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Full Reimbursement Support Services

Navigate managed care roadblocks and secure patient access to therapy

Cardinal Health Specialty Solutions provides comprehensive reimbursement support for major medical and pharmacy benefits, and helps providers and patients with benefits investigation, prior authorizations, appeals, billing and coding and claims tracking. 
Conducting benefits investigation

Benefits Investigation

Upon program enrollment, we initiate a benefits investigation to verify the patient’s eligibility prior to billing through our real-time benefits investigation process. Status and results are communicated to patients, caregivers and healthcare providers utilizing portal, email, fax and telephone.

Prior authorizations

If a prior authorization is needed, the case manager uses specific payer healthcare forms that are electronically filed in our system to facilitate the process with the physician’s office. If an appeal is required, the case manager will initiate and coordinate the appropriate response, up to three levels of appeals. 

To expedite the benefits investigation process, Cardinal Health will deliver electronic prior authorization through our relationships with key third-party service providers. Once prior authorization is received, we communicate this information back to the patient and the healthcare provider.

Prior authorizaton

Appeals management

We have the ability to perform multiple levels of appeals, from providing the physician or patient with the appropriate forms as requested by the payer to reviewing clinical documentation. We will also manage advanced level appeals that may include clinical support expertise. All outcomes are communicated to the patient and/or healthcare provider in a timely manner. 

Claims tracking

We conduct educational calls to the physician’s office to resolve any errors in claims processing as a result of incorrect coding and errors in billing. We assist the physician’s office in resubmitting the claim back to the payer and tracking for correct billing processes. We aggregate the data on common claims errors and report back to the manufacturer.

Billing and coding

The Patient Services Center specialist will identify and resolve any inquires associated with billing questions, coding errors and form completion.