Universal Rx provides TPAs with information pertinent to the group’s plan design. This information includes co-payments, deductibles, maximums, covered and non-covered items, day supply limits, mail order pharmacy information, diabetes management program information and information pertaining to the EPS program.


Reporting

Currently Universal Rx offers both TPAs and their Clients online access to approximately 60 different reports. This ensures data is readily available when needed.


Claims Utilization Data

Universal Rx provides prescription benefit data which is integrated with medical data for a more inclusive review of the plan’s performance.


Invoicing

Universal Rx provides invoicing to the TPA every two weeks. These invoices are also provided to any other parties requested by the group.


Data Support

Universal Rx realizes sharing such valuable information allows all parties involved to closely monitor the success of the overall plan design. Data is provided in formats such as:

  • Secured Email
  • FTP server
  • Fax
  • Expedited delivery

HIPAA Compliance

Universal Rx has long made it a practice to safeguard the confidentiality of the personal health information of its clients’ members. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 has advanced this effort by implementing privacy standards throughout the healthcare industry.

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Universal Rx Executive Management Offices

URx Verical Logo

Universal Rx
710 3rd Street
Roanoke, VA 24016

(540) 777-7179 — Phone
(540) 777-7184 — Fax
Monday - Friday, 8:30am - 5:30pm EST / EDT

Executive Staff

President: Jan Sessor
Phone: (540) 777-7179 Ext 101    Email: sessor@universalrx.com

Director of Operations: Jeni Cameron
Phone: (540) 777-7179 Ext 102    Email: cameron@universalrx.com

Director of Business Development: Holly Hodges
Phone: (540) 777-7179 Ext 106    Email: hodges@universalrx.com

Director of Accounting: Lisa Tomlinson
Phone: (540) 777-7179 Ext 103    Email: tomlinson@universalrx.com

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