Call Center Services for Commercial Plans

Clinical Pharmacy Services operates a full-service clinical call center for our commercial health plan clients, which we serve through our affiliation with MedMetrics Health Partners, an SXC company.

We reduce the burden on health plan providers who need prior authorizations for their patients — and on the community pharmacists who deal directly with the patients whose prescription coverage is denied. They receive answers quickly when they call our state-of-the-art clinical call center. We make determinations on prior authorization within 24 hours of receiving a request.

Our pharmacy associates receive an average of 150 calls and 100 faxes each day, on behalf of our commercial plan clients. All members of our team are trained to answer these prior authorization requests and claims processing questions — and meet the high standards of our call center.

• Make fast, accurate decisions for both the commercial health plan providers and the community pharmacists who contact them
• Use specially designed algorithms to determine whether prior authorization requests should be approved
• Have extensive preparation and knowledge of all the contracts we service
• Provide excellent customer service to providers and pharmacists

Many of our customer service representatives have prior retail pharmacy experience and so understand the challenges of working with customers, providers, and insurers. Clinical Pharmacy Services provides our call center staff with additional preparation and ongoing training on top of that experience — ensuring that each of our associates is cross-trained and can answer questions pertaining to any of our current contracts.