Invoice Screening™ targets Providers, Physicians, and Pharmacies responsible for rejected claims that did not meet contract requirements preadjudication by use of the "Three C's":
- Collecting -dollars from inappropriately paid claims
- Correcting - vendor claims processing mistakes
- Controlling - provider "abuse"
Did you know that review of biweekly PBM Pharmacy Invoices for Pre-Adjudication Claims could save you 7-11% in overall drug spend? Coupled with Claims Review, these screens can also target the Providers, Physicians and Pharmacies responsible for rejected claims that did not meet contract requirements.
Savings for most clients are realized when Pharmacy Invoice Amounts are verified and Billing Details are Screened in the following areas:
- Formulary Compliance
- Pricing/MAC Compliance
- Invalid Claims
- Excluded Benefits
Benefits of Screening Invoices Every Two Weeks at Check Write as a Management Tool Are:
- Turn-Around Time (TAT) is within one week of receipt complete data sets, to prevent payment on rejections
- Peripheral Identification of Physician and Pharmacies responsible for outlier and/or for potential “abuse”
- Put Dollars Back in Your Pockets Concurrently!
The following are necessary to complete Invoice Screening accurately:
- Pharmacy Claims
- MAC List
- Eligibility File
- Summary Plan
- Description (SPD)
- Provider / Pharmacy Network File