CPCSI Consulting is a nationwide consulting firm dedicated to the specialized practice of pharmacy compounding. Our professionals include highly skilled doctors of pharmacy trained in the area of compounding as well as in-house attorneys who have committed their practice to defending the rights of independent compounding pharmacies by educating pharmacy owners of their rights and responsibilities when billing third-parties. Together, our team of professionals is prepared to educate, guide and assist you and your pharmacy with any issue or obstacle that may arise when billing third-parties.

Education & Membership Services

Education

Third-Party Billing & Audit Response Education: Our team of professionals has over 25 years of experience and success in properly billing third-party entities for sterile and non-sterile compounds. Let CPCSI Consulting work with you and your pharmacy in acquiring third-party contracts; reviewing and understanding the terms of third-party contracts and manuals as they relate to compounded pharmaceuticals; how to properly bill third-parties within the meaning and terms of the contracts and manuals; and, the proper methods of responding to third-party audits. Even if your pharmacy currently bills third-party entities, let us ensure that your methods are up-to-date and accurate according to the terms of the most recent third-party contracts.

Membership Services

Direct Audit Response Assistance: If you bill third-party entities, you will get audited. Members of CPCSI receive unlimited assistance and guidance on properly responding to third-party audits. As a CPCSI member, you can be assured that your audit response will be justifiably accurate to help prevent third-parties from recouping or withholding your hard earned money. But remember, if you fail to bill properly, your success during an audit diminishes greatly. Become a member of CPCSI and let our professionals guide you through this stressful and sometimes convoluted process to ensure a successful outcome for you and your pharmacy.

Third-Party Contract Review: At CPCSI Consulting, our team has extensive knowledge and experience in working with third-party entities and their contracts. As a CPCSI member, our doctors of pharmacy and attorneys can work with you and your pharmacy to demystify the language and meaning of a third-party contract and help you understand your rights and obligations when working within the terms of the contracts. The professionals at CPCSI will help point out potential pitfalls and potential negotiating points of individual third-party contracts.

Contract Library Database: CPCSI members have access to our extensive Contract Library Database, which allows our clients to get answers to specific questions about contracts our members are currently a party to or contracts our members wish to join. This access allows our members to make educated decisions about which third-parties are right for their pharmacy.

Third-Party Contact Points: Members of CPCSI will have access to our vast database of third-party contacts, including the names, phone numbers, and addresses of key third-party personnel who can assist you and your pharmacy in resolving third-party billing issues.

Litigation Consulting: If you and your pharmacy have conformed to the terms of the contract, billed properly and accurately and adequately responded to an audit request only to have a significant portion of that billing recouped or withheld, talk to CPCSI. Members of CPCSI have unlimited access to CPCSI’s attorneys who can help you identify your options, weigh your alternatives, and discuss how you should move forward.

Legal Referral Services: CPCSI members have access to our network of attorney contacts located throughout the United States giving you an immediate advantage if you choose to pursue legal action. We have worked hand in hand with attorneys in all parts of the country who have significant experience in defending independent pharmacies who choose to fight back. Let CPCSI be your starting point to a successful outcome.

For more information about CPCSI or to contact us, use the link provided below.

RelayHealth is an intelligent network that improves clinical communication, accelerates care delivery and drives cash collections by connecting patients, physicians, hospitals, payers, and pharmacies.

Our pharmacy solutions save time, increase productivity, and minimize claim submission errors built on the foundation of RelayHealth’s Intelligent Network, our state-of-the-art claims processing network offering instant access to payers with efficient and reliable real-time processing.

Value-added services include:

• RxSafety Advisor®
• Electronic Prescription Services
• Pre and Post Editing
• B-ClaimsRx™
• and others which offer editing and reconciliation capabilities that maximize claim reimbursement while supporting patient safety.

Stop erosion of retail market share, enhance competitiveness, and ensure medication compliance with our patent-pending Patient AssistanceRx™, Preferred PatientRx™, and eVoucherRx™ programs.

Enhance decision-making capabilities with AWP Resubmission Services*, Prescriber Data Management Services, and our analytic reporting. These solutions provide actionable business intelligence and tools to improve profit margins and tackle the most prominent issues facing pharmacies today.

