New Medical Specialty Drug for Real-Time Clinical Claim Editing

New Medical Specialty Drug for Real-Time Clinical Claim Editing

The new software application handles the growing healthcare costs, helping the industry to utilize medical specialty drugs effectively.     

FREMONT, CA: Avalon Healthcare Solutions (Avalon), the first comprehensive Lab Benefit Manager (LBM), has launched Medical Specialty Drug Benefit Management software. This new software tackles the healthcare cost, a leading concern for payers. In Avalon, pharmacy costs represent approximately 20% of the healthcare spend, and specialty drugs are projected to make up more than 50% of costs. Nearly half of the specialty drug spend is processed under medical advantage. Prior authorization is an essential tool, but not enough to handle the volume and utilization of medical specialty drugs efficiently. 

Medical Benefit Management Software (MBMS) is cloud-based, which connects to health plans' claim processing systems, providing real-time clinical editing and savings. The core software of Avalon's medical benefits management services is utilized to boost outpatient laboratory services, saving health plans up to 8 to 12% of outpatient lab spend. Now, Avalon has launched a second module to provide clinical claims editing for medical specialty drugs. Avalon's MBMS configures health plan's policies and edits covering excessive units, vial optimization, off-label usage, and more. 

Avalon is a healthcare IT company focused on medical benefits management. The company aims to drive significant savings from health plans for individuals by automating current plan policy adherence. Also, an independent clinical advisory board has developed a series of evidence-based laboratory policies addressing all lab testing categories. The majority of these policies affect high-volume, low-cost services, and are administered via Avalon's real-time medical benefit management software.