Medicare and Medicaid Processing
Achieve Accuracy, Compliance and Support 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
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Patient co-pay and deductible amounts returned at the point-ofsale, when appropriate
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Automatic submission of dispensing and supply fees for eligible products
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Robust viewing and reporting capabilities
Our solutions subject claims to numerous policy, format and eligibility edits to reduce claim denials and maximize reimbursements.
Third Party Network 866-429-7747
[email protected]
Focus on Customers not Compliance
Recover Substantial Revenue
Navigating the ever-changing landscape of Medicare and Medicaid policies can be overwhelming and time consuming. By assisting with policy compliance, we enable you to focus on your customers. Features include checks for coverable quantity and frequency limits diagnosis codes and formulary inclusion.
Solve back-end Medicare and Medicaid claims management challenges with our optional denial management service that features a dedicated recovery agent to work underpaid and denied claims through to final determination. On average, those who supplement our Medicare DME solution with this service achieve a payment rate of 99%.
Features include checks for coverable diagnosis codes, quantity and frequency limits and formulary inclusion.
• Access detailed reports on demand via a secure web site • Review electronic remittance from Medicare and Medicaid for an entire chain or single pharmacy on a daily basis
Determine Eligibility Faster Minimize unpaid claims with real-time eligibility edits that check a patient’s Part B or Medicaid coverage for the product being dispensed at the point-of-sale. Specific edits check for other primary insurance, managed healthcare plans and more.
Simplify the Claims Filing Process Filing Medicare Part B and Medicaid claims should not require working outside standard pharmacy workflow. Using your existing pharmacy management system, our Medicare and Medicaid DME billing solutions simplify the claims filing process with features that include: • Conversion of quantities to Medicare and Medicaid billing units • Up-to-date Medicare/Medicaid allowable amounts Solutions powered by Emdeon®