Other solutions include Easy340b™, EasyFSA™ , and IntegrateRx™.

For more information about RelayHealth solutions or to contact us, use the link provided below.

EZ-DME

Electronic DME Claims Submission with EZ-DME

Bill, Track, & Reconcile Durable Medical Equipment Claims

Nothing is easier, more efficient, or more cost-effective.

• Eliminate Costly Manual Billing Service Fees
• Submit DME Claims via the Internet or Your Pharmacy System
• Automate Recurring Rentals Billing
• Submit Electronic Medicare Flu Vaccine Claims
• Work Held Claims or Rejects via Secure Internet Site

FDS offers online Durable Medical Equipment (DME) claims processing with EZ-DME® - the most complete and comprehensive choices for online Durable Medical Equipment (DME) billing services available today. DME Billing with EZ-DME helps you to submit claims quickly and accurately. You can use your current pharmacy software to prepare and submit your DME claims—fill and submit a DME script just like a drug script and receive payment in about 17-24 days. Nothing could be easier, more efficient, or more cost-effective. EZ-DME bills all of the Durable Medical Equipment Regional Contractors (DME MACs), state Medicaid programs, and Third Party payors. EZ-DME is a service product of FDS, Inc. We offer a complete electronic Service Bureau using National Council for Prescription Drug Programs (NCPDP) Telecommunications Standards.

If you have a DME billing question and want to know what you can bill or what modifiers you should use, you can call our toll-free support desk and speak with our knowledgeable representatives. EZ-DME interfaces with most pharmacy software packages and can also be used via a secure Internet portal.

Service Highlights

A secure Internet site gives you information about all of your DME claims. Login with your unique user ID and password, and then work any claims that are being held for additional information such as CMNs and facility information.

• Rental Claims - Rental claims are entered into the system once, and then are automatically billed monthly or according to capped rental logic where applicable.
• Secondary Claims - Secondary claims that do not crossover can be automatically sent to the secondary payer once remittance information and patient IDs have been updated.
• Rejections - Rejections from either the front end of the payer or your 835 show up in a queue with additional tips on how to fix the errors. Once fixed, these claims are resent to the payer electronically.
• Reconciliation - Reconciliation of your DME claims is automatic when an 835 is received electronically. Manual payments can also be easily applied for a full accounting of these claims.

FDS, Inc. dba Freedom Data Services® (FDS) is a Service Administrator providing value added services to the healthcare industry in the form of competitive switching services, on-line claim reviews, electronic Durable Medical Equipment (DME) claims processing, market share administration, and pharmacy profitability management. FDS offers professional, comprehensive and affordable solutions to everyday management and the business processes of its trading partners.

Freedom Data Services has developed strategic alliances with wholesalers, buying groups, Pharmacy Benefits Managers (PBMs), pharmacy associations, software vendors, product suppliers, and independent pharmacies throughout the United States. Being wholly owned by a Registered Pharmacist gives Freedom a program perspective that impacts our customer's bottom line.

EZ-DME Online DME Claims Processing

Freedom Data Services (FDS) offers online Durable Medical Equipment (DME) claims processing with EZ-DME® - the most complete and comprehensive choices for online Durable Medical Equipment (DME) billing services available today.

EZ-DME has over twenty years of durable medical equipment billing experience and the know-how to get customers reimbursed quickly for DME claims. Billing durable medical equipment claims is EZ-DME's business.

Submit DME Claims Directly From Your Current Pharmacy Software

Freedom Data Services' On-Line EZ-DME Claims Processing Service allows participating pharmacies to submit DME claims directly from their existing pharmacy management system using standard National Council for Prescription Drug Programs (NCPDP) formats.

Claims are edited and responses are returned, generally, within seconds. Claims processed using EZ-DME generally are paid in about 17-24 days of submission from FDS to Medicare.

• EZ-DME does not just switch claims.
• EZ-DME is not just a submitter.
• EZ-DME will not assume anything pertaining to a claim.

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.

Electronic Prescribing

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.™