• Specialty Distribution
• PharmaGen
• Emergency Shipment
• GPO Partnerships
• 340B
• Reimbursement Solutions
• Clinical Trial Procurement

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.

Third Party Network

Improve cash flow, boost profits and level the playing field with payers and PBMs through the Third Party Network. We act as a liaison between pharmacies and healthcare plans in negotiating contract terms and rates. Our established relationships with industry partners and knowledge of the intricacies of reimbursement plans allow our members to attain the highest level of profitability. Experienced with the challenges faced by independent pharmacies today, we actively listen to our network of over 1,000 pharmacies and develop responsive solutions to address their needs. With a customized approach to matching our programs to each pharmacy’s unique businesses, we empower our members to stay highly competitive in this rapidly changing industry.

Our members benefit from the following resources:

• A network managed by a pharmacist with over thirty years of industry experience
• Contract database to assist in all negotiations
• Accessible and responsive Help Desk
• Proactive communication of industry developments

Reconciliation

Manage account receivables more efficiently. Reconciliation, available exclusively to Third Party Network members, is a highly effective solution for reconciling dispensed prescriptions. We are the only wholesaler to not only reconcile but also chase outstanding underpaid and unpaid claims. Payments are verified electronically to ensure pharmacies are paid according to the agreed amount from adjudication. Designed with busy pharmacies in mind, the Reconciliation online portal shows the current status of a claim and detailed reports, allowing our members to stay informed at the click of a button.

Reconciliation program benefits:

• Dedicated specialist chases partially paid and unpaid claims
• Accessible reports of your outstanding receivables
• Detailed funds disbursement and aging
• User-friendly online portal with real-time updates

Profit Optimizer

Gain peace of mind and a more profitable operation. Profit Optimizer assists pharmacies in maximizing the revenue potential of each claim dispensed. Our pharmacy-experienced analysts work directly in your system through a secure connection to diligently re-bill erroneous transactions, adjust brand and generic pricing and make other adjustments to maximize future transactions. We handle AWP, billing errors, incorrectly priced drugs and other data issues to minimize time and labor at the pharmacy level. In addition, our process proactively updates settings to prevent future loses.

Profit Optimizer program benefits:

• Dedicated pharmacy analyst working on behalf of your business
• Increased profit margins through proactive analysis
• Maintains competitive and profitable cash pricing
• Re-bills incorrect claims to obtain maximum reimbursement
• Quarterly business reports track increased profits

Power Pre and Post Adjudication

Improve your reimbursements and in-store productivity through our Pre and Post Adjudication services. The increasing volume in third party claims makes it difficult to operate efficiently and receive the maximum payment. We offer an advanced, real-time pre and post editing (PPE) solution designed to increase your pharmacy’s overall profitability by reducing submission errors and optimizing reimbursement amounts.

Power Pre and Post Adjudication program benefits:

• Compliance reviews to ensure accurate reimbursement
• Eliminate input and processing errors that cause negative margins
• Automatic updates of current AWP increasing profits
• Competitive pricing evaluation tools
• Verification of reimbursement against contracts

Medicare and Medicaid Processing

Our proactive and innovative services are developed by on-staff pharmacists and veteran retail pharmacy experts. With specialized processing and billing solutions, we utilize state-of-the-art technologies designed to quickly and seamlessly adapt to customer demands and changing industry needs. This speed and flexibility, coupled with an experienced support and network services team, provides our customers with a significant competitive advantage. Our comprehensive suite of solutions will allow your pharmacy to submit Medicare Part B and most state Medicaid durable medical equipment (DME) claims electronically using your existing pharmacy management system.

Medicare and Medicaid Processing program benefits:

• POS messaging when U & C pricing is below the Medicare and Medicaid allowable
• Patient co-pay and deductible amounts returned at the point-of-sale, when appropriate
• Automatic submission of dispensing and supply fees for eligible products
• Robust viewing and reporting capabilities

Flu and Pneumonia 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. As with our Medicare and Medicaid DME billing solutions, our vaccination billing solution similarly subjects claims to a variety of real-time edits and eligibility checks that significantly reduce denials and maximizes reimbursements. On average, customers that use our solution benefit from a 98% overall payment rate.

Flu and Pneumonia Vaccination program benefits:

• Real time edits and eligibility checks to minimize billing errors
• Electronic billing to reduce payment turnaround
• Integrates with existing pharmacy systems

Electronic Funds Transfer

We understand that your pharmacy works best if PBM reimbursement payments are made in a timely fashion. With Electronic Funds Transfers (EFT) for over 20 PBMs, we help you receive payment faster via direct deposit. Enrollment in Electronic Funds Transfer means checks are no longer delayed or lost in the mail. Many PBMs currently only offer EFT for Medicare Part D reimbursement. Your pharmacy will be enrolled with all of the insurance plans that currently offer EFT, as well as all future EFT plans that become available. Our dedicated support staff will complete all of the necessary paperwork; All you have do is sign!

EFT program benefits:

• Simplified enrollment process
• Faster cash flow
• Automatic enrollment in future EFT programs