Improve cash flow, boost profits and level the playing field through our reimbursement and managed care services.
Experienced with the challenges faced by independent pharmacies today, we actively listen to our over 1,000 pharmacies and develop responsive solutions.
Our programs enable pharmacies to benefit from streamlined processes and improved profitability. We leverage an experienced team to negotiate competitive contract rates, terms and conditions and to provide reimbursement support. With a customized approach to matching our programs to each pharmacy’s unique business, we empower our members to stay highly competitive.
Let our experienced team be your liaison. We negotiate contracts on behalf of our members to maximize reimbursement opportunity. Our strategy is to increase reimbursements while slowing or eliminating decreasing rates. We leverage our network connections and plan knowledge to help our members attain the highest level of profitability. We negotiate retail, Medicare, Medicaid, long-term care, home infusion and specialty network contracts.
Program Benefits Include:
- Responsive and Knowledgeable Help Desk
- Thorough Reimbursement Research
- Proactive Industry Communications
- Credentials Submission
- Fraud Waste and Abuse Training
- Patient Safety Program
Manage account receivables more simply. Reconciliation is available to all pharmacies and is an industry recognized program for claims tracking. Our service electronically verifies each payment to ensure correct reimbursement. In addition, Reconciliation offers an elite claims chase program to track underpaid and unpaid claims for TPN members. Reconciliation ensures you’re paid the right amount in a timely manner.
Program Benefits Include:
- Electronic verification of payments to ensure correct payment
- Detailed funds disbursement
- User-friendly online portal
- Robust reporting tools
Electronic Funds Transfer
Your pharmacy works best if reimbursements are received in a timely fashion. With Electronic Funds Transfers (EFT) for over 30 payers, we help our pharmacies reduce delayed or lost checks and receive reimbursements faster via direct deposit.
Many PBMs currently offer EFT for Medicare Part D reimbursement only. Pharmacies are enrolled with all of the payers that currently offer EFT, as well as all future plans as they become available. Our dedicated support staff will complete all of the necessary paperwork for you; all you have to do is sign!
- Improve cash flow
- Enrollment in future EFT programs
- Reimbursements for Medicare Part D and a growing list of Commercial plans
Accounts receivable is a critical function of any business. When you enroll in our Central Pay program, we will set up your pharmacy to receive a daily direct deposit that merges all of your payments together so you don’t have to mess with multiple checks or waste time at the bank. Your daily deposit will also have a matching remittance advice and 835 file.
By teaming with Reconciliation, our Central Pay solution provides a 360o perspective for payment tracking. Customers will also benefit from script for script comparison and payment accuracy. Third Party Network’s skillful analysts will be able to ensure your money is routed into your account, reconciled on a script level, while also managing your Aging Report.
- Improve cash flow
- Reduce reconciliation complexity
- Enjoy all of the benefits of Reconciliation
- Dedicated reconciliation analysts
Medicare and Medicaid Processing
Through this specialized processing and billing solution, you can submit Part B Medicare claims for eligible durable medical equipment.
Our comprehensive suite of solutions will allow your facility to electronically submit vaccines, Medicare Part B and most state Medicaid durable medical equipment (DME) claims using your existing pharmacy software system.
Program benefits include:
- Point-of-sale alerts when U & C pricing is below the Medicare/Medicaid allowable price point
- Increased accuracy and profitability and decreased bad debt
- Patient co-pay and deductible amounts returned at the point-of-sale
- Automatic submission of dispensing and supply fees for eligible products
- Robust viewing and reporting capabilities
Simplify Part B vaccine billing and increase pay rates and accuracy with electronic vaccination billing. Our solution allows you to submit Medicare Part B flu and pneumonia vaccination claims electronically at point of fill, using your existing pharmacy software system.
As with our Medicare and most Medicaid billing solutions, our vaccination billing solution similarly submits claims to a variety of real-time edits and eligibility checks for NDC to HCPCS mapping and reimbursement calculation. This solution significantly reduces denials and maximizes paid claims allowing members to benefit from a 98% average overall payment rate.
Pre and Post Adjudication
The increasing volume in third party claims makes it difficult to operate efficiently and receive the maximum reimbursement. Reduce submission errors and improve your reimbursements, in-store productivity and overall profitability through our advanced, real-time Pre and Post Adjudication services.
- Compliance reviews to assure accurate reimbursement
- Eliminate input and processing errors that cause negative margins
- Automatic updates of current AWP increasing profits
- Competitive pricing evaluation tools
- Verification of reimbursement against contracts