In the fast-paced world of pharmacy management, efficiency isn’t just a goal; it’s a necessity. Pharmacists and their teams are tasked with a multitude of responsibilities, from filling prescriptions to managing inventory and providing patient care. Amidst these critical tasks, the opportunity to streamline processes and enhance accuracy is invaluable. This is where QRx Solutions Pre and Post Edits (PPE) come into play, serving as a pivotal tool in optimizing pharmacy operations.
QRx Solutions Pre and Post Edits refer to automated checks and validations applied to pharmacy claims before (Pre) and after (Post) they are submitted to insurance payers. These edits are crucial for ensuring that claims meet specific criteria, adhere to regulations, and minimize errors.
Pre-Edits:
• Before Submission: Pre-edits are performed during the claim creation process. As pharmacists enter prescription details into their pharmacy management system, the system runs checks to identify potential issues, such as verifying dosage accuracy, claim compliance, and formulary compliance.
• Real-Time Feedback: Pharmacists receive immediate feedback on any flagged issues, allowing them to address discrepancies before submitting the claim.
Post-Edits:
• After Submission: Post-edits occur once the claim has been submitted to the insurance payer. The payer’s system performs additional validations to ensure accuracy and reimbursement.
• Customized Reports: QRx Solutions provides customized reports Audit Report Package, Reimbursement Report Package and many other reports to identify where the pharmacy could improve with the claim submissions.
Implementing Pre and Post Edits can lead to significant improvements in pharmacy operations:
1. Reducing Rejections and Denials: By catching errors early and addressing them promptly, PPE significantly reduces the chances of claim rejections or denials, leading to smoother cash flow and less time spent on claim resubmissions.
2. Enhancing Accuracy: PPE helps catch potential mistakes related to patient information, and claim compliance requirements, leading to better reimbursement outcomes.
3. Formulary Compliance: Pre-edits ensure that prescribed medications are covered by the patient’s insurance plan, allowing pharmacists to proactively discuss alternatives with patients if necessary.
4. Time Savings: PPE automates corrections, reducing the time spent on manual claim adjustments and allowing pharmacists to focus more on patient care.
5. Customization: By implementing QRx Solutions allows customization of PPE based on the pharmacy’s specific needs, enabling pharmacists to tailor the checks to address common issues they encounter.
To maximize the benefits of PPE, consider the following tips:
1. Choose the Right System: QRx offers seamless integration and robust PPE capabilities, including real-time feedback and customizable rules.
2. Staff Training: QRx provides comprehensive pharmacy staff training on how to interpret QRx PPE alerts and how to take corrective actions promptly.
3. Stay Updated: Keep abreast of changes in regulations, formulary updates, and coding requirements, and update your PPE rules accordingly.
QRx Solutions Pre and Post Edits are not just about compliance; they are about maximizing operational efficiency, reducing errors, and enhancing patient care. By embracing these automated checks, pharmacies can streamline their workflow, improve profitability, and provide better service to their communities.
To schedule a demo or for additional information contact Angie Smith at angiesmith@qrxsolutions.com or call directly at (678) 400-0738.
