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Day specific effective member terminations and additions |
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Duplicate claim and "refill too soon" protection |
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PC Pros Customer specific "mail order" and "walk in" cost structures |
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Formulary, AWP, and MAC pricing structure base support |
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Co-pay and Co-insurance specifics and exclusions |
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Customized "Plan" reimbursement scheduling |
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Complete "paper claim" adjudication procedures |
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Brand vs. Generic and Formulary vs. Non-formulary differentiation |
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Custom edit checking per price ceilings, limitations, restrictions, and exclusions |
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Generic equivalent management procedures |
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Exception rule implementation per individual member |
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Quantity and days supply limitations |
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Special limits and restrictions pertaining to dependents |