MDScripts has partnered with BillingScripts to provide NCPDP claim adjudication of workers compensation pharmacy claims. The program enables physician practices using the MDScripts dispensing platform (or any of over 40 re-branded versions) to adjudicate pharmacy claims with a Net-21 reimbursement, paid weekly.
The main benefits of the program are:
1) Shorter reimbursement period as compared to traditional printing/mailing of HFCA forms
2) No additional billing staff requirements
3) Real time claim payment and status information - at the time of dispense
Experience the benefits of weekly revenue from your workers compensation pharmacy claims. Contact us today for complete details.
With shrinking workers compensation reimbursements, organizations are finding it increasingly difficult to process workers compensation pharmacy claims and remain profitable. Payer-specific complications with HCFA forms coupled with extended reimbursement periods present a challenge to organizations utilizing a physician dispensing program. When pharmacy claims are printed on HFCA forms and mailed, typical reimbursement periods can exceed 45 days, provided the claims are not returned for missing information, with no certainty of payment.
NCPDP Claims Adjudication:
Your organization can now utilize NCPDP 5.1 to adjudicate claims immediately after dispensing. Within seconds, the claims are factored and the reimbursement amount is known. (Factoring means the claim is purchased and cannot be returned, even if reimbursement is not received from the payer.) Net 21/Weekly means that three weeks later the reimbursement amount is paid, on a weekly basis. Claim adjudication experts resolve any missing data or problems with claims from a central location. This usually involves obtaining missing information from the practice through the software's help desk system.
Reimbursement amounts are based on AWP and vary from state to state depending on several factors, including the prevailing reimbursement rate for any specific state workers compensation program. This program is currently not available in California or Utah.
Frequently Asked Questions:
Does the practice staff need to learn NCPDP claim adjudication in order to participate in the program?
No. The practice is hardly aware of the NCPDP claim process since the claims are adjudicated automatically by the system. Whenever an exception occurs, our NCPDP claim processing experts quickly resolve the issue from a central location.
What are the actual reimbursement rates for the states that we operate in?
Our business relationships prohibit us from providing the rates publicly. Please contact us for the rates.
How is reimbursement distributed?
All paid claims are remitted weekly on a net 21 day basis. The proceeds are deposited via ACH (automated clearing house) credit to your bank account. No more lost or missing checks. With weekly reimbursement reporting, you will know in advance the amount due under the BillingScripts program.
We've been doing our own billing for years so why would I need this?
That's terrific if you have the staff and experience to do your own billing, but how efficient are you? Depending on the resources you expend to bill and collect (payroll, commissions, overhead) and how effective you are at collecting (after all discounts and uncollectable claims), our unique program may enhance the profitability of your dispensing program.
Does this program work with any repackager? What about repackager or manufacturer AWP's (Average Wholesale Price)
With the MDScripts platform, you can purchase and dispense medications from any repackager. Some repackagers have been blacklisted because of inflated and unrealistic AWP's. Fortunately, the MDScripts platform supports multiple repackagers, allowing you to better manage the AWP's of products you purchase.
What are the program costs?
You will need to spend $125.00 for a Non Pharmacy Dispensing Site Number (or NPDS, available from the National Council for Drug Prescription Programs at www.ncpdp.org) in order to electronically submit claims. Send a few claims, wait three weeks and get paid. If you don't like the program, fire up the printers and start mailing again.
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Contact us today to learn more about MDScripts or to request a demo of the software. We can be reached by phone, email or by submitting the contact form below. We look forward to hearing from you!
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