OWCA is expanding our SRPS in-network conversion (Network Enforcement) to include auto no-fault prescription (script) claims. Historically, SRPS been a third-party biller specific to workers’ compensation. SRPS buys workers’ comp script claims from pharmacies at point-of-sale and collects payment from payers. When scripts are found to be for Optum clients, we convert them in-network, adjudicate using client-specific edits and bill the client at their contract rate, just like an in-network transaction.
How clients benefit
Our pharmacy care management clients benefit through increased network penetration, reduction in higher-cost third-party bills and associated collection calls, application of client-specific edits to ensure the medication is appropriate for the claim, cost-savings and improved data capture for clinical oversight.
Expanding to auto no-fault
We are now building functionality to allow SRPS to also buy auto scripts at point-of-sale so that auto clients can realize the same kinds of savings that workers’ comp clients already achieve. This auto expansion incorporates auto-specific regulations, as well as policy-limits that vary state-by-state. Over the coming months, SRPS is expanding existing contracts with major pharmacy chains and independent pharmacies to include auto no-fault claims. This initiative will help to improve SRPS' position in the auto market and benefit our auto clients.
We will roll out the program in New York, New Jersey, Pennsylvania, Michigan and Florida by August 1, 2020. Client participation in the Optum Network Enforcement program with SRPS requires a signed PBM contract, as well as electronic eligibility from the client. Existing auto clients who meet these requirements will have the SRPS expansion turned on automatically. Additional existing and new auto clients can be onboarded once they meet the contract and eligibility requirements.