Claims Processing

The Araya claims processing system provides a flexible, cost-effective and real-time solution for drug benefit administration. The system receives, approves, and denies claims; creates payments to pharmacies and patients; and remits statements and explanations of benefits.

This platform is fully integrated to administer and process claims across all pharmacy providers. Drug interactions, refill too soon, accumulators and dozens of other edits are performed on every prescription regardless of which pharmacy in the network submitted the claim.

The adjudication platform processes over 100 million claims annually. It supports health plans, insurance providers, government programs, and private employers with thousands of benefit design options. It is compliant with the most recent National Council for Prescription Drug Programs (NCPDP) standards and protocols.

The platform is housed in a fault-tolerant redundant data center to ensure that member services are not interrupted by software failure or natural disasters.

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