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Pharmacy Receivables & Reconciliation Management
Our services for Pharmacy chains, grocery store chains, mass merchant chains, and independent pharmacies provide comprehensive receivables and reconciliation management backed up by robust software to improve cash flow, reduce write-offs and costs. We take care of all related activities such as electronic claim filing, RA processing and reconciliation, Paper-to-Electronic conversion, claim level reconciliation and follow up.
We are HIPAA compliant and have been processing 835 formats prior to the HIPAA mandated deadline.
Our pharmacy receivables services are backed by robust software, technology, domain expertise, onsite consultants, back office personnel and proven delivery processes.
Pharmacy Receivables Management Services
Processing pharmacy claims:
We receive and process claim files from pharmacies in multiple electronic formats. These are imported into a database after any pre-processing, if required.
RA Processing and reconciliation: When the remittance advice file is received, it is also imported into the system to enable matching with claims received earlier. Since payers use varying formats, business rules are applied to read each file correctly before import. If the Remittance Advice(RA) is received on paper, we do a Paper-to-electronic conversion. Checks are also entered into the PharmTracker system manually. We ensure that the data is reconciliation-ready.
Check - RA reconciliation: Business rules for reconciliation have been built into the system over the last 6 years to identify reimbursement discrepancies. However, all claims don't match with payments resulting in unapplied cash and open claims. Some claims are paid only partially or not paid at all and this amounts to 15 to 20 percent of the claims.
Claim level reconciliation:
Detailed claim-level matching is done by our Research Team using various fields and manual exception processing tools. Exception Reports list out specific claims that have been submitted to the Pharmacy Benefit Manager (PBM) but have only been partially, or not paid. This knowledge allows our representatives or you to follow up with the payer.
Payer follow up: We talk to clients and the PBMs / Payers about mismatches, understand the cause for it, and are able to increase collections as well as reduce unapplied cash to below 1%.
Reporting & Business Intelligence: Standard reports are sent to clients plus custom reports can be viewed on our PharmTracker™ system for analysis.
Document image management: We offer complete document storage and management services using our ImageCADE / TeleFiche technology
Why is Claim level matching important?
If you can match each claim with its check, you are in a position to follow up with the payer, find the cause for denial, re-submit claim. It gives you the opportunity to recover the money.
Don't show unrealistic high receivables in your books. With compliance laws like Sarbanes Oxley and SAS 70, each company is required to report revenue accurately.
Proven improvement in collections of up to 2% which is pure profit.
Claim level reconciliation provides detailed analysis and enables action to reduce write-offs and open claims
Our services include software that can be accessed over the web
We offer compliance with Sarbanes Oxley with requirements for reporting revenue and a well defined, documented process for billing, collections and auditing that is SAS 70 compliant.
Low cost addition of billing and AR follow up staff
Better predictability of reimbursement patterns using payer business rule database
Technology and management systems highly developed to handle complexities of the work and back offices spanning the globe.
Employees with an average experience of over five years in receivablesmanagement, claim analysis follow up.
Advanced IT systems: Our highly tuned process and PharmTracker™ software to support the process enables tracking receivables.