In the pharmacy business, you can’t afford to not reconcile your claims. The majority of your business deals with third party claims, and you have to ensure that you’re being reimbursed—and in the right amount—for the services you provide.
Letting remittance advices pile up won’t help your business. You need a service that streamlines the claims reconciliation process and that makes certain you get paid correctly.
Whether you’re looking for a third party claims reconciliation service for the first time, or considering switching services, what features do you check for in a reconciliation service? You have a lot of facets to consider when choosing the right reconciliation service for your business. Here are a few features we recommend looking at.
Central pay or direct pay?
When looking for a reconciliation service, it’s important to check whether the service uses a direct pay or a central pay model. In a central pay model, the PBM sends your reimbursement money to an intermediary firm, and then the firm passes it onto you. This puts a middleman between you and your money, and can potentially delay payment to your pharmacy and slow down your cash flow. With a direct pay model, your payments go straight to your pharmacy.
Secure claims data
Your pharmacy’s claims reconciliation information is your private data. It needs to stay protected. Some claims reconciliation services extract pharmacy data in order to reconcile third party claims. It’s important to look for a reconciliation service that keeps your claims data in house, so you manage the process and your data stays secure.
Automated reconciliation
With technology today, your pharmacy should have a fast electronic solution to reconcile third party payments. An electronic claims reconciliation service should reduce your amount of work—not increase it. Look for a service that uses 835 electronic remittance files for fast reconciliation, and a service that allows you to reconcile using your current pharmacy software system.
Knowledgeable staff and support
Reconciliation questions are bound to come up. You don’t want a service that makes it difficult to get in contact with a real person to answer your questions. Look for a service that provides support with all reconciliation questions or payment issues.
PBA Health offers an electronic third party claims reconciliation service—one that can dramatically improve your third party business. Called EnsurePay, this reconciliation service enables you to electronically reconcile your third party claims in minutes. With EnsurePay, you can easily monitor expected payments and identify missing or short payments. Take a look at how EnsurePay can meet the qualifications you seek in a reconciliation service—and find out what makes it different from other services.
