This system will enable some Prospective Drug Utilization Review and on-line edits. Improving just one part of a system will generate a positive effect on other parts. Another Congressionally directed action the Department is pursuing is the extension of the pharmacy benefit to Medicare-eligible beneficiaries at two sites beginning October 1999. Planning is underway, however the sites have not been identified to date. Although meeting the standard, it is not good enough.
Several initiatives are underway to improve the timeliness and the efficiency of claims processing.
We will strengthen our timeliness standards for faster payment and require the contractors to pay interest on claims not processed on time. We plan to revise prescriptive government requirements and adopt commercial business practices. This will reduce the number of claims requiring review and the amount of clinical information required. With our managed care support contractors we have identified a number of reforms and one result will be a bottom-up review of the entire system by an independent firm with claims processing expertise. As these reform measures take effect, we expect beneficiary and provider satisfaction to increase, administrative burdens to disappear, and best commercial practices to become widespread.