5 minute read
Claims Processing & Reconciliation
Accreditation Commission for Health Care
For Providers. By Providers.
Accreditation Commission for Health Care (ACHC) has 35 years of experience promoting safe, quality patient care and is known for providing value, integrity, and the industry’s best customer service. As a national accreditor, ACHC develops solutions trusted by healthcare providers nationwide and is committed to delivering exceptional, personalized service and a customized, collaborative accreditation experience that continually enhances quality of care and business efficiencies. ACHC, a nonprofit, offers accreditation and certification options across the continuum of care and has CMS deeming authority for multiple programs, including hospitals, laboratories, DMEPOS, and home care providers. As a recognized leader in pharmacy accreditation, ACHC provides a broad suite of accreditation choices, including specialty pharmacy, infusion, long-term care, and mail order services, and PCAB Accreditation for sterile and non-sterile compounding services. Pharmacies seeking to distinguish themselves further within the market can also obtain various accreditation distinctions from ACHC, such as rare diseases and orphan drugs, oncology, and hazardous drug handling. In achieving ACHC Accreditation, pharmacies confirm their commitment to quality, safety, and operational excellence and demonstrate their compliance with current rules and regulations to regulators, payors, and patients.
CONTACT INFORMATION: Accreditation Commission for Health Care (ACHC) Matt Hughes Director of Business Development 139 Weston Oaks Court Cary, NC 27513 TOLL-FREE: 855-937-2242 Ext. 458 FAX: 919-785-3011 customerservice@achc.org www.achc.org
Certification & Accreditation
Accreditation Advisory Services
Accreditation Support for Pharmacies Nationwide
Innovatix, the nation’s leading non-acute care group purchasing organization (GPO), has a longstanding commitment to helping pharmacies provide the best service at the lowest cost while maximizing reimbursements. With respect to reimbursement rates, third-party accreditation has become increasingly important to pharmacy benefit managers and other payers to verify quality and patient safety. To this end, Innovatix launched a fee-for-service program in 2015 — Innovatix Accreditation Advisory Services — to support pharmacies in achieving recognition from various accrediting bodies, including URAC. Innovatix offers pharmacies three levels of support to best meet each client’s needs and available resources. In a Level 1 engagement, Innovatix will review your pharmacy’s standards and processes against accreditation measures and help to polish your application prior to submission to the accrediting body. A Level 2 engagement is more hands-on, with Innovatix experts helping your staff create the required standards and processes through a series of weekly calls and monthly on-site meetings. Level 3 offers the most comprehensive support through a full-time consultant who will prepare your pharmacy’s accreditation submission from start to finish.
CONTACT INFORMATION: Innovatix 555 West 57th Street 12th Floor New York, NY 10019 TOLL-FREE: 888-258-3273 info@innovatix.com www.innovatix.com
NABP®
Innovating and Collaborating for a Safer Public Health
Founded in 1904, the National Association of Boards of Pharmacy® (NABP®) is a 501(c)(3) nonprofit association that protects the public health by assisting its member boards of pharmacy and offering programs that promote safe pharmacy practices. We aim to ensure the public’s health and safety through our pharmacist license transfer and pharmacist competency assessment programs, and accreditation programs including Community Compounding, Digital, DMEPOS, Drug Distributor, Home Infusion Therapy, OTC Medical Device Distributor, and Specialty. Our accreditation programs provide businesses a cost-effective, streamlined, and collaborative approach to meet business, patient, and regulatory needs. Our innovative and data-driven approach supports the creation of forward-looking services that provide a clear and actionable path for state boards, pharmacists, and the industry to maintain and enhance pharmacy practice standards.
