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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.


Your Benefits:

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

Our strengths:

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.

 

Related Reading

Case Study: Claims reconciliation and receivables management for a Pharmacy Chain, 73 Kb

White paper: Emerging from the black hole - perfecting pharmacy claim level reconciliation, 45 Kb

Brochure: Pharmacy Receivables Management services, 33 Kb

 
   
     
  Key Facts  
 

No of stores: 400 including a large chain

Claims processed: 1m /month

Collections: $400 million / year

Key Metrics measured: Unapplied Cash, DSO, $ collected, Partial Payments, Revenue Reconciliation, Revenue Enhancement

Technology: PharmTracker and ImageCADE

Reports: Standard and custom online reports

 
     



     
  THE PHARMACY CLAIM RECONCILIATION RESEARCH TEAM

is a group of highly trained and experienced executives who sniff out the reasons for Check and Claim mis-match manually. They research further by even making phone calls to the payer
 
     



     
  Customers Speak  
 
"Since implementing this solution we have been able to reduce our bad debt to an acceptable level and run our business more efficiently.
I believe this solution is a highly effective resource. We've found a partner that understands the retailer perspective and the nature of the business."

    - Assistant Vice President and General Manager of Pharmacy Operations



"We've been able to outsource the tedious task of reconciliation and instead focus our in- house staff on higher-level analysis."

    - Director of 3rd Party Programs

 
     
         
 
 
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