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Many "Plan specific" service features are built-in to the PC Pros System:
  • Day specific effective member terminations and additions
  • Duplicate claim and "refill too soon" protection
  • PC Pros Customer specific "mail order" and "walk in" cost structures
  • Formulary, AWP, and MAC pricing structure base support
  • Co-pay and Co-insurance specifics and exclusions
  • Customized "Plan" reimbursement scheduling
  • Complete "paper claim" adjudication procedures
  • Brand vs. Generic and Formulary vs. Non-formulary differentiation
  • Custom edit checking per price ceilings, limitations, restrictions, and exclusions
  • Generic equivalent management procedures
  • Exception rule implementation per individual member
  • Quantity and days supply limitations
  • Special limits and restrictions pertaining to dependents
    PC Pros welcomes any custom features suggested and implemented by the PC Pros customer.