A Better Way to Manage Prescription Claims
Posted on Jan 19, 2022
Without a system in place to manage prescription claims, pharmacies may experience processing errors or delays. They may not be receiving maximum reimbursement either. To help, BestRx and CoverMyMeds have joined forces to offer independent pharmacies Pre and Post Editing (PPE) services.
PPE acts as a second set of eyes, working behind the scenes in the BestRx software, reviewing each claim and making recommendations. PPE provides actionable measures that enable pharmacies to make faster, more informed decisions and achieve optimal results.
Check out the average savings achieved by real BestRx pharmacies using the PPE tool:
PPE compares the submitted ingredient cost to the most current AWP. If the submitted ingredient cost is lower, the program will send an alert to update the claim. This ensures the higher AWP is submitted for reimbursement.
PPE validates a DAW code is appropriate for a multisource brand. If the DAW code is NOT equivalent to 1, 2, or 5, the program will send an alert. Then, pharmacies can ether switch to a generic substitute or update the claim with an appropriate code.
PPE compares a prescription’s daily dose against the Maximum Allowable Daily Dose. This prevents third-party audits, rejects or inappropriate payments. It also checks that the submitted quantity is appropriate for unit-of-use packaging as well.
With just these three PPE services, BestRx pharmacies save an average of $2,000/month*. PPE also offers support for cash transactions, DEA and NDC validation and more. In addition to these services, pharmacies can also access information about their PPE edits through comprehensive web-based reporting. The additional visibility into their edits enables pharmacies to identify additional ways to utilize the program. result. With PPE, pharmacies can save valuable time and money avoiding claim rejections, while increasing their productivity.
*Individual results may vary.