Click the buttons below to jump to specific PBM modules.
Aria Membership Gateway extracts and consolidates information across all departments of the PBM, providing plan sponsors with a 360° patient view that enhances critical health/financial decision-making and results in best outcomes.
Aria empowers customer services representatives (CSRs) by providing comprehensive information in a single interface.
Aria empowers plan sponsor staff:
Formulary management requires the coordination of many moving parts in order to meet the unique needs of plan sponsors. At the core of Aria Formulary Management is the capability for users to perform extensive modeling and analytics to land upon the most cost-effective and quality-optimized standard and specialty formularies.
Aria Formulary Management provides:
Aria Utilization Management offers a fully configurable solution to yield the optimal balance of clinical efficacy and cost management strategies.
Key configurable Utilization Management rules include:
Ease of use and configuration allow business users to quickly and effectively implement, test, and productionize changes.
In the marketplace, a pharmacy claims processing is often considered a commoditized and low value-added process. Dated PBM claims engines have fragmented and inflexible subsystems with incompatible data models — and they need to be replaced. Aria Claims Adjudication provides payers with a core transactional process that has is high-value and low-cost.
Aria Claims Adjudication provides users with:
Aria Network & Pricing is a granular, multi-level configurable, and fully integrated module within the Aria platform. Aria Network & Pricing delivers cost management, quality improvement, oversight, and incentive alignment features. This module also facilitates prospective cost and quality modeling for better financial/clinical outcomes.
Aria Network & Pricing provides users with:
Aria PDE & Encounter Management generates PDEs automatically and submits them to CMS. During PDE file generation, Aria performs built-in validation to ensure 99.9999% accuracy on the submitted PDE files. Aria PDE & Encounter Management also provides validation to ensure certain error codes will never be a result on the PDE return file. Examples of such error codes include: 633 GDCB is missing or invalid, must be >= zero, 654 The Brand/Generic Code is missing or invalid. Valid values are ‘B’ for brand or ‘G’ for generic, 703 The DOS cannot be less than the DOB and 704 The DOS cannot be greater than the date of death (DOD) + 32 days.
Aria PDE & Encounter Management provides tools and features to business users to allow adjustment, correction, and auditing of PDE submissions during the process of reconciliation. All errors related to claims processing are actively identified to allow resolution of any eligibility-related errors. All PDE submission and errors are available in real-time to the client through Aria.
Within the Aria platform, claim adjudication is fed by the eligibility engine, which keeps track of the eligibility of members on a “period of eligibility” basis. This includes but is not limited to LIS and SPAP. When updates to enrollment occur, the eligibility gateway engine analyzes the new eligibility updates along with the eligibility on file. In this process, the system identifies any encounters/ PDEs which might have occurred during the eligibility change period and flags any claims that are in question. The system alerts are set up to notify if claim restacking / adjustments are required due to FIR, reversals, or PDE deletions.
CMS currently requires the following for PDE submissions, all of which are available through Aria PDE & Encounter Management:
The frequency of PDE submissions can also be configured within Aria.
Aria Rebate Management is an integrated, comprehensive, and flexible rebate management platform that enables contract setup and maintenance with minimal personnel support.
Aria Rebate Management provides:
Designed with payer staff needs in mind, Aria Rebate Management provides users with the following sub-modules:
The goal of Aria MTM is to empower plan sponsor staff, pharmacists, and prescribers with the needed tools to work collaboratively to produce low cost and high-quality MTM outcomes.
Aria MTM delivers a fully integrated MTM solution that provides the following:
Aria Data Warehouse has been built to meet all user reporting and analytical requirements and is constantly evolving to best meet the needs of users. Aria Data Warehouse can be replicated in real-time or in batch mode from Aria Claims Adjudication and can also be integrated with the client’s downstream systems or data warehouse for any further analytics. We have created specific report models for ad-hoc reporting, which power users can access and run various ad-hoc reports through our data warehouse.
Data inputs include:
nirvanaHealth has unique abilities to support and empower risk-bearing entities through our Aria Pharmacy Care Management capabilities. Aria is uniquely able to integrate medical, pharmacy, and lab data, providing nirvanaHealth the ability to engage physicians meaningfully at the point-of-care by providing actionable intelligence that will lower costs and improve patient outcomes. nirvanaHealth proactively engages physicians at the point-of-care, as well as pharmacists at the point-of-sale, alerting them within their EMR and practice management systems–therein avoiding disruption to their workflows.
