ClaimSecure - DrugClaims

By: ClaimSecure  09-12-2011

When it comes to drug claims management, ClaimSecure matches reach and rigour with speed of service. ClaimSecure’s real time prescription drug system is connected to 99% of all licensed pharmacies across Canada. The ClaimSecure drug management system performs more than 100 checks and edits on every electronically transmitted prescription drug claim before the claim is accepted, adjusted or rejected. The adjudication results are immediately transmitted in real time back to the claimant and to the pharmacy.

Key features:

  • National Coverage – ClaimSecure’s pay direct health benefit card is recognized and accepted across Canada, and we perform real time claims processing using the most advanced adjudication protocols available.
  • Rigorous Standards – ClaimSecure’s drug management system is designed to ensure that member/dependant eligibility, therapeutic choice and cost containment measures are strictly adhered to at the pharmacy level.
  • Concurrent Drug Utilization Review – Before medication is dispensed, the ClaimSecure drug management system evaluates the requested drug therapy online in real time, and checks against patient history, therapeutic duplication, drug interactions, and other risk factors.
  • Speed and Functionality – ClaimSecure’s state of the art system allows drug claims to be submitted directly from the pharmacist. The patient’s history is reviewed and the transaction is approved, adjusted or declined online in real time; within seconds. All transaction data is then stored in the ClaimSecure central data warehouse for reporting, invoicing and clinical analysis.

Flexible plan design options:

  • Generic substitution
  • Preferred provider network
  • Tiered co-payment: brand vs. generic; government vs. private; pharmacy chain
  • Therapeutic price substitution
  • Managed cost formulary
  • Exception coverage
  • Deductibles/maximums
  • Coordination of benefits – private and provincial

Other products and services from ClaimSecure


ClaimSecure - ClinicalServices

It also includes clinical recommendations leading to cost-savings and improved patient outcomes by eliminating unnecessary drug therapies, promoting more cost-effective drug prescribing and avoiding healthcare expenses associated with inappropriate drug use. ClaimSecure’s experienced Clinical team develops, maintains, and refines customized formularies, while complying with the rules and regulations of each provincial prescription drug program.


ClaimSecure - default

ClaimSecure offers comprehensive plan design, claims management, clinical consulting, and claims reporting and analysis solutions for Canadian corporations and health benefit plan sponsors seeking to effectively manage their group health benefit plans. For 30 years, our products and services have led the industry in innovation, technology, rigour, speed of service, cost effectiveness, and client value.


ClaimSecure - DentalClaims

Rigorous Standards – ClaimSecure’s dental claims management system is designed to ensure that member/dependant eligibility, procedure code eligibility, and specific cost containment measures are strictly adhered to within each dental office.