How it Works
We have developed extensive processes and technology to manage pharmacy billing for clients of varied scale.
While physical documents are scanned in the US, data capturing, processing reconciliation and AR follow up is done in our offices in India.
We process paper and electronic pharmacy claims and also the remittance advice (RA) in NCPDP or 835 format into PharmTracker™ , Tranquilmoney's AI backed solution for reconciling pharmacy claims with RAs / checks, enabling 100% matching of the two. This allows follow up of the unpaid or partially paid claims. Our system also talks to many Enterprise Pharmacy Systems (EPS)
Why is Claim level matching important?
Matching each claim with its check/ RA allows identification of unpaid or partially paid claims (15 to 20 percent of claims). This enables re-submission of claims to the Insurance payor.
Show realistic receivables in your books. With compliance laws like Sarbanes Oxley and SSAE TYPE II, each company is required to report revenue accurately.
Key Benefits
- Proven improvement in pharmacy collections of 2% within 3 months and up to 99.9% collections on adjudicated claims
- Reduce write-offs, open claims using Claim level reconciliation and detailed analysis
- Better predictability of reimbursement patterns using payor business rule database
- Our highly tuned process and AI backed PharmTracker™ software enables accurate tracking
- Compliant with Sarbanes Oxley with requirements for reporting revenue
- SSAE TYPE II compliant well-defined processes for billing, collections and auditing
- Low cost addition of billing and AR follow up staff
PharmTracker™ - AI backed software to manage Pharmacy billing
Our proprietary web-based solution for pharmacy receivables management. It addresses reconciliation of checks with corresponding payment, application of payments to claims, exception processing, reporting and compliance with laws.
- Auto matching of claims and payments
- The software integrates with electronic switch data and data feeds from POS systems including Condor, TechRx, PDX, QS1, Renlar, MPS, etc.
- The high end functionality allows easy identification of rules used by each payor for each retail pharmacy client.
- The technology follows Deming's principles of workflow management and accountability