NCPDP creates national standards for electronic healthcare transactions used in prescribing, dispensing, monitoring, managing and paying for medications and pharmacy services. They also develop standardized business solutions and best practices that safeguard patients.
Your organization can now utilize NCPDP 5.1 to adjudicate claims immediately after dispensing.
Within seconds, the claims are ‘factored’ and the reimbursement amount is known. “Factoring” means the claim is purchased and cannot be returned, even if reimbursement is not received from the payer.
Claim adjudication experts resolve any missing data or problems with claims from a central location. This usually involves obtaining missing information from the practice through the software’s help desk system.
In most states, reimbursement amounts are based on AWP and vary from state to state depending on several factors, including the prevailing reimbursement rate for any specific state workers’ compensation program.
Benefits of pharmacy claims adjudication:
- Quickly and efficiently verify coverage eligibility. You and your team can focus your time on your patients instead of spending time on the phone.
- Our experienced team is available online and over the phone to support you at every step.
- Effectively manage this small but profitable segment of your business.
- Achieve the results you need to effectively measure your members’ pharmacy benefit management experience.
