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Net-Rx Recent News

Are you considering conducting Coronavirus (COVID-19) testing at your pharmacy? In this article we discuss the types of tests and the requirements pharmacies must meet in order to provide COVID-19 testing.

Pharmacists sometimes have hundreds of prescriptions to fill each day. In a fast-paced environment, sometimes good billing practices and operational habits can be overlooked, jeopardizing the health of your business. Here are the top 5 things you should do to make sure you receive optimum reimbursement from third-party payers.     

Some situations require a pharmacist to submit a claim that, under normal circumstances, would be rejected by the third-party payer.  For example, a patient is going on a vacation and requests a three-month supply of their medication.  To prevent rejection, this claim must be submitted with a Submission Clarification Code. In this article, we look at how submission clarification codes are used and offer some best practices that may help you ensure proper reimbursement. 
Pharmacies can benefit from proactively managing transition fills by working through prior authorizations and Medicare Part D prescription drug changes for non-formulary drugs during the transition fill period.

Have you ever wondered why payers will reject some claims, adjudicate others with profits, or respond on some with losses? The answer may lay with whether the medications’ NDC (National Drug Code) is on the payer’s formulary list.  If it is on the list, what tier is it on and is it a preferred medication? The answer may affect the reimbursement amount and patient copay assignments.

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