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Case Study
US-Rx Care Uses Astera to Efficiently Manage High-volume Data File Exchanges with Multiple Third Parties.
Background
Since 2007, US-Rx Care has been a leader in pharmacy benefits and risk management, providing fiduciary services to self-insured employees, union trust funds, and health plans. With over 30 years of experience, the company has consistently delivered significant reductions in pharmacy benefit spend (more than 30%-50%) and helped insurance plans achieve higher HEDIS/Stars quality scores, including five – star ratings under Medicare. Their proven programs and solutions support efficient and effective healthcare management for over five million insured individuals.
Use Case
US-Rx Care engages in file transfers encompassing millions of pharmacy claims and member eligibility records in EDI format monthly. They faced challenges in managing over 1,000 individual workflows for custom files shared with third parties and internal use. Accurate and efficient data exchange was crucial for their operations.
US-Rx Care relied on a third-party vendor for their data file exchange processes. However, accuracy and consistency became recurring issues.
Enter Astera
To address their needs, US-Rx Care sought a solution that would enable them to compile, send, receive, and decrypt EDI files securely. They required a reliable method to transfer sensitive data from trading partners while maintaining data integrity and security.
After evaluating several products on the market, US-Rx Care turned to Astera. These solutions leverage the power of EDI functionality and an integration ETL engine, enabling US-Rx Care to extract, transform, and generate EDI files within a single platform. This significantly decreased their reliance on third-party applications (TPAs) and alleviated the challenges associated with managing and maintaining numerous isolated systems.
Profile
US-Rx Care is a trusted leader in pharmacy benefits and risk management, delivering cost savings and improved quality scores for 30+ years. Empowering healthcare plans with efficient solutions for over 5 million insured individuals.
Industry
Healthcare
Use Case
Using Astera, US-Rx Care was able to extract, transform and generate EDI files within a single unified platform.
Results
By bringing data file exchange in-house by leveraging Astera, US-Rx Care achieved transformative efficiency gains, empowering non-technical staff while reducing reliance on external resources.
After implementing Astera, US-Rx Care established a streamlined process from source to destination. Their preferred method of file transfer became Secure File Transfer Protocol (SFTP), allowing them to pull client files from third-party vendor servers or receive files dropped on their servers. These files are then processed through numerous custom workflows within Astera to be loaded into their systems. Conversely, data is pulled from their systems, formatted according to third-party specifications, and either dropped on their servers or the third-party’s servers. Astera serves as the backbone of these automated processes, ensuring efficiency and accuracy throughout.
By adopting Astera, US-Rx Care achieved significant improvements in their data workflows. Using EDI module, they seamlessly compiled and sent EDI files while securely receiving and decrypting files from trading partners while Astera’s ETL capabilities enabled efficient data utilization within their system. This implementation led to enhanced accuracy, consistency, and security in data exchanges, streamlining critical operations like eligibility verification and claims processing.
The company can now handle the substantial volume of data file manipulations and workflows with ease, empowering non-technical staff to set up and manage the entire process. This reduced their reliance on database developers and freed up resources for other critical tasks. The streamlined workflows and automation facilitated by Astera have resulted in substantial time and cost savings for the company as it eliminated the need for a third-party vendor. US-Rx Care gained greater control over their data exchange processes, reducing reliance on external providers and achieving increased efficiency, cost savings, and overall performance.
Authors:
Vaishnavi Padmanathan
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