Things change quickly in the pharmacy world, and it’s challenging to keep up with billing reports and pricing changes when your first priority is patient care. But things like inaccurate pricing, incorrect quantities, outdated NDCs, and other small errors can chip away at your pharmacy’s profits.
RECLAIM|Rx offers a proactive approach to analyzing your claims data and maximizing your bottom line. Our team has extensive pharmacy experience, and we understand the challenges you face each day. We combine comprehensive reports and proactive outreach to identify potential opportunities to reclaim profits. We’re watching out for your profitability so you can focus on patient care and other important aspects of running your pharmacy.
RECLAIM|Rx offers:
- Data analytics that combines market intelligence and industry knowledge.
- Customized reports with highlighted savings opportunities and profit increase potential.
- Proactive communication and customer outreach.
- Enhanced pre and post edit (PPE) service to maximize reimbursements.
Automated AWP Updates
We monitor changes to AWP daily and update claims at time of submission with no action required from you.
AWP Resubmission
We’ve saved our customers $18 or more per eligible claim when they use auto resub as part of RECLAIM|Rx. Our data analytics software and our experienced team identify claims that were paid based on outdated AWPs, resubmit them within certain parameters, and provide an actionable report for you.
DAW Verification
Using the wrong DAW code can increase audit risk and reduce reimbursement. Our verification service ensures you’re using the most appropriate DAW code to reduce that risk and maximize reimbursement.
Standard Dispense Quantity
Common errors of submitting incorrect quantities for inhalers, solutions, and other packaged medications can be costly to your pharmacy. We make sure your claims have the correct quantities to ensure accurate reimbursement.
NDC Validation
An outdated NDC can mean lower reimbursement from the pharmacy benefits manager. We analyze each claim to identify outdated NDCs and provide the updated NDC where available.
Prescriber Schedule Authority (PSA)
This service validates each prescriber’s DEA number to ensure it’s current and has the correct prescribing class authority. This extra protection increases compliance and reduces the risk of audit that could occur from filling prescriptions for an unauthorized DEA number.
This post is related to:
Finance: Worker's Comp, Claims, PA Management, Adjudication
