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Not Magic - Just Innovation

Not Magic - Just Innovation

I remember my first day working at a pharmacy like it was yesterday. It was fast-paced, exhilarating and the work was meaningful. Now 20 years later I’m still in the industry, just not behind the counter. Instead I work to build products and services for all types of pharmacies – chains, independents, grocers and everything in between. In this rapidly changing healthcare environment, pharmacies must utilize all of the tools at their disposal, not just to remain financially viable, but to thrive as providers of healthcare.

One of those tools is switch-based claim editing. Claim editing has been around for decades, but it’s no longer just for average wholesale price and dispense-as-written updates. Just this past October, we experienced one such example as hydrocodone moved from schedule III to schedule II. With the help of claim editing, pharmacies were able to implement multiple edits to support their individual approaches. Some opted for a pre-message to remind patients of the need to get a new script. Others utilized date-of-service logic to reject refill claims after the implementation date. Not only did claim editing help pharmacies remain compliant, pre-messaging well before the rule enactment improved the patient experience.

The following are just a few other off-label uses for claim editing that just may bring value to your pharmacy. Today’s editing platforms are flexible and scalable, and when fully leveraged, can help drive pharmacy success.

Recalls and Discontinued Products

By continuously monitoring Food and Drug Administration communications, a claim editing tool can activate real-time edits to notify pharmacy employees of recalls and discontinued products at point-of-fill. While both wholesalers and software vendors also provide these updates, the ability of claim edits to trigger notifications within hours of the alert right at point-of-dispensing is important, especially for recalled products.

Custom Messaging

Claim editing is no longer one size fits all. Savvy owners and chains are using customized messages to drive unique business goals.

  • Inventory Management - Whether it’s because of excess inventory or better acquisition costs, pharmacies often have preferred products. Claim messages triggered when a non-preferred National Drug Code is utilized can encourage staff to consider your preferred alternative. The significant impact inventory management has on the bottom line makes it a great area to consider customized editing.
  • Loyalty and Customer Engagement - Pharmacies are competing for prescription market share, front-of-store sales and healthcare services. Because of this many of them have carved out niche programs for a variety of health conditions for humans and even pets. Triggering immunization reminders based on payer or alerting a diabetic patient receiving insulin of additional support services are just a few examples. The possibilities for how customized claim editing can help drive these programs are endless.
  • Automated Field Population - We all have those special circumstances that require rare claim fields to be populated. Claim editing is a great way to automate a process that might otherwise require numerous key strokes or toggling to infrequently used fields and screens. For instance, you can automate the entry of incentive fees on immunization claims or auto populate unique field requirements for state-specific Medicaid claims. Again, when you find yourself or your staff losing efficiency, revenue or time due to unique claim requirements, consider that claim edits could help.

These are just a few examples of the numerous possibilities for claim editing as a solution to pressing industry challenges. Hopefully, by scratching the surface of available and evolving claim editing options, you can consider other ways to better leverage it for your business.

Emdeon is a leading provider of healthcare revenue and payment cycle management and clinical information exchange solutions in the U.S. healthcare system, including Emdeon Edit®. Emdeon Edit provides claim editing services customized to QS/1 Customers. To learn more, visit emdeon.com/qs1edits or call us at 877.707.0024.

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