Background 

Since 2007, US-Rx Care has been a leader in pharmacy benefits and risk management, providing fiduciary services to self-insured employees, union trust funds, and health plans. With over 30 years of experience, the company has consistently delivered significant reductions in pharmacy benefit spend (more than 30%-50%) and helped insurance plans achieve higher HEDIS/Stars quality scores, including five – star ratings under Medicare. Their proven programs and solutions support efficient and effective healthcare management for over five million insured individuals. 

Use Case 

US Rx Care engages in file transfers encompassing millions of pharmacy claims and member eligibility records in EDI format monthly. They faced challenges in managing over 1,000 individual workflows for custom files shared with third parties and internal use. Accurate and efficient data exchange was crucial for their operations. 

US Rx Care relied on a third-party vendor for their data file exchange processes. However, accuracy and consistency became recurring issues.  

Enter Astera Solutions 

To address their needs, US Rx Care sought a solution that would enable them to compile, send, receive, and decrypt EDI files securely. They required a reliable method to transfer sensitive data from trading partners while maintaining data integrity and security. 

After evaluating several products in the market, US Rx Care turned to Astera Centerprise and EDIConnect. These solutions leverage the power of EDI functionality and an integration ETL engine, enabling US Rx Care to extract, transform, and generate EDI files within a single platform. This significantly decreased their reliance on third-party applications (TPAs) and alleviated the challenges associated with managing and maintaining numerous isolated systems. 

After implementing Centerprise, Us-Rx Care established a streamlined process from source to destination. Their preferred method of file transfer became Secure File Transfer Protocol (SFTP), allowing them to pull client files from third-party vendor servers or receive files dropped on their servers. These files are then processed through numerous custom workflows within Centerprise to be loaded into their systems. Conversely, data is pulled from their systems, formatted according to third-party specifications, and either dropped on their servers or the third-party’s servers. Centerprise serves as the backbone of these automated processes, ensuring efficiency and accuracy throughout. 

“The ability to allow non-developer staff to set up the workflows and manage the whole process from end to end was the most important goal that we achieved. Overall, the system, is reasonably intuitive though does require some learning to get up to speed and to leverage the many flexible features the system has to offer. The support team has been valuable to provide suggestions and evaluate possibly efficiencies we can take advantage of.”

– Renzo Luzzatti, President at US-Rx Care 

By adopting Astera’s EDI Connect and Centerprise, US Rx Care achieved significant improvements in their data workflows. Using EDI module, they seamlessly compiled and sent EDI files while securely receiving and decrypting files from trading partners while Astera’s ETL capabilities enabled efficient data utilization within their system. This implementation led to enhanced accuracy, consistency, and security in data exchanges, streamlining critical operations like eligibility verification and claims processing.  

The company can now handle the substantial volume of data file manipulations and workflows with ease, empowering non-technical staff to set up and manage the entire process. This reduced their reliance on database developers and freed up resources for other critical tasks.The streamlined workflows and automation facilitated by Centerprise and EDI Connect have resulted in substantial time and cost savings for the company as it eliminated the need for a third-party vendor. US Rx Care gained greater control over their data exchange processes, reducing reliance on external providers and achieving increased efficiency, cost savings, and overall performance.