Managed Care

Strategic Contracting

Stand united with more than 4,600 members when you join our PSAO, Elevate Provider Network. Using our proprietary pharmacy analytics system, we model and negotiate smarter payer contracts with more than 50 PBMs based on our long-term strategy for managing the impact of preferred cost-share networks. Our data-driven approach helps us determine which plans we should join at the preferred or the standard cost-share level, and that clear objectivity helps us maximize your profit margins.

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Pre and Post Edit

Minimize your risk of making costly reimbursement mistakes by using this solution, which is like spellcheck for your claims. It automatically reviews every submission for data accuracy and applies real-time edits, so small typos never jeopardize your full reimbursement. You can even customize the edits in advance to ensure financial, administrative and legal compliance every time.

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Claims Reconciliation

Avoid write-offs with our sophisticated reconciliation software, which automatically tracks every reimbursement for you and provides you with the tools you need to chase claims. We make it easy to verify your third-party payments, pinpoint underpaid claims and prevent missed checks from going unnoticed, so you can be sure you’ve collected every dollar that’s due to your pharmacy.

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Central Pay

Get complete cash flow visibility so you can be sure that none of your claims have slipped through the cracks. With Central Pay, you can see when your cash is tied up in receivables or when claim errors are preventing you from getting the reimbursement you deserve. Plus, our convenient mobile app helps you stay on top of your deposits anytime, anywhere.

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MAC Challenges

Have MAC challenges handled on your behalf with full visibility into your active challenges, cases with favorable outcomes and legislation pending. With more than a million claims loaded into our Pharmacy Performance system each week, we’re able to identify negative-margin MAC prices and file all applicable claims for you, saving you time and maximizing your reimbursement.

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