Plan Features
Many "Plan specific" service features are built-in to the PC Pros System:
PC Pros welcomes any custom features suggested and implemented by the PC
Pros customer.
| 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 |
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