Processing third-party claims and dealing with insurance companies can be frustrating even for the most experienced pharmacy technicians.
Processing third-party claims and dealing with insurance companies can be frustrating even for the most experienced pharmacy technicians.
Fortunately, there are a number of tools available to pharmacists and techs to make it easier to adjudicate and reconcile prescription claims.
Technicians looking to improve workflow in their pharmacies might consider using one of the following services.
eConcile
FDS Healthcare Solutions’ eConcile service automates the reconciliation process, eliminating the need for paper checks and verifying the accuracy of third-party payments. The tool will also identify unpaid or underpaid claims, reducing the potential for write-offs.
Additionally, eConcile users can view status reports on third-party payers and claims. These reports can be securely accessed through financial software programs installed in a pharmacy or on personal electronic devices.
Currently, 2 versions of eConcile are available, Complete and Auto.
With eConcile Complete, users just need to input their payment information, and then an FDS team will handle the entire reconciliation process.
Users who purchase eConcile Auto will be responsible for processing claims through FDS’ EZ Data Warehouse themselves. The program will then automatically match standard 835 remittance files against claim data, with users handling exceptions and validating check receipts.
FDS will provide assistance to users who are experiencing difficulties with this process.
EnsurePay
Developed by PBA Health, EnsurePay is another automated service that allows pharmacies and technicians to reconcile third-party claims electronically.
EnsurePay works by comparing remittance files submitted by a pharmacy to incoming payments. Once payment has been confirmed, the claim will be electronically reconciled.
The tool also enables users to create reports and monitor payment discrepancies.
Unlike many other claims services, EnsurePay allows its users to manage the process entirely from a pharmacy computer instead of outsourcing the reconciliation to the developer’s system.
Additionally, EnsurePay doesn’t use central pay intermediaries, allowing payments to go directly to pharmacies.
Like eConcile, EnsurePay provides access to a support team that can assist with problems such as incorrect reimbursements or missing payments.
Scriptmax
Innovatix recently launched Scriptmax, a Web-based prescription claim support program and data analytics service available to long-term care, home infusion, mail-order, retail, and specialty pharmacies.
Scriptmax helps to improve the accuracy of the adjudication process, matching third-party payments with adjudicated amounts to ensure that pharmacies receive the appropriate payment for each claim. The tool also flags unpaid or underpaid claims and tracks reimbursement rate discrepancies and transaction fees.
Additionally, Scriptmax performs a number of reviews, including average wholesale price updating, National Drug Code verification, standard dispensing quantity, and Dispense as Written code validation, to verify that all information submitted on a claim is accurate.
Following these reviews, users are able to make the appropriate corrections.
Users can access claim information and reports at any time through the Scriptmax Web portal and also customize which of the tool’s functions they wish to use.