Leaf Health Maximizes Savings With J-Code Claim Review
Leaf Health’s Clinical Hub maximizes savings on many specialty medications, including Ocrevus. Through J-code review, our clinical team reveals significant saving opportunities for employers and members.
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What is Ocrevus?
Ocrevus is a prescription medication used to treat Multiple Sclerosis (MS). It’s special because it’s billed under the medical benefit as a J-code instead of the pharmacy benefit. Advanced research, development, and manufacturing processes are required to ensure Ocrevus is safe and effective for patients. Ocrevus is difficult and costly to produce, and the sticker price shows as much.
What’s a J-Code?
A J-code is a billing code used in the U.S. healthcare system to identify injectable drugs and certain biological products for insurance reimbursement. These codes are part of the Healthcare Common Procedure Coding System (HCPCS) and are used by healthcare providers when submitting claims to Medicare and other insurers.
Facts on J-Codes
J-codes are essential for accurate billing and reimbursement, especially in outpatient settings.? They are:
? Used to identify injectable drugs, biologics, and certain medical devices.
? Used to standardize billing for medications and treatments across providers and insurers.
? Updated regularly to include new therapies and remove outdated ones.
? Utilized for administering chemotherapy and immunotherapy treatments.
Our Clinical Hub Found 41.39% Savings on Ocrevus Claims
For one client, the Leaf Health Clinical Review Hub revealed savings opportunities for an employer using medical benefits to mitigate provider-billed Ocrevus claims. Through our comprehensive J-code review, and our team’s extensive expertise and support, we were able to deliver significant savings of over $28,000 per claim.
Annual Savings of Over $56,000 for One Client
Discover how much we can save you and your organization. Reach out and we’ll get things started!
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