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DAW codes are an important part of pharmacy billing and the code used in the prescription will factor into how the third party reimburses the pharmacy. Know what the DAW codes are, how they affect claim adjudication, the impact to your bottom line and technology solutions that can identify potential errors or missed opportunities. These solutions work as safeguards to catch potential errors or missed opportunities both before and after adjudication to help you get paid accurately for what was dispensed.
Split billing can introduce many subtle but complex scenarios that can result in reimbursement issues and delays. The extra time to process and complicated coding (such as other coverage codes) impact the pharmacy workflow and reimbursement.
When it comes to optimizing prescription claim billing with third party payers and PBMs, effective use of both pre edit and post edit solutions can improve pharmacy revenue. This article discusses the benefits of each solution and how having both can help create a win-win by protecting the revenue you already earned and opening time for your team to grow the business.
DIR fees have long been a concern for pharmacies. These fees have steadily increased over the last few years with no end in sight and no little to no transparency.  In this article, we define DIR fees, how it affects pharmacies, and why transparency is important.

In this article we discuss pharmacy claims reconciliation, managing electronic remittance advices, and tracking outstanding payments.

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