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Pharmacy Claim Reconciliation FAQ

Electronic claims reconciliation is the process of automatically matching third-party claims payments to your billing data.

 

Net-Rx™ reporting keeps you up-to-date on claims that have not reconciled - whether it is due to non-payment, partial payment, or payer take backs.

 

Central Pay is not required. Net-Rx is vendor neutral; we can reconcile all third-party claims, regardless of your participation with a Central Pay.

 

Yes, Net-Rx can obtain electronic EOB files from any payer that offers them, including state Medicaid.

 

Yes. You can enter your remaining paper remittances, and RecRx will convert them into electronic files to achieve 100% third-party electronic claims reconciliation.

 

The Net-Rx RecRx service allows you to access your third-party claims information and identify missing and/or short paid claims. In addition, Net-Rx offers a Third Party Accounts Receivable service to help you balance your month-end process.

 

Net-Rx’s Days Sales Outstanding (DSO) report identifies the average number of days between claim transaction dates and their payment dates, giving you payment timeline trends by payer.

 

Yes. Net-Rx’s RecRx Fee/Adjustment report allows you to quickly and easily identify and quantify adjustments made to payments, including DIR fees, at the claim and check level.

 

Net-Rx’s RecRx Fee/Adjustment report allows you to quickly and easily identify and quantify adjustments made to payments at the claim and check level. If a previously paid claim is reversed as part of an audit, a record of the adjustments can be found on this report.

 

Typically, setup takes 2-4 weeks to complete. Our RecRx service includes a manual remittance entry tool that allows you to manually enter paper remittances received during your setup period to ensure complete third-party reconciliation. We perform periodic payer reviews to proactively identify and set-up any outstanding payers.

 

Net-Rx works with all major third-party payers and software vendors to collect your EOB remittance data and dispensing data through a secure FTP connection.

 

At Net-Rx, data security is our top priority. All of our solutions require authentication to use; we have firewalls to deny unauthorized access. We perform regular vulnerability assessments and our employees participate in regular HIPAA and security certifications.

 

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