Through are affiliate IBSP LLC, we are able to provides a compilation of services, programs and consulting. The original focus was that of PBM Pharmacy Benefit Management) through which Senior Care Associates sought to win the drug management relative to self insurance plans of businesses, unions, municipalities and state. However, Carleton Consulting saw the opportunity to expand into the consulting and TPA (Third Party Administration) industries. As such, IBSP LLC is now fully functional in offering opportunities each of the aforementioned spaces. The services we offer are TPA services, PBM services, consulting services and audit program through which we audit existing PBM's and recapture over expenditures. We are compensated on a contingency basis for these audits as we are with all others.
Third Party Administrator:
Our affiliate IBSP LLC offers a full service TPA platform specializing in partnering with our clients in directly being able to provide customized management programs, suitable to each client's specific needs. Through the utilization of industry leading business practices, software and proprietary tools we are able to not only partner with, but also provide our clients a truly unique and customized experience.
Along with experienced professionals and the industry's most thorough combinations of enhanced multi-lines claim services, we provide clear, straightforward plans, with pre-defined deliverables and well understood expectations relative to how we can aid in achieving your objectives. By creating this partnership, we can fully understand each client's specific needs and challenges, allowing us to create client specific solutions that revolve around those needs.
- Claims Administration
- Claims Auditing
- Claims Management
- Risk Management
- Cost Contained Services
- Utilization Review
- Enrollment and Eligibility
- Online Claims Access
- Cobra and HIPAA Administration
- Customized Reporting Packages
Our Specialized Patient Services outreach program educates members and their physicians so they may make safe and cost-effective prescription choices. In turn, creating a win-win by decreasing plan and member out-of-pocket costs, while increasing wellness and member satisfaction.
Prescriptions are one of the highest out-of-pocket medical expenses for members. Our Rx Outreach Specialists team helps to lower this expense by using our outbound Patient Services Center as the information facilitator to change member and physician buying behavior.
Our Rx Specialists Team proactively reaches out to members taking expensive marketed brand name drugs, and educates the members about less expensive but equally effective alternatives. With the member's permission, the Rx Specialists team then offers to contact the member's physician on their behalf, educating both the member and physician on how to most cost effectively achieve the highest level of sustained health for the member, while saving both the plan sponsor and the member money. This results in generic utilization rates that consistently exceed 80%, and mail order rates averaging in excess of 23%.
Rx Outreach Specialists are creating a new dynamic marketplace alternative as a solution to controlling pharmacy spending. Clinical in focus, our management team, which is physician and pharmacist led, is one of the most dedicated in the industry resulting in generic and non generic alternative conversion rates that are several hundred percentage points higher than the national average.
Rx Outreach Specialists is providing a disciplined approach in helping manage our client's pharmacy benefits. With a non-traditional approach it creates a client base with the highest prescription compliance rate in the industry. Plan and members end up savings on prescription drug costs, service and satisfaction levels increase, and strong prescription compliance drives medical plan costs down. All while respecting a member's choices.
This is a contingency based audit of the Self Insured platform utilized by businesses and entities of all types. We engage in a free preliminary audit wherein we identify (in every case) over expenditures related to the processing, management, adjudication and or reporting relative to self insured platforms. Pharmacy costs can range from 10% to 20% of your total health care expenditures and is expected to grow to 30% by 2020. For busy benefit plan administrators, the decision to not allocate a portion of your limited budget to audit your pharmaceutical benefit is likely influenced by the relative cost of your medical benefit. However, a small error in pharmacy claim pricing can quickly amount to substantial overcharges. Unlike medical claims, an error with pharmacy claim pricing that is refilled repetitively can affect every claim until the fault is found and corrected. Even if you have a pass-through pricing arrangement where your Pharmacy Benefit Manager (PBM) does not add any spread on your pharmacy claims, an honest mistake on the PBM's part in implementing your pricing can inflate your costs. Although pricing errors often result in the most significant overcharges, mistakes also can routinely occur within the benefit implementation, formulary administration and even within standard claim edits and controls. A review of these elements should not be disregarded. If you are a Medicare plan sponsor, then you know the onus is on you to self-audit according to Medicare requirements.