Group Plan >> Medical Claims Data

ECT has systematic approaches to evaluate rejected claims to confirm appropriate benefit administration, protected class drug claims and/or non-formulary process performance.  These same processes and procedures can be applied to determine if paid claims meet Medicare processing rules including:

  • B vs D
  • Vaccine administration
  • Drugs for transplants, dialysis, ESRD and hospice patients
  • Drugs that are Medicare approved per NHI and manufacturer’s participating in the Part D rebate program
  • Compliance with transition fill policies.