Alerts include the following: Generic substitutions, Inappropriate duration of drug treatment, Drug allergies, Clinical abuse and misuse, Inappropriate dosages, Cost savings opportunities, Coverage gap prediction and prescription planning, Drug-Disease Interactions, Over and Under Utilization, Drug-Age Precautions, Drug-Gender Precautions, Therapeutic Appropriateness, Medication Adherence, Star Ratings, Specialty Management, etc.
Additionally, nirvanaHealth provides extensive capabilities to leverage our Aria platform to create and administer disease-focused clinical programs.
Forty-five to fifty percent of the overall US population has at least one chronic condition, and one in four Americans have multiple chronic conditions. This population utilizes approximately 86% of the total US healthcare spend. While pharmacotherapeutic research has produced many novel therapies to reduce the disease burden of chronic conditions, many patients are still unable to control their illness due to prescription and care plan non-adherence.
We believe that engaging and motivating this population to take charge of their health early in their diagnosis will reduce avoidable medical costs significantly. Technology lies at the heart of our solution. Smart-phones, machine learning, and connected devices are reshaping the way people interact with the world, and these same technologies should reshape healthcare. Aria delivers targeted actionable intelligence at all nodes of the care continuum, while continuing to support, educate, and engage patients as a companion in their health journey. Click the Learn More button to discover how the Aria platform drives our Accountable Care Management services.
nirvanaHealth provides members, plan sponsors, pharmacies, and prescribers with the industry’s first cloud-based PBM platform, Aria. Aria Mobile Apps & Portals provides unparalleled access and transparency opportunities for stakeholders collaboratively manage pharmacy benefits.
Aria Apps & Portals provides user-centric web-based tools catered to the specific needs of:
Aria integrates all data, creates a 360-degree member view, derives actionable intelligence, and pushes that actionable intelligence to all care continuum stakeholders within their workflows.
All relevant information is maintained at the same source, ensuring a consistent, up-to-date, and holistic view of them member, including all patient profiles, conditions, treatments, benefit configurations, reports, pharmacy network information, and other data. Role-based authentication allows for full control of all user access permissions. By offering fully customizable access to rich a variety of information, nirvanaHealth is able to grant clients full and uncompromising transparency into all operational, clinical, and financial areas.
Aria’s mobile cloud strategy engages members, plan sponsors, pharmacies, and prescribers to more meaningfully impact cost and quality of care. Our disease-driven member mobile app proactively delivers actionable intelligence and member education, taking into account a patient’s disease conditions and comprehensive medication history. Aria integrates all demographic, medical, pharmacy, and lab data to derive a 360° view of the member opportunities surrounding cost and quality. The personalized health coach provided by our mobile solutions drives constant engagement through gamification, allowing the app to more meaningfully influence consumer behavior. This disease-driven mobile platform encourages members to make intelligent health and well-being decisions, leading to unparalleled member cost reduction and quality improvement. Information accessible through our disease-driven member app includes:
Rewards: Gamification empowers engagement. Members earn points by completing achievable health goals and bonus missions defined through their specific medical conditions, medications, weight, age, and gender. They are consistently engaged for the opportunity to redeem points in exchange for plan sponsor-defined rewards. Through engagement, this rewards program encourages the development of long-term healthy habits. Additional features include multi-layer rewards schedules, leaderboards, and achievement-based badges. Motivate members to collect them all!
Convert “buy & bill” to a value-based and outcomes-driven specialty management model.
Specialty pharmaceuticals continue to contribute significantly to the rise in the nation’s drug costs. Click the Learn More button to discover how the Aria platform drives our Specialty Drug Management services.
Since 2013, the RxAdvance team has been dedicated to disrupting the healthcare industry, specifically in pharmacy benefit management. After 3 years of development, we went live with our first client in 2016 and delivered groundbreaking pharmacy benefit management services. Now that we have proven success year-after-year, we have decided to expand our impact beyond just the PBM industry—onto the payer industry. These two industries alone control the majority of the healthcare spend in the United States, including the $900+ billion of waste generated annually. With our expansion into a new portion of the industry, we have outgrown the RxAdvance name, since it does not accurately capture the scope of our healthcare reach and mission. We are excited to announce our new name and brand—nirvanaHealth. The RxAdvance name has served us well for many years and will continue to do so under nirvanaHealth.