Payors
P5 Connect offers a comprehensive portfolio of services designed to assist our partners from physician referral to product delivery while maintaining the best adherence and therapy completion rates. All services are managed through the P5 Connect HUB which provides a branded consistent patient and physician service model irrespective of where the medication is delivered from.
Referral Managemt
Referral Services
P5 Connect will work with the Pharmaceutical Company to produce a Referral form that captures the information necessary to get patients started on therapy quickly as well as capturing the information to manage benefits verification and prior authorization process. Referrals are submitted to a P5 Connect dedicated team member to initiate the start of therapy process. Referrals are reviewed immediately to ensure completeness and an acknowledgement of receipt is sent back to the physician. If any information is missing a call is made to the physician’s office to obtain the missing data elements.
Reimbursement Support
Benefits Verification
Our benefits verification team is expert in handling all aspects of insurance coverage and will complete the process for physician, pharmacy, and patient. All outcomes from the benefit verification process are then communicated to the physician and patient to determine product delivery model that is best suited for each patient. In the event the patient needs additional assistance where coverage is limited, one of our experienced team members will assist the patient in selecting the appropriate patient assistance program.
Prior Authorization
We don’t just assist with the Prior Authorization, we manage it. P5 Connect will ensure and follow the prior authorization process from start to finish and proactively manage the renewal process to ensure there are no interruptions in patient therapy. A full database of coverage and criteria for each medication for each insurance is maintained to effectively collect the pertinent information from the physician that will result in higher approvals and quicker turnaround time.
Appeals Management
We support physicians and pharmacies in all appeals. These appeals can occur for either billing issues or prior authorizations. All correspondence with the insurance companies and Prior Authorization process are documented within the HUB to assist in the appeal process.
Payer Benefit
All payer benefit coverage criteria for the medication and therapy is documented in the P5 Connect HUB system. This information is utilized to obtain all necessary data elements prior to requesting benefit coverage resulting in quicker approval time frames for coverage and prior authorizations. We also share the coverage criteria and partner with the Pharmaceutical Medical Affairs division to improve overall benefit coverage for their products.
Billing & Coding Support
We support the billing process for both the physicians and dispensing pharmacies. Our proprietary “How To Bill Document” is sent to the physician’s office for every administration and contains all the necessary information to assist the physician in the creation of the billing invoice.
Additional Services
Patient Assistance Programs
P5 Connect team members are well informed of all programs that will provide patient assistance either through co-pay cards, co-pay assistance programs, free product, samples and/or free trials. In our Benefit Verification process we identify what the patient out of pocket will be per fill as well as the estimated amount out of pocket cost for the benefit year. This provides the patient with the financial information needed to determine if any patient assistance program will be needed throughout the course of the therapy and allows P5 Connect team members to be proactive in finding the patient the financial assistance they need to complete the therapy.
Data Management | Analysis | Reporting
P5 Connect collects robust data from the physicians, patients, payers and pharmacies to produce market intelligence that assists the participants in effectively making business and care decisions. Reports are distributed through our web based reporting tools for easy and quick access.
Web/Mobile Application
Our fully customized mobile application allows a competitive edge: Uninterrupted can improve patient compliance and adherence. Real-time and immediate access to shared: Clinical Care Plans; Medication Therapy Management; Progress Notes; Patient History, Drug Information, Recommendations and Interventions.
P5 Connect offers its clients an opportunity to gain the competitive edge through the use of a fully customizable mobile application that allows uniform direct access and secure information sharing among the pharmacy team, the provider, and the patient. The application provides the tools necessary to engage patients and improve outcomes through increased medication adherence monitoring, side-effect tracking, appointment and refill reminders, as well as education and training.
The application allows uninterrupted quality of care via real-time and immediate access to shared Clinical Care Plans, Medication Therapy Management, Progress Notes, Interventions, and Recommendations. Integration with tablets and smartphones for field work forces like nurse educators and sales representatives enables real time access and interaction on the go.
Sales & Marketing Support
Our inside sales and marketing team can be utilized to support physician sales, provide education through web based and in-person seminars as well as the distribution of marketing materials. We offer concierge services to physician’s offices by assigning a dedicated in house sales/account representative to provide direct support to the physician and their staff.
Adherence & Clinical Services
P5 Connect develops customized adherence programs that centers around the patient needs. Through our risk assessment programs we identify the care plan and patient outreach program that will work best for the individual patient.
Our Clinical programs are designed to manage clinical pathways, therapy management and patient outcomes. All data is reportable and utilized in the communication with the physician and health care team.
Our clinical programs also provide Disease and Therapy educational materials for the patient, family and caregivers. Our clinical staff of Pharmacist and Nurses provide assistance throughout the course of therapy and become an extension of the patient health care team.
Pharmacy Network
P5 Connect works with the Pharmaceutical Company to create the Specialty and/or Infusion pharmacy network that meets their objectives and goals. We provide exclusive, limited and/or open networks