Are you changing central pay providers and want to know if there is an interruption in your pharmacy cashflow? Are you thinking about changing your pharmacy’s dispensing system and are worried how you will identify missing payments during the transition? No need to worry, by choosing to work with a vendor neutral reconciliation provider you will be able to identify missing payments, freeing up your time to concentrate on other operational issues during these types of transitions.
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How do you identify and recover missing third-party payments and short paid or unpaid claims in the pharmacy? Approximately 95% of prescriptions are billed through a third-party payer (Number of Retail Prescription Drugs Filled at Pharmacies by Payer, 2019) for reimbursement. Payment to the pharmacy for any number of these claims can be short paid or missing which not only affects reconciliation, but negatively impacts your bottom line.
Choosing a career path in long-term care (LTC) pharmacy, especially as an owner-operator, is challenging yet rewarding for those who enter this specific segment of the profession. Often, an LTC pharmacist is also the owner-operator of their LTC pharmacy business. That means doing it all. Owner-operators wear many hats like CEO, COO, CFO, and HR, which builds upon the responsibilities already faced with caring for a long-term care patient population.
Do you find yourself wondering when will you get paid for third-party prescription claims that have been recently adjudicated? Or how long it takes to receive payment from the Pharmacy Benefit Manager (PBM)? Does one PBM pay faster than another? Do your payments seem to be taking longer than normal to arrive? As a pharmacy owner, knowing when you will be paid provides an advantage to making strategic decisions, budget forecasting, and making investments to grow your business.
Do you know when you can expect payment from third party payors for prescription claims? According to a Net-Rx study of 2,187 NCPDP’s over a 6-month period, 86.1% of claims are paid within 15 to 30 days after the promise to pay was issued (Peterkin, 2021). Whether the funds are received by paper check or electronically deposited into the pharmacy’s bank account, they are usually delivered along with an explanation about the payment.