Programs & Services: Reimbursement Solutions
We negotiate advantageous contracts and provide premium business solutions, responsive service and timesaving resources, enabling pharmacies to increase profitability and remain focused on quality patient care.
- Navitus Quarterly Newsletter December 26, 2011
- Express Scripts Emergency Override Codes April 29, 2011
Medicare Part D Resources
- Medicare Fraud, Waste & Abuse Attestation Statement January 19, 2011
- Prescription Solutions 2010 Fraud, Waste & Abuse Training September 27, 2010
Third Party Network
Our programs enable pharmacies to benefit from streamlined processes and improved profitability. We leverage an experienced team to negotiate competitive contract rates, terms and conditions and to provide reimbursement support. With a customized approach to meeting each facility's unique needs, we empower our 1,000+ members to succeed in the dynamic healthcare industry.
- Free fraud, waste and abuse training
- Proactive industry communications
- Responsive and knowledgeable Help Desk
Manage account receivables more simply. Reconciliation is available to all pharmacies and is an industry-recognized program for claims tracking.
- Electronic verification of payments to ensure correct reimbursement
- Elite chase program to track underpaid and unpaid claims
- Robust reporting tools
Electronic Funds Transfer
With Electronic Funds Transfers (EFT) for over 35 PBMs, we help you reduce lost or delayed checks and receive reimbursements faster.
- Improve cash flow
- Reimbursements for Medicare Part D and a growing list of Commercial plans
- Automatic enrollment in future EFT programs
Medicare and Medicaid Processing
Submit dispensing and supply fees automatically for eligible durable medical equipment through our specialized processing and billing solution.
- Point of sale alerts when U & C pricing is below the Medicare/Medicaid allowable price point
- Achieve accuracy, profitability and decrease bad debt
Flu and Vaccination Billing
Increase pay rates with electronic vaccination claim billing. Our solution enables your pharmacy to submit Medicare Part B flu and pneumonia vaccination claims electronically using your existing pharmacy management system.
Did you know that on average, customers that use our solution benefit from a 98% overall payment rate?
- Increase pay rates and electronic vaccination claims billing
- Simplify the claims filing process through point of sale eligibility
- Real time edits and electronic billing for NDC to HCPCS mapping and fee calculation
This new comprehensive program creates financial efficiencies for independent pharmacies.
- Aggregates daily payments and 835 files into one payment
- Includes all payers that offer 835 files
View and download your 835 files in Excel or as a PDF via a web portal.
- Beneficial for pharmacies whose systems do not support 835 files