Emdeon Pharmacy Services
A leading provider of electronic solutions to the pharmacy industry, Emdeon provides comprehensive and innovative services for claims management and analysis, electronic prescribing and specialized processing, such as Medicare/Medicaid DME billing. Our expansive offerings provide pharmacy customers with the tools needed to become more competitive, improve patient care and combat inefficiencies and errors that lead to low reimbursement rates.
Specialized Processing Solutions
Emdeon offers a comprehensive suite of services that will allow your pharmacy to submit Medicare Part B and most state Medicaid claims electronically using your existing pharmacy management system. Emdeon Medicare DME and Emdeon Medicaid DME subject claims to numerous policy, format and eligibility edits before being accepted into our system. These real-time edits and eligibility checks can significantly reduce claim denials, and, as a result, maximize reimbursements.
Submit flu, pneumonia and H1N1 vaccination claims electronically to Medicare Part B and commercial payers* using your existing pharmacy management system. As with our Medicare/Medicaid DME billing solutions, Emdeon Flu and Emdeon H1N1 eligibility edits check patient coverage in real time at the point of sale.
Solve back-end Medicare/Medicaid claims management challenges with Emdeon Recovery,™ a denial management service that features dedicated recovery agents to work underpaid and denied claims through to final determination.
Emdeon Adjudicate™ provides assistance in managing patient loyalty offerings, employee plans and discount generic drug programs, as well as other pharmacy programs that require specialty adjudication and/or processing. Services available in this product suite include Emdeon Patient Loyalty solutions and Emdeon Cash pricing and rebate management.
Emdeon’s eRx Network® ePrescribing enables the direct exchange of ePrescribing transactions between pharmacies and physicians through their ePrescribing application. By automating new prescriptions and refill requests/ responses, eRx Network ePrescribing improves the prescription process’ overall efficiency and, as a result, the quality of patient care. Utilizing its Intelligent Routing to determine the most efficient electronic route between pharmacy and physician, eRx Network is able to provide a single route for all refill requests (fax or electronic), regardless of the prescriber’s participation in ePrescribing.
eRx Network ePrescribing is further set apart by a variety of value-added, online self-help and troubleshooting tools. Our real-time script-viewing application allows pharmacy users to view all transmitted refill requests and new prescriptions.
*Contact an Emdeon sales representative to find out which services are available for certain commercial payers.
Claims Management & Analysis Solutions
Emdeon Connect claims switching service provides full access to all third-party processors in the United States via a high-speed, next generation network. Exclusive online tools like Emdeon ScriptView make real-time claim research and processor troubleshooting easier.
Emdeon Edit is an advanced, real-time edit engine designed to increase your pharmacy’s overall profitability by reducing submission errors and optimizing third-party reimbursements. A series of pre/post edits is automatically performed, providing financial, administrative and legal compliance reviews on prescriptions prior to being sent to and received from the processor.
Emdeon CardFinder is an industry-leading, real-time eligibility service that can help your pharmacy save valuable personnel time and, as a result, provide enhanced customer service. A single transaction quickly returns commercial coverage information for more than 220 million covered lives and Medicare Part D coverage information for patients 65 years of age or older.
Emdeon offers two solutions to monitor and track payments of third-party prescriptions. Emdeon Reconciliation Elite and Emdeon Reconciliation Essential easily balance sales and remittance with check information, reporting discrepancies via a user-friendly web interface. Elite includes pursuit of outstanding unpaid claims.
Emdeon Payer Compliance resubmission service is designed to maximize third-party claim reimbursements by helping your pharmacy easily identify, reverse and resubmit claims that have been paid based upon outdated average wholesale pricing (AWP). This automated solution is a value-added service available to customers who utilize Emdeon Connect or Emdeon Edit.
Through Emdeon’s pharmaceutical brand programs, pharmaceutical manufacturers are able to target patient persistency and compliance by delivering to pharmacies real-time, point-of-sale messaging and electronic co-pay offset vouchers. Our revenue-generating programs include Emdeon Voucher on Demand, Emdeon Inform, Emdeon Redeem and Emdeon Print-to-Pharmacy.