Reimbursements are a pharmacy’s primary revenue stream and are continuously challenged, requiring proactive steps to reduce the impact of their compression. Pharmacies must diligently contract with third-parties and ensure payments for the monies they are owed are accurate and timely, while driving process improvements to reduce risk from payer policies and process changes.
Managed Care Services
Managed Care Services offers a full suite of solutions including third-party payer contract negotiation and administration as a Pharmacy Services Administration Organization (PSAO); assistance when Maximum Allowable Cost (MAC) reimbursements are below acquisition; and support when pharmacies face a payer audit. Managed Care Services enables pharmacies to focus on providing patient care and dispensing prescriptions without the burden of contract administrative responsibilities and problem solving.
Reconciliation Complete is an industry-leading, Web-based tool enabling pharmacies to maintain a centralized collections process to better manage their sources and subsequent uses of outstanding third-party payments.
Reimbursement Consulting Services
Reimbursement Consulting Services provides pharmacies with a dedicated advisor to help pharmacies ensure their claims are adjudicated correctly. Armed with industry experience and customized reports for each pharmacy, advisors will coach pharmacy staff on data management, effective adjudication processing and the identification of missed opportunities – all designed to maximize reimbursement pull-through.
Prescription Editing solution is a “real-time” pre-adjudication editing solutions that can help improve third-party payer reimbursements