Managed Care Exclusion Reimbursements

SRX’s automated solutions and experts help identify valuable, drug-based exclusions that enable you significantly increase claims submissions and put dollars back into your facilities.

How It Works

Many facility managers have not fully leveraged the power of managed care exclusions to increase savings on their drug costs. With the power of automation, our customers are able to identify exclusions in real-time, and submit claims that turn into tangible dollars.

Our solution also identifies all drugs needing prior authorization and includes every data point for every medication in one place, enabling billing officers to capture more reimbursements with greater ease.

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Solutions that Save

Areas of Impact
  • Medication exclusions / carve-outs
  • Authorization notifications and reporting
  • Plan performance metrics
Key Program Features
  • Programs each Managed Care contract’s exclusions into the system
  • Creates real-time alerts
  • Flags medications that need prior authorization
  • Monthly reconciliation report lists all billable exclusions
  • Care manager dashboard updates with real-time data
  • Operations dashboards for oversight at facility, regional, or corporate levels

Two operator dashboards deliver high-level oversight and tracking for VPs and C-level officers, providing rich data to inform future negotiations on Managed Care contracts.

Plan Performance Dashboard tracks the following for each plan:

  • Length of stay
  • Per diem cost on medications
  • Number of exclusions being captured
  • Highest cost drugs

Exclusion Tracking Dashboard features:

  • Real-time tracking of Managed Care exclusions
  • Cumulative reimbursement figures


Average Increase in Identified Exclusions

SRX customers who use our pharmacy management service capture even greater savings.

Learn More About Complete Pharmacy Management

More About Managed Care