Cardinal Health Expands Its Comprehensive Managed Care Offering To Help Independent Retail Pharmacies Improve Prescription Reimbursements

Written on February 4, 2024 - 9:39 am | by admin

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Cardinal Health announced enhancements to its broad suite of managed care services, which provide the industry’s most comprehensive array of tools to help pharmacies improve prescription reimbursements.

Nearly 3,000 independent pharmacies participate in Cardinal Health’s managed care network, making it one of the largest in the industry. Especially in today’s tough economic climate, Cardinal Health encourages independent pharmacies to tap into its full array of managed care services to ensure they get paid every dollar of prescription reimbursement they are owed from payors.

“One of the key reasons why a growing number of independent pharmacies use our managed care services is that they consistently deliver tangible results,” said Steve Lawrence, senior vice president of independent sales for Cardinal Health. “Customers who use all of our managed care services experience an average annual savings of $42,000 - $70,000 per year. With returns like that, pharmacy owners realize that they can’t afford not to take advantage of the expertise they can get from Cardinal Health.”

The centerpiece of Cardinal Health’s comprehensive managed care offering is LeaderNET® - one of the industry’s largest Pharmacy Services Administrative Organizations (PSAOs) - which manages network contracting and plan administration for community pharmacies in the United States, Puerto Rico and the Virgin Islands.

Through LeaderNET®, Cardinal Health negotiates prescription reimbursement rates with virtually all managed care networks in the United States, including more than 50 Medicare Part D plans. An independent managed care panel, comprised of independent pharmacy owners, reviews and approves all new LeaderNET® contracts.

In the past year alone, Cardinal Health has more than doubled the number of long-term care contracts it offers LeaderNET® members. The company has recently added contracts for niche markets including immunizations and 90-day medication supply programs. Cardinal Health also offers participating pharmacies access to a call center support team that can provide audit assistance and answer managed care, reimbursement and other general questions.

Key features of Cardinal Health’s comprehensive managed care offering include:

- Automated Prescription Claim Editing - By electronically pre-editing prescription claims before they are sent to payors, Cardinal Health’s automated pre-adjudication editing tool helps pharmacies improve profitability by maximizing reimbursements paid by third parties. It seamlessly adjusts claims to make sure they contain accurate pricing information and are properly coded. It also provides financial, administrative and regulatory compliance reviews on prescriptions, helping to reduce the likelihood of third-party audits, underpaid claims and billing errors.

- Electronic Payments from Payors - LeaderNET® members receive prescription reimbursements faster and more efficiently through direct deposit. This service also saves pharmacists time by removing the time-consuming step of having to deposit and track hundreds of checks into an account.

- Reimbursement Reconciliation - Even when prescription claims are properly submitted to payors, many can be underpaid - or worse - they can go completely unpaid. Unfortunately, the process of making sure that every individual claim is paid in full can be very time consuming, taking pharmacists’ time away from patients. Cardinal Health analyzes dispensing data, and then contacts payors directly to resolve outstanding payment issues. Participating retailers receive customized reports letting them know which reimbursements are still outstanding and which have been recovered by the service.

- Customized Reimbursement Consulting Services - Cardinal Health offers independent retail pharmacy owners one-on-one consultations with an experienced managed care expert who can identify additional opportunities for revenue growth and profitability through customized analytics of each customer’s pharmacy dispensing data.

- Audit and Reimbursement Assistance - Professional audit assistance is also available to help independent pharmacists understand how to improve prescription claim compliance and reduce the likelihood of audits. The company also provides an online tool for independent pharmacies to submit - and receive prompt responses to - reimbursement questions and issues.

Cardinal Health also offers a broad suite of services that help independent pharmacies streamline operations, create alternate revenue streams and increase local market share.

Independent pharmacies interested in learning more about how Cardinal Health’s comprehensive managed care offering can visit http://www.cardinalhealth.com/improvingreimbursements.

Source
Cardinal Health

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