The Benefits of Direct Pay Reconciliation Services
Independent pharmacies play a vital role in improving the health of their local communities. However, the obligations required to keep a pharmacy running – including chasing claims and recovering owed money – can often create a significant burden that takes away time from providing actual patient care. With the support of a quality direct reconciliation service, pharmacies can improve their visibility on paid and unpaid claims and reduce the number of hours spent performing administrative tasks.
The Pharmacy First Direct Reconciliation program was developed with the independent pharmacy in mind. Providing transaction-level reconciliation services, this stand-alone program utilizes an in-house, state-of-the-art system designed to accommodate pharmacies of all sizes with a direct pay model. In short, pharmacies receive oversight on all money promised to them while having the ability to manage their own funds.
I really value the security of ACH payment information entering the reconciliation portal. The checks remits are received and marked weekly.
~Felix Bocheti, Farmacia Jardines Toa Alta
Created in-house with the same HIPAA-compliant standards and technology adopted by the Healthcare industry, this program helps pharmacies identify any paid, unpaid, or short-paid claims. With access to a comprehensive reporting system inside a dedicated Member Portal, pharmacies can reduce labor costs, giving them time to focus on patients and maximize profits.
The Pharmacy First Direct Pay Reconciliation service allows pharmacies to access a secure data platform to manage their receivables efficiently. Pharmacy First accepts adjudicated claim responses directly from the member’s PMS system’s third-party switch company and compares them to the pharmacy’s 835 payment files from the PBM for fast and efficient claims reconciliation. With this service, pharmacies have access to a reporting system that provides complete visibility of payments (365 days of reporting) with drill-down reports by PBM. Payment files are received daily, and the anticipated funds are reported in their Member Portal to review and confirm payments when received.
The system is quite “friendly” in terms of information acquisition and documentation. If we do not have this system, we have to manually reconcile all claims, which is almost impossible. The Claim process when a check has not been received is through the platform and it is very effective.
~Delila Bula, Super Farmacia Rebeca
Direct pay reconciliation provides 24-hour online claim reporting, allowing pharmacies to securely track claims with custom export options, including accounts receivables per claim level per PBM. Pharmacies also receive access to a recovery feature where outstanding claims are researched on behalf of the pharmacy. Status updates are provided to the pharmacy on the findings.
While most reconciliation programs only identify short-paid or unpaid claims, the Pharmacy First program recovers all funds owed to member pharmacies. All claims are reconciled up to the penny, with no write-offs. Pharmacies also gain access to a Live Customer Service support team Monday through Friday that can help pharmacies navigate features of the Member Portal and Money Management tools. Additional training and webinars are also provided throughout the year to help pharmacies understand the capabilities of the system.
The customer service is excellent. Whenever there has been any change or situation they communicate with us, and they have always resolved any questions we have.
~Adalberto Llera, ALLMED Pharmacy
If your pharmacy is looking for a direct reconciliation service to ease the administrative burden on your stores and strengthen your independence, consider partnering with the program already trusted by more than 400 pharmacies. Contact Pharmacy First to see how our Direct Pay Reconciliation program can improve your pharmacy’s administrative efficiency and give you time back to what matters most – the care of your patients.