Eligibility & benefits
The carrier, claim number and date of loss confirmed before the fill, not after the bill comes back.
- Primary plan
- Active
- Secondary plan
- Found
- Copay
- Confirmed
- Deductible
- Confirmed
- Checked before the fill
- ✓
Three checks, before the fill
Eligibility checked up front, including plans the patient did not mention.
Copay, deductible and coverage limits confirmed so the counter conversation is accurate.
Plan changes caught at the start of the year, which is when a quiet month of rejections usually begins.
What actually happens
Coverage is verified against the plans on file and the ones the patient did not mention, so the claim goes out to the right payer the first time.
Copay, deductible and coverage limits are confirmed in advance, so the number your staff quotes is the number the patient pays.
Plan changes are caught at the turn of the year, which is when a quiet month of rejections usually begins for pharmacies that do not check.
Coverage that changes mid-year is picked up on the next check rather than discovered through a rejection weeks later.
What we take on
Our desk- 01Verifying eligibility ahead of the fill
- 02Finding plans the patient did not mention
- 03Confirming copay, deductible and limits
- 04Catching plan changes at the start of the year
- 05Flagging coverage that has lapsed
What stays yours
Unchanged- Your dispensing system and your data inside it
- Your payer contracts and your relationships
- The way a prescription gets filled at the counter
- Final say on anything written off or appealed
- The ability to see every claim we touched
Before you ask
A dispensing system checks the plans it knows about. The work here is finding the coverage that is not on file, and confirming the detail behind it before the claim goes out.
It moves the check earlier rather than adding one. The alternative is a rejection after the fill, which costs more time than the check does.
Plans change at the start of the year in volume. A pharmacy that does not re-verify sees it as an unexplained run of rejections through January and February.
Works well alongside
Talk to us about your pharmacy
Send a month of remittances and we will show you what is being left behind before you commit to anything.