CONTACT INFORMATION: National Association of Boards of Pharmacy® (NABP®) 1600 Feehanville Drive Mount Prospect, IL 60056 PHONE: 847-391-4406 FAX: 847-375-1114 industry@nabp.pharmacy www.nabp.pharmacy
Claims Processing & Reconciliation
IND Consulting
Expert Claims Adjudication and Resolution
IND Consulting’s dedicated team can provide support with daily and cycle-fill claims adjudication. Our experts can assist with: 1) Rejection Resolutions (including rejection codes requiring a phone call to insurance or facility), 2) Overrides, 3) Prior Authorizations, 4) Split Billing, 5) Census Management, 6) Rebills, and 7) Therapeutic Interchange. IND’s network offers 24 hours a day, seven days a week, 365 days a year availability with productivity standards and quality assurance checks to ensure excellent performance.
CONTACT INFORMATION: IND Consulting 731 Shotgun Road Sunrise, FL 33326 PHONE: 954-756-6883 info@indconsulting.com www.indconsulting.com
Net-Rx™, an MHA Company
Net-Rx™, an MHA Solution, has specialized in providing operational and software-driven solutions exclusively for pharmacies for more than 15 years. Led by industry experts, Net-Rx™ solutions drive operational excellence and optimum financial performance across reconciliation, reimbursement verification, and prescription pricing. For more information about our solutions, please visit www.net-rx.com.
CONTACT INFORMATION: Net-Rx™ 2300 E 3rd Loop Suite 200 Vancouver, WA 98661 TOLL-FREE: 866-336-3879 FAX: 360-567-0394 sales1@net-rx.com www.net-rx.com
CUSTOMER SUPPORT: TOLL-FREE: 866-336-3879
Claims Processing & Reconciliation
ReconRx From Pharm Assess
Doing More for Our Clients
ReconRx from Pharm Assess is a state-of-the-art third-party payer claim reconciliation program. Designed to make your pharmacy money, ReconRx automatically goes after payment up to two weeks earlier than competing programs to ensure you recover missing payments. Save time and enhance cash flow without installing any software. Track your payments at the claim level and recover missing payments to the penny. With an automated process, ReconRx offers a hassle-free way to make the money your pharmacy has earned. There are no write-offs, so unpaid or short-paid claims are tracked until the full balance is recovered. ReconRx provides reports to track DIR fees at the transaction level and payment level. You can also track the status updates for unpaid claims and missing checks. With ReconRx on your side, we guarantee no money is left behind. Best of all, ReconRx values your time by going after claims faster than any other program. Money is recovered in full in a timely manner.
CONTACT INFORMATION: Pharm Assess, Inc. P.O. Box 12428 Overland Park, KS 66282 TOLL-FREE: 888-255-6526 PHONE: 913-897-4343 TOLL-FREE FAX: 888-512-1381 www.pharmassess.com
Are you getting the maximum reimbursement possible on every claim?
Ask us about our full suite of reimbursement solutions:
» Claims Reconciliation » Claims Editing » Contract Verification » Prescription Pricing Tools » Reimbursement Verification » Accounts Receivable » Advanced Business Analytics
Net-Rx. The Recognized Leader in Reimbursement and Business Analytics Solutions for Pharmacies
P: (866) 336-3879 / sales@net-rx.com / www.net-rx.com
Claims Processing & Reconciliation
ScriptPro
Third Party Management System for Improved Financial Health
ScriptPro’s Third Party Management System (TPMS) gives you real-time visibility paired with real accountability. TPMS combines transparency with action, helping clients navigate the blizzard of third party transactions with ease. It oversees all aspects of third party contracts, third party insurance, and private-pay billings, plus facilitates timely and accurate collection of third party prescription reimbursements, including 340B. TPMS isolates and reports on various fees charged by PBMs including adjudication fees, DIR fees, network access fees, and audit recoups. Powerful exceptions reporting, comprehensive revenue cycle management, and robust financial metrics empower clients to take back the reins of their financial health and gain control over their pharmacy operations.
CONTACT INFORMATION: ScriptPro 5828 Reeds Road Mission, KS 66202 TOLL-FREE: 800-673-9068 info@scriptpro.com www.scriptpro.com
