Medical & Pharmacy Benefits Management Application

The management, maintenance, and migration of Benefit Plans are a time consuming, potentially error-prone task that has a direct impact on a PBMs performance. GxCare™ provides key opportunities to automate a majority of the analytical, management, migration, and testing activities associated with Benefit Management and has proven to be 67% faster with an 85% reduction in errors.


Increase in efficiency through the use of Automation


Reduction in errors decreasing performance penalties


Reduction in production errors

Globally Implemented at Fortune 20 Organizations

Product and Managed Services for
  • Automated parsing and building of dependency maps in a database
  • Automated impact report generation for each of SDLC e.g. requirements, code, and QA
  • Integration with tools such as McCabe to generate test cases and provide objective data on code coverage
  • Provides different views for business analysists, dev team. and QA
  • Provides impact in terms of areas such as Medicare and Medicaid
  • Import claim history
  • Create, save, copy, and merge selection scenarios
  • Targeted drug lists with wildcarding
  • Targeted member lists with include/exclude
  • Targeted plan parameters
  • Add random selections for additional breadth
  • D.O adjudication ready output
  • Automated analysis of claim outcomes
  • Direct drill down to root cause claim components
  • Traceability to plan configuration and plan requirements
  • Organize, tag, and track claims by deficit ID
  • Pricing threshold settings limit false positives
  • Pricing comparison/analysis
  • GxCare™ integration
  • Typically a 4-8 week process depending on complexity of claim and benefit data sources
  • Alignment of claim history format
  • Integration with adjudication system
  • Linkage or import of plan data (GxCare™ recommended)
  • Linkage or import of eligibility data (optional)
  • Hosted option available
Claim Selection – Key Features

  • Selection summary
  • Claims by member
  • Claims by drug or category
  • Claims by client or group
  • Formulary coverage
Claim Analysis – Key Features

  • Paid/reject analysis
  • Reject frequency
  • Pricing analysis
  • Claims by defect tag
  • Threshold analysis
Learn More About GxCare™