Does the “PlanBuilder” module offer commonly used Managed Care controlling techniques popular in Managed Care environments?
Yes. PlanBuilder is the “fill-in-the-blanks” scheme for easily created benefit plans that execute as a fixed algorithm during the adjudication process. The user simply checks off items, marks Y or N, fills in a price or percentage, or marks with an “X” something to be excluded. No mark ordinarily means an included default for the designated drug or procedure. Each plan is unique by the identification that is given to it. TeleCLAIM can literally manage millions of unique benefit plans. There is no practical limit. A benefit plan can be reduced to one individual if need be. Many of the inclusions and exclusions performed by the PlanBuilder may be global in nature for an entire class of drugs. Exceptions may be designated by one of the attached Appendices. These are really lists that exempt a global exclusion or inclusion by providing a list of one or more exceptions to the global control. It can be asserted that the PlanBuilder is an accumulation of innovative techniques that represent a
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