AbacusRx

Third Party Reconciliation

Reconcile third party payments fast, electronically or manually. Claims reconciliation allows you to easily post claims processor remittance data to the system. Claims billed both online and offline are posted to the tracking system. The tracking system provides you with a highly functional maintenance interface. Using the interface, you are able to filter the billed claims by specific date ranges for both individual plans and all plans. Sort the claims by billed or fill date. Search for individual records by prescription number. In addition to these filtering capabilities, the tracking system interface also provides on-screen editing of claim entries, reporting, and reject re-billing.

There is an assumption made by pharmacists that when a third-party company electronically accepts a prescription for reimbursement at a specific dollar amount, the pharmacist will receive a check for that same amount. This seems to be a reasonable assumption, but is it true?

Studies have concluded that that approximately 1% to 5% (depending on the PBM) of the claims is paid a different amount than billed.

In addition, consider how much time your staff spends on manually tracking prescription payments from third parties? Those days are over! We can electronically reconcile 835 remittance and we have formed relationships with partner companies to help your staff spend more time working with patients, not paper remittances.

The Reconciliation module offers independent pharmacy "transaction level" reconciliation and provides reimbursement audits similar to those the chain pharmacies have employed since 1996. It compares data received from the pharmacy's switched data (paid claims response) to electronic remittance advice submitted by third party payers. We support reconciliation with all third party payers that offer electronic claims remittance.

You work hard to earn the money that is owed to you. Call us to find out how we can help you collect money for the services you provide to your patients.