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.
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CPCSI: A Division of Freedom Pharmaceuticals
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
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.
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.
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Workers’ Compensation with ServRx is More Profitable and Easier Than You Think!
ServRx™ was founded by veterans of the pharmacy claims processing industry. Our executive team has collectively overseen processing in excess of $3 billion in workers’ compensation and commercial prescription claims over the last decade. We have experience working with many different types of clients including independent pharmacies, compounding pharmacies and regional chains. Since its inception in 2008, ServRx™ has expanded significantly, processing claims with thousands of payors throughout the country. While the company continues to grow, our mission remains the same: ServRx™ works closely with each client to develop solutions that maximize the revenue cycle and improve access to medications for injured workers nationwide.
ServRx™ is a leading electronic prescription claims processing and management company. We partner with pharmacies to develop customized electronic solutions that are designed to accelerate the revenue cycle. Many claims processing companies rely on antiquated technology and IT infrastructure. ServRx™ uses the most sophisticated IT systems in the industry, allowing our clients to benefit from real-time adjudication.
ServRx™ Customized Solutions Offer Many Benefits to Clients:
- Increased revenue and profits.
- Decrease non-compensable claims volume.
- Minimize risk, short pays and losses.
- Decrease staff costs
- Implement patient and payor specific clinical edits.
- Customer Care Center
- No co-pays or out-of-pocket costs for your patients.
- Real-time online claims adjudication.
- Fast and free pharmacy setup with ServRx™ BIN.
Diversification is Key:
PBMs continue to put downward pressure on reimbursements for independent pharmacies, especially in the Compounding segment. In the past, pharmacy owners have either contracted with third party billers that stifle workflow and allow claims to be heavily discounted by PBMs; others have limited their Workers’ Compensation volume, or even decided not to take it at all. In the face of a changing and increasingly hostile payor environment, both within workers’ compensation and beyond, you owe it to your business to talk to ServRx™ today about maximizing your opportunity in workers’ compensation.
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Reconciliation and Tracking of Third Party Reimbursement
ReconRx is a state of the art third party claims reconciliation program that tracks payment at the transaction (claim) level. ReconRx ensures payment to your pharmacy in the amount promised at the time of adjudication. Payment is directed to your pharmacy so ReconRx will not impede cash flow.
Cash flow is paramount in independent pharmacy. More than a reconciliation program, our system is designed to actively pursue money due from third party payers up to 15 days BEFORE any other reconciliation program. Whether payment is partially paid, late or lost, our services enhance your cash flow. We secure your money faster and make sure it resides in your bank account and available for use when you need it.
- Save time
- Enhance cash flow
- Recover money
- No software to install; no specific software needed
- User-friendly website
- No research fees
- Aging report available 24/7
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AutoRx, A Mitchell Pharmacy Solution
What we do
We allow pharmacies to process prescriptions related to auto accident injuries and get guaranteed payment. With over 4 million prescriptions processed, AutoRx is the largest and most advanced processor of auto related pharmacy transactions in the US.
We make it easy for patients injured in auto accidents to fill their related prescriptions at a pharmacy of their choice. AutoRx enables pharmacies to electronically process and bill No-Fault / PIP auto claim prescriptions - eliminating the need for patients to pay cash and submit receipts*. By contracting with over 47,000 pharmacies and working with all major auto insurance companies, we are able to ensure that qualified prescriptions get dispensed and billed, properly and immediately.
Who we serve
We serve you – If your have patients with auto accident related prescriptions, AutoRx can help you.
If your patients have been injured in an auto accident and have first party medical benefits (No-Fault, MedPay, or PIP auto policy), prescriptions and DME related to the accident may be covered by their auto insurance. We allow you to process these scripts and be guaranteed payment on valid claims.
How We Do It
By utilizing electronic connectivity with our pharmacy network and auto insurance partners, AutoRx is able to increase efficiencies in the processing and dispensing of auto claim prescriptions.
Pharmacies - Too Many Unknowns With Auto Prescription Claims?
Over 2.3 million persons are injured every year in auto accidents - one every 13 seconds. Many of those injured are eligible for medical benefits under their No-Fault/PIP auto insurance. However, many questions that must be answered before you can process a claim. Questions such as:
- Whom do I bill and where do I send it?
- Is the medication related to the accident?
- Does the patient have benefits available?
- Will I get paid, and when?
AutoRx Has the Answers
- Immediate adjudication for most claims
- 15 min. verification response (if needed)
- Guaranteed payment on all processed claims
- No out-of-pocket costs incurred by patient*
- Qualified support by in-house Help Desk
- AutoRx accepts all major auto insurers
*depending on state insurance laws and individual policy limits
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