Data Analysis of Pharmacy Rejection Claims for a Reimbursement Solutions Provider
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The scope of the internship revolved around the flow and use of information stored in the database of a pharmacy reimbursement solutions provider, STI Technologies Limited. This organization, based in Halifax, started out by offering a new, revolutionary way for pharmaceutical companies to sample their medications. The company has since grown to include patient choice programs, which allow patients to remain on brand medications who have loss exclusivity in the marketplace. The organization also offers services to diabetic supply companies, such as Lifescan, for meter reimbursements for patients, as well as coordination of benefit programs and patient assistance programs for high cost medications, such as Humira®. One of the core responsibilities of the author during the internship was centred on the accuracy and completeness of the information contained in the database. The author used Oracle SQL Developer® to write SQL queries used to insert, update and retrieve information. The author supported the database administrator in her role at maintaining and updating the database as new information became available as well as carrying out quality assurance tasks related to the database. Another core responsibility of the author was the analysis of pharmacy rejection claims. the organization receives between 20,000 to 25,000 rejection claims daily. These claims for prescription drugs are submitted to a third party provider, ESI Canada, by pharmacies throughout Canada. The author was tasked with analyzing the rejection data to meet the ultimate goal of reducing the overall rate of rejected claims. The analysis of the rejection claims generated four solutions for the organization to implement to decrease the rejection rate. The solutions centred on making courtesy calls targeting pharmacies that are generating high volumes of rejection claims. These solution met the needs of the financial department but did not fully meet the requirements of other company members. The author could not explore additional avenues to offset the rejection costs due to the conclusion of the internship.