Corporate Experience and Technical Capabilities

Our companies have provided technical, policy and analytical data consulting services, conducted educational seminars and developed various educational resources for use in both Medicaid fee-for-service and Medicaid managed care sectors. Specifically, consulting services have been provided in over 20 states to Medicaid agencies, legislative committees, and other governmental entities in the areas of pharmaceutical program management including operational procedures involving claims processing, evaluation of system edits, preferred drug lists, prior authorization procedures, coverage policies, utilization review, drug pricing and reimbursement, and drug and medical expenditure and utilization analysis.

Additionally, consulting services were provided for many states in the areas of clinical and quality outcomes measurement, disease and care management program development and intervention strategies, fraud and abuse auditing, co-morbidity and demographic population profiling, predictive cost modeling, provider profiling and Medicare Part D implementation.

We have provided extensive Medicaid consulting and claims data analysis for over 30+ million covered lives in the states of Alabama, Indiana, Ohio, Florida, Pennsylvania, New Jersey, Virginia, and others. Specifically, we have conducted pharmacy and utilization review, evaluated and recommended cost containment strategies, disease/care management program design and implementation, predictive modeling, disease based expenditure and utilization population profiling, claims payment auditing, provider prescriber profiling, performed drug use evaluations, developed drug protocols and performed other consulting related to pharmacy benefit management operations and policies.