A streamlined, software-based, self-service approach that puts you in the driver’s seat

What is our Core approach?

Core is a streamlined grouping of capabilities that provides a unified view of member data for simpler, more efficient utilization management (UM) with improved outcomes and greater savings.

How does it work?

Core drives out waste by giving you independent control of OnePASM, a single, Software-as-a-Service (SaaS) system that you use directly to integrate your UM strategies, allowing you to avoid duplicate PAs and dosing errors.

Applying consistent and up-to-date review criteria helps capture additional value for medical drugs that don’t require a PA, driving a 3:1 ROI.

What capabilities are included?

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OnePA SaaS platform
(managed by your plan)

Request a demo
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Core claims management
Prepayment review
Medical claim edits

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Standardized clinical policies

Connected for Better

Click to learn more about how Core’s software connects you for better:

Better integration

A seamless platform that offers more oversight and
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  • Better Integration

    The Core offering takes cross-benefit utilization management to the next level — putting you in the driver’s seat

    Core starts with OnePA, a Software-as-a-Service (SaaS) tool that integrates medical and pharmacy drug claims data on a single platform to better execute consistent UM. This unique tool makes your plan’s specialty UM practices and decision making more accurate, efficient and compliant.

    1. Increasing Digitization of Inputs = Healthcare Data Growing at 48% Y/Y,” Internet Trends 2017 Code Conference Presentation: Mary Meeker for Kleiner Perkins, 31 May 2017, via IDC and EMC,© Kleiner Perkins.

Better Optimization

Core helps
alleviate administrative burdens
associated with UM
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  • Better Optimization

    Increase efficiency, reduce costs and improve patient safety — all without overextending your valuable resources

    Core is uniquely designed to relieve operational strain and make your plan’s UM practices and decision-making more accurate and efficient.

    • Achieve greater efficiency through automation and a single digital review platform.
    • Reduce costs by steering members to the most clinically appropriate benefit and the lowest cost drugs.
    • Improve safety by capturing and acting on more accurate
      and complete data.

Better Decisions

Leverage our expertise and technology to
take control
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  • Better Decisions

    Decades of deep clinical knowledge and expertise are baked right in

    Even though Core is self-service, OnePA is continually updated by our clinical and regulatory experts, ensuring you have access to the clinical expertise you need to make more informed, real-time decisions.

    Click the arrows to explore how OnePA can improve your plan’s decision processes and provide much-needed relief for plans, clinicians and patients navigating the PA process.

    Request a demo
  • Better Decisions

    With OnePA, you can:

    Build cases and perform clinical reviews using a single set of clinical criteria

    Saves an average of 20 minutes per case by having clinical criteria and necessary clinical Q& embedded into the software1

    1. ESI Clinical Ops evaluation, examining OnePA system medical drug reviews compared to manual reviews of a clinician referencing clinical policy documents. Without the questions and answer format, reviewers have to consider what is outlined in the document and check against available clinical documentation to make a decision. They also have to take the time to actually document what they’ve reviewed to justify their decision

    Eliminate manual calculations necessary to determine appropriate dosing

    Automated calculations using OnePA are 60x faster than side-of-desk manual calculations.2

    2. ESI Clinical Ops evaluation examining OnePA system calculations (3 seconds) compared to manual calculations (3 minutes), Aug. 2019. Calculations dependent on regimen, clinical criteria and policies.

  • Better Decisions

    With OnePA, you can:

    Accept and approve electronic PAs across benefits and avoid approving duplicate PAs

    1. Medscan 2017 data, cost of Remicade per claim in hospital outpatient setting
    2. 2018 Cost of Humira 40MG/0.4 and 0.8ML PEN 2’S – ESI BoB data June 2019
    3. Estimated waste calculated for Remicade based on 56 day supply (6 annual fills/infusions) $49,100.
    4. For Humira, estimates assume 34 day supply and 10.7 fills per year, approximately $70,670.
  • Better Decisions

    With OnePA, you can:

    Auto-generate process and decision communications to the patient and provider, which drives accountability and eliminates opportunity for oversight

    Lower the risk of regulatory non-compliance with self-service activity reporting

    OnePA includes regular consultation and support on regulatory requirements and system application use.

Better Savings

Capture more value and achieve a
Greater ROI
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    Drive a 3:1 ROI

    In order to help you take full advantage of the software, Core pairs OnePA with our core claims capabilities and standardized clinical policies to optimize your ROI and capture the most savings.

    By not offering these additional capabilities, other SaaS vendors may leave you with dose management savings gaps still to close.


    Core claims capabilities help you capture savings in areas that are often overlooked

    • Align and validate drug units and dosing, as approved during the PA process, for claims prior to billing – this ensures the claim only pays for the approved dose
    • Help enforce FDA guidelines for medical drugs not requiring PA review

    Our solution has driven a 66% increase in provider application of appropriate PA. 75% decrease in claims over recommended dosage.1

    1. Large ESI BoB Client PA data – 2/11/2015 thru 9/30/2019


    Using standard clinical policies can relieve the burden of having to maintain your own policies, and help to drive maximum cost savings1

    • Apply our clinical expertise, rigor and specialist expertise in treating rare and complex conditions
    • Determine medical necessity, validate dosing, and deploy step therapy best practices

If you'd like more information, please contact
[email protected]