Pharmacy Benefit Management

OPUS-ISM’s Pharmacy Benefit Management (PBM) software provides a highly customizable solution that can handle an unlimited number of coverage plans. The OPUS-ISM PBM system has been designed to address virtually every benefit management function imaginable.  The core features of the system include:

• Online Adjudication Processing of claim and reversal requests for in-house pharmacy systems, large volume chains, and independent network providers.
• Online Maintenance functions that allow users to define and change Formulary and Coverage Structure as necessary.
• Online linkage to centrally maintained membership and eligibility files.
• DUR and Rebate Management functionality.
• Online Help Desk functions that include issuance of Prior Approvals and rejection overrides.
• Processing of manually submitted and indemnity claims.
• Ad-hoc reporting.
• Payment processing that is linked to corporate A/P systems
• Weekly Price and Formulary file update.

In addition to the extensive functionality provided with the OPUS-ISM PBM system, we take pride in our ability to meet your needs by integrating with your existing systems, cost-effectively scaling our system to grow along with your expanding business, and providing a high level of service to ensure that your business operates smoothly and profitably.

For more information about the OPUS-ISM Pharmacy Benefit Management system, contact our Sales team.