We manage in the neighborhood of 6.5 gigabytes of pharmacy claims data every day. Individual claim files fuel our platform and generate the savings opportunities for our plans and members. They’re also very personal and private.
Important stuff, to say the least. Here’s how Rx Savings Solutions uses claims data, and how we handle it with care.
Data In
Whether from a client, health plan or the pharmacy benefit manager (PBM) they work with, Rx Saving Solutions receives claims data files through an SSH File Transfer Protocol (SFTP). The SFTP protocol runs on a secure channel, with no clear text passwords or file data ever transferred.
Rx Savings’ policy is to encrypt all claims data both during transit and “at rest” in our secure, back-end storage server, where it lands. From there, it’s fed into our database, where any column containing sensitive information is “hashed” and “salted.”
You may be getting hungry for breakfast now, but these steps typically kill a hacker’s appetite. Different than encryption, hashing makes it impossible—well, extremely difficult—to decode data once it is encoded. Salting adds a random secret value for extra protection against cracking.
Data Out
Claims data feeds usually happen weekly but can be daily or monthly depending on the client, plan or PBM. Whatever the case, claims files are then matched with our eligibility files for every eligible member on a given plan. Once matched, they are fed through our patented algorithms for analysis.
Boom, all the savings opportunities found within the entire group are matched to the individual members, whether they are registered with Rx Savings yet or not. We match those opportunities to every eligible member for whom we have contact information. Then, we send that savings opportunity in the form of savings notifications that are emailed or texted to the individual.
Per HIPAA regulations, the notifications contain no sensitive personal health information (PHI). All PHI can only be viewed in the secure member portal, through a member’s personal, password-protected account.
Our system continually searches for savings opportunities with every fresh claims feed. But a member doesn’t have to wait for the next claims update or a savings alert to arrive. Anytime they’re prescribed a drug, they’ll get the same results by searching for the medication on the portal.
There you have it—the short version of a very long, complex story of how claims data lead to savings opportunities. We’re into simplifying pharmacy, but if you’re interested in more about our data use and security practices, please feel free to contact me.
