Reimbursement consulting services
ProfitLeader®
While you're busy with the day-to-day pharmacy tasks,
ProfitLeader® analyzes electronic claim flow and identifies ways to realize increased profits on a regular basis. A team is assigned to your account and is responsible for finding high-value opportunities and devloping a plan of action for your pharmacy. Find lost margin opportunities with no significant impact on every day operations in your pharmacy.
ProfitLeader® can help you find lost opportunities by focusing on five core areas including:
- Cash prescription pricing
- Generic utilization and efficiency
- Third-party profitability
- Correction of underpaid claims
- Cardinal inventory promotion product
Reconciliation
The process of matching the reimbursement check you get from third-party payors with the transactions recorded by your pharmacy system or switch. Our reconciliation services are the first in the industry offered for a flat monthly fee and will acheive the highest return through plan and line alignment. Partnered with Carolina Services/PRISM, all claims with discrepancies of more than $25 are pursued and payment verification is provided on all third-party claims. (Must be a LeaderNET
® member)
Pre-Adjudication Editing
Pre-Adjudication Editing consists of a series of edits that evaluates your prescription claims and provides financial, administrative and legal compliance reviews prior to being sent to the processor. This real-time solution comprehensively improves a pharmacy’s third-party reimbursements and in-store productivity. Pre-Adjudication Editing receives the claim from the pharmacy’s switch network (eRx or QS1) and performs a set of pre-edits. Reports are provided via email in a weekly summary.
Featured edits include:
- AWP pricing updates
- Enhanced DAW code validation
- Formulary compliance
- Standard dispense quantity checks
- Discontinued NDC alerts
