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Area firm to audit insurance claims

A Western New York-based drug consulting firm specializing in prescription benefit management will review 8.4 million prescription drug insurance claims for a Pittsburgh business group to ensure compliance with its prescription drug program.

Williamsville-based Arxcel will conduct the audit of 165,000 people under a three-year contract with the Pittsburgh Business Group on Health. Arxcel beat out four other firms to win the deal.

The consulting firm will ensure the details of the drug claims comply with the program, including the pricing of the drugs, the application of eligibility requirements, the use of copayments, and the inclusion or exclusion of certain items. It will also provide the Pittsburgh group with an overview of the program's financial performance and the health of its members in high-cost categories, while evaluating the agreement and business practices of the program's current pharmacy benefits manager.

The Pittsburgh Business Group is a coalition of 66 companies with more than 1 million employees, dependents and retirees and more than $3 billion in health care expenditures. The drug program serves employees of member companies.

Arxcel is a national drug benefit consulting firm that works with self-funded employers, health insurers and third-party administrators to control costs, design plans, analyze data and audit operations.


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