Embracing the future of clinical pharmacy
By Gold Eneyo, PharmD
With reimbursement for clinical services being a concern for scope expansion, The Elevate Provider Network has contracted with Cigna Health and Life Insurance Company (Cigna) to enable eligible Elevate pharmacies to bill for ancillary clinical services under a Cigna member’s medical benefit. Eligible pharmacies can provide enhanced services, create additional patient touchpoints, and foster stronger loyalty while improving community health outcomes. Eligible pharmacies can administer a wide range of services such as vaccines, tests, administer medications, and provide patient evaluation visits. Pharmacists must verify patient eligibility before providing services, as not all services or patients may qualify. Coverage can vary by plan.
Elevate Provider Network Pharmacy Clinical Services Program highlights:
- No enrollment required for eligible Elevate Provider Network independent pharmacy members
- Pharmacies billing for medical services will not be credentialed by Cigna at this time under the Ancillary Services Agreement. Pharmacies assume all responsibility for ensuring that the pharmacy and all individuals rendering services through the pharmacy comply with all requirements set forth in the Agreement, including, without limitation, requirements associated with state/federal licensure or registration.
- Eligibility is verified at claim submission through Change Healthcare, including patient cost share (if applicable)
- Pharmacist NPI is required for the pharmacist providing the service
Next steps (to get set up)
- Review the program overview, billing guide, FAQ, and patient marketing document
- Proactively load the proprietary NDCs for the services you plan to offer
- Identify patients that may qualify for services
- Confirm the pharmacist(s) who will provide services have an active NPI
- Begin submitting claims for eligible Cigna members
For additional support or questions:
- For claim submission/rejections (Change Healthcare): (866) 379-6389 (Mon–Fri 8am–10pm ET; Sat 9am–6pm ET)
- Elevate Provider Network Help Desk: (888) 880-1388 | Elevate@Cencora.com
- Clinical solutions: ClinicalSolutions@Cencora.com
Would you like to schedule 15 minutes to walk through the billing process and confirm you’re ready for your first claim submission? Reach out to clinicalsolutions@cencora.com
Topics:
Good Neighbor Pharmacy
