Healthcare Benefit Technologies

The art of pharmacy claim auditing.

Leaders in pharmacy claim audit solutions.

EXPERTISE

Decades of experience ensuring claim submission compliance in the PBM, pharmacy, and claims processing industry.

EFFICIENCY

Our analytics engine and audit workflow processes allow clients to find and fix issues before they evolve into potential fraud, waste, and abuse recoveries.

CONTROL

We are not a blackbox that is set and you do not know what is happening. Clients have full control of setting parameters to find and fix discrepant claim submissions.

HBT has been assisting Pharmacy Benefit Managers, Claims Processors, and Health Plans audit pharmacy claims since 2008. Conceived from spreadsheets and a desire to improve document tracking, the ClaimWiseRx claim auditing platform was born. ClaimWiseRx has facilitated the improved oversight of submitted claims within client pharmacy networks to ensure those claims meet health plan, federal and state requirements. Headquartered in Austin, Texas, HBT's team consists of senior level managed care professionals, experienced accredited auditors, and a healthcare compliance officer who have worked at health plans, PBMs, and pharmacies. Being centrally located in the United States enables us to serve our clients in a timely and effective manner. Our platform, expertise, and background uniquely positions us in the design of user-friendly, pharmacy-friendly, efficient and comprehensive auditing solutions for the industry.

Our focus is primarily medium to small PBMs, managers of pharmacy networks, and includes commercial, Medicare, and Medicaid lines of business within retail, mail order, specialty, and long-term care pharmacies.

328317604

CLAIMS AUDITED

23314304

ESTIMATED RECOVERIES

DEPENDABILITY

It is a formidable proposition to meet fiduciary responsibility and proactively manage costs. HBT provides an independent state of the art claim auditing system and professional services tailored to meet the specific and ever-evolving auditing needs facing our clients.

Audit Control
There is no one-size-fits-all for pharmacy auditing. With HBT, you configure audit parameters starting with our standard global edits and may add an unlimited number of client-specific custom edits with just a few keystrokes. Because ClaimWiseRx is a web-based application, work can be done wherever your computer can access the internet. Claim data is analyzed in minutes versus hours to identify discrepancies and find potential error, fraud, or waste.

Streamlined Workflow
Pharmacy audits encompass enormous amounts of data, reporting, and follow-up documentation. ClaimWiseRx integrates and automates every step with our proprietary Pharmacy Audit Case Management workflow. From Desk audits and Onsite audits, global to custom edits, automated letter generation, audit documentation storage, appeals and cost recovery... information is available in seconds.

How We Help You
We know what to look for. ClaimWiseRx was developed by our pharmacy auditors and healthcare compliance experts including industry expertise and insider knowledge to build proprietary algorithms that drive the audit engine. You can trust the accuracy of audit results.

ClaimWiseRx FEATURES

SAS Solution - Work from anywhere. Broad library of edits. Automated notices. Simplified yet quick, accurate, repeatable process. Integrated desktop and on-site audit solution.

Desk Audits - FOCUS

Enables clients to fully administer and manage their auditing program by utilizing the ClaimWiseRx system via the internet hosted on HBT controlled servers.

Desk Audits - RESOLVE

Provides clients with full-service auditing services performed by HBT staff.

On-Site Audits

In addition to offering On-Site Audit services for FOCUS or RESOLVE clients, HBT may perform stand-alone On-Site Audits on a client's behalf.

Edit Design

Our auditors have over 20 years of designing effective edits finding discrepant claims.

Audit Survey

Compare your data with our edits. Let's see your results.

Professional Services

Encompasses ClaimWiseRx training, system configuration and edit support, additional or backup staffing, onsite or investigation audits, and custom development.