Pharmacy billing
Prescriptions billed every day, in your own system, to the carrier that actually owes them rather than the plan that will send them back.
- Primary
- Paid
- Secondary
- Billed
- Coordination of benefits
- Applied
- Rejection
- Worked same day
- Reconciled to remittance
- ✓
Four things, run every day
Daily claim preparation and submission from your dispensing system. We work inside it, you keep your data.
Rejections worked the day they come back, not swept into a report for someone else to read.
Secondary and tertiary billing, coordination of benefits, and cash-to-insurance conversions.
Workers' compensation, no-fault and PIP claims, which follow different rules from a retail claim and are where most pharmacies lose the money.
What actually happens
The previous day's fills are prepared and submitted from your system. Anything missing a plan, a prescriber detail or a quantity is flagged before it goes out rather than after it comes back.
Rejections that came back overnight are worked. Each one is corrected and resubmitted, or escalated with a reason, the same day it arrived.
Secondary and tertiary claims go out behind the paid primaries, and coordination of benefits is applied where a patient carries more than one plan.
Payments are matched back to remittances line by line, and the month closes with a figure you can check rather than a total you have to trust.
What we take on
Our desk- 01Preparing and submitting the day's claims
- 02Working every rejection to a resolution
- 03Secondary, tertiary and coordination of benefits
- 04Workers' comp, no-fault and PIP claim rules
- 05Reconciling payments against the remittance
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
No. We work inside the system you already run, with your credentials. There is no migration, no new software for your staff, and no change to how a prescription gets filled.
The day it comes back. A rejection that sits for a week is a rejection that turns into aging, so they are worked on the same cycle they arrive on.
Yes. Pharmacy billing runs on its own, or alongside AR and denials, prior authorizations and eligibility as a full revenue cycle. Take the whole cycle or the one part that is costing you.
They follow different rules from a retail claim, which is why they are where most pharmacies lose the money. They are handled as part of the daily cycle, not set aside as exceptions.
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.