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MedHOK’s Pharmacy External Review Solution

Pharmacy External Review Solution

Solution Overview

MedHOK’s Pharmacy External Review is a CMS-compliant workflow solution for processing and tracking IRE cases for Medicare and External Review cases for Medicaid and commercial lines of business. The system tracks and processes out-of-compliance cases and systematically routes them into the IRE/External Review workflow to be auto-forwarded to the IRE/External Review entity for processing. The IRE/External Review module facilitates outbound and inbound cases as well as member-requested reviews. The module allows for key data input and tracking of cases sent to the IRE/External Review entity as well as their decisions, documentation and associated effectuation dates. All IRE and External Review cases are linked to the original appeal to support quick, efficient review of information related to all aspects of the process.

The MedHOK Pharmacy External Review functionality (RxExRM) manages, tracks, and auto-forwards cases to an external review entity and manages and tracks appeals received from the external entity or from the ALJ, MAC, or for Judicial reviews. The solution assists plans in following the external review process and allows plans to document and process any level of external review.

Customers use the solution to:

  • Collect information and generate or upload packet to IRE
  • Follow the external review process
  • Document and process any level of external review

Have You Considered …

With Pharmacy External Review, you may also want to manage related functionalities on one platform to ensure compliance, improve efficiency and productivity, and deliver better quality care. Consider adding these MedHOK solutions:

Medical Appeals
Pharmacy Appeals


Manages cases received from multiple external agencies, and ensures documents are submitted by due dates


One platform, total control. Manage all medical and pharmacy appeals in one system for the ultimate control of workflows, compliance, and documentation


Automate correspondence with built-in letter templates and field mapping to reduce manual entry and ensure compliant action is taken with inbound and outbound correspondence

Request a Demo

See MedHOK’s Pharmacy External Review solution for yourself

Please complete the form and let us know which capabilities you would like to see. One of our demo specialists will contact you to schedule your custom demo.

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