Using proprietary methodology and indispensable industry knowledge, RJ Health Systems maintains a portfolio of drug information resources that helps health care and pharmaceutical professionals around the world. Our resources provide fast, efficient access to accurate drug/product coding, pricing, and reimbursement information for HCPCS and CPT® coded items, as well as specific Medicare Part B versus Part D benefit coverage criteria, and formulary management tools for injectable and specialty drug products.
Beyond coding and pricing information, we provide CMS updates, coding tutorials, drug reference information, continuous systems enhancements and drug updates that keep our clients current in the evolving arena of drug coding and reimbursement. Continuous, 24/7 access to our websites, guides, and other resources allow health care professionals to code and bill with confidence.
When questions arise, our clinicians and analysts are readily available.
Websites
RJ Health Systems develops drug information websites that support the way our clients operate. As a one-stop destination, the websites offer clinical information and historical data as well as coding and pricing guidance. With our reimbursement code product, our staff has developed the only comprehensive system that uses proven methodology to validate and update the price of each drug code, delivering the most current information available.
With crosswalking functionality, our website makes rapid work of resolving miscellaneous drug codes and matching NDC and HCPCS/CPT® codes. Beyond expediting day-to-day billing operations, the website also helps our health care industry clients with longer-term forecasting, reporting and formulary management. Search functionality allows users to identify a specific code or analyze drug spending by a therapeutic class search.
RJ Health Systems has developed the Part B or Part D website to provide complete Medicare coverage criteria for each drug, as well as guidelines for appropriate billing. The Specialty Drug Management website was designed to address the increasing drug spend on injectables or other medications that require various forms of monitoring. As a web-based management tool, the specialty drug management site provides information on health plan-specific drug policies, prior authorization criteria, procurement guidelines, and other requirements, such as reimbursement guidelines.
Learn more about what we offer:
- Reimbursement Codes
- - Drug Name (generic/brand)
- - HCPCS/CPT® code
- - NDC number
- - ICD-9-CM
- - Therapeutic Class
- - AWP (Average Wholesale Price)
- - WAC (Wholesale Acquisition Cost)
- - ASP (Average Sales Price)
- - APC (Ambulatory Payment Classification)
- - Current and historical NDC AWP pricing per unit and package
- - NDC active/inactive status indicator with inactive date, if applicable
- - APC group and rate
- - Status Indicators
- - Revenue Codes
- - Provides billing and clinical information for drugs new to market
- - Provides FDA and Compendia approved ICD-9-CM information for the HCPCS/CPT® code
- - Provide updated HCPCS and CPT® coding and billing information as well as website enhancements
- Part B or Part D Website
- Link to Medicare Local Coverage Determinations
Search and confirm whether a particular service is covered by the Medicare carrier in the area. - Link to Part B SAD Exclusion List
Search the Self-Administered Drug Exclusion List. - Link to Part D Formulary Finder
Search for plan-specific coverage information. - Link to CMS Prior Authorization and Appeals Process Forms
Have the necessary information in advance to eliminate extra paperwork. - Specialty Drug Management
- - Injectable drug formularies/Preferred products
- - Prior authorization guidelines & forms
- - Policies & procedures
- - Pharmacy & Therapeutics Committee decisions
- - How/where to obtain product
- - Administration services rates and information
- - Customized information by provider specialty
- - Customized information by drug or NDC
- - Customized reimbursement information
RJ Health Systems has established and maintains a database that provides the most comprehensive, trusted, and up-to-date coding and reimbursement information in the industry. This database incorporates the CMS HCPCS and AMA CPT® codes into a system that crosswalks each code with the drug's NDC and brand/generic name.
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Health care professionals have access to updated pricing and coding data on medications, vaccines, toxoids, and immune globulins. The reimbursement website helps provide consistency and eliminates rejected claims, which are a common cause of discord between payors, providers and members. It also helps healthcare professionals contract and forecast with confidence.
Features:
Searchable database by:Sample claim forms for billing using CMS 1500 and UB-04 in various scenarios
Monthly NewslettersDatabase Updated Monthly
The Part B or Part D website guides health care professionals in identifying the appropriate Medicare benefit for billing, which eliminates phone calls and time spent recoding and reprocessing claims. The site determines whether a drug is covered under Part B, Part D, both Part B and Part D, or excluded under both Medicare benefits. Beyond accurate coverage guidance, RJ Health Systems also provides valuable updates and newsletters.
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The website provides information for all drugs (HCPCS/CPT® coded and non-coded) including oral and OTC medications. It encompasses more than 88,000 NDCs and a list of all active and inactive NDCs for each drug, including activation date, if applicable. The Part B or Part D site provides complete coverage criteria for each drug and guidelines to ensure appropriate billing.
Other features include:
To address the increasing drug spend on injectables, RJ Health Systems has developed a web-based management tool that helps health plans inform providers about health plan-specific coverage criteria. This formulary management tool ensures compliance with health plan-specific policies at the time of administration. The Specialty Drug Management website gives providers access to health plan-specific prior authorization criteria, procurement guidelines, quantity limits, and preferred product information.
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Providers can access the information they need in advance to identify preferred drugs to avoid preauthorization requirements. Information can be customized by provider type and by specific drug and/or NDC.
Features include:
Services
Healthcare professionals choose RJ Health Systems for services that extend beyond our drug information websites. We provide custom formulary development and consulting services that work independently or in conjunction with our websites. We are available to research and answer questions about a specific drug code, and we can make recommendations about drug claims to determine if the ulitization and reimbursement were appropriate.
Our clinical staff is also available to offer our forecasting services to validate predictions of future revenues and expenditures for code-related products. We also develop, produce and maintain prescription and drug information products for improving clinical outcomes. Our materials include reimbursement and clinical information for drugs and vaccines administered in the provider’s office, clinic, or home health agency.
Databases
RJ Health Systems understands that health care decisions happen round the clock. We provide continuous access to our drug information databases so that health care professionals can use them 24/7. This information is also available in printed form, in ASCII or Excel format, and through our customizable websites.
We update our databases regularly to reflect the latest drug information and news about our most recent enhancements. Health care professionals will also find links to other useful information.
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