Pharmacy Medical Billing Services
CureCode MBS offers specialized medical billing services for pharmacies and pharmacy benefit managers, addressing the unique challenges of pharmacy billing. Our team of experts understands the complexities of pharmacy claims processing, including prescription drug billing, medication therapy management services, and immunization administration.
Pharmacy Billing Challenges We Solve
- Complex Reimbursement Models: Navigating the various pharmacy benefit manager (PBM) reimbursement structures.
- NDC Code Management: Ensuring accurate National Drug Code (NDC) usage for proper reimbursement.
- Prior Authorization Requirements: Managing prior authorizations for specialty medications and high-cost drugs.
- Rejected Claims: Resolving rejected claims due to formulary issues, coverage limitations, or quantity limits.
- Coordination of Benefits: Handling primary and secondary insurance billing for prescriptions.
- Compliance Requirements: Maintaining compliance with pharmacy-specific regulations and requirements.
Our Pharmacy Billing Services
- Prescription Claims Processing: Accurate submission of prescription drug claims to PBMs and insurance carriers.
- Clinical Services Billing: Billing for medication therapy management, immunizations, and other clinical pharmacy services.
- Rejection Resolution: Prompt resolution of rejected claims to improve cash flow.
- Audit Support: Assistance with PBM audits and documentation requirements.
- Contract Analysis: Review of PBM contracts to ensure optimal reimbursement rates.
- Financial Reporting: Detailed financial analytics and reporting for your pharmacy.
Benefits of Our Pharmacy Billing Services
- Increased revenue through accurate claims submission and processing
- Reduced claim rejections and improved cash flow
- More time to focus on patient care and clinical services
- Compliance with pharmacy-specific billing regulations
- Transparency through detailed reporting
- Expertise in pharmacy billing requirements and PBM policies