Reconciliation

The Libra Reconciliation Program offers independent pharmacy "transaction level" reconciliation and provides reimbursement audits similar to those the chain pharmacies have employed since 1996. Libra compares data received from the pharmacy's switched data (paid claims response) to electronic remittance advice submitted by third party payers.  Libra supports reconciliation with all third party payers that offer electronic claims remittance.

To participate in the Libra Reconciliation Program, your pharmacy should enroll in the Third Party Station chain network (code #866).  For more information, please contact us toll-free at (800) 460-1575 - Option #3.

Reconciliation simplifies your payment process; you’ll receive remittance advice and payment from one source – Third Party Station.

Here's what you can expect from our Third Party Claims Reconciliation:

• Accurate reimbursement from contracted third party payers
• Weekly and monthly reports identifying those third party payers that have not reimbursed 100% of the owed amount
• Identification of claims that third party payers hold for “post audits” even though you may have received a “paid” response
• Central payment and reconciliation for participating pharmacies on third party payers
• Fast payment via electronic funds transfers rather than mailed checks
• Easy access to web-based remittance advice reports

Success Stories!

Our reconciliation program identified the following payments that were dropped or otherwise paid incorrectly. We recovered these funds on behalf of our pharmacies and deposited the money directly into their bank accounts. We will continue to scrutinize these payers as well as the others in our program to make sure that our pharmacies are compensated correctly.

Date	Third Party	Amount	Pharmacies
2008-02-27	LDI	$16,895.24	36
2008-02-27	Pharmacy Data Management	$113.55	1
2008-02-25	Netcard Systems	$18,262.36	71
2008-02-22	Ameriscript	$641.05	2
2008-02-22	Restat	$60,978.39	242
2008-02-20	Restat	$139,230.78	254
2008-02-19	Ameriscript	$921.29	2
2008-02-19	Anthem Prescriptions	$1,561.43	8
2008-02-15	Web MD	$3,847.79	5
2008-02-13	Ameriscript	$457.36	2
2008-02-13	Netcard Systems	$17,163.72	65
2008-02-01	Medimpact	$17,292.70	114
2008-01-25	Anthem Prescriptions	$1,294.99	3
2008-01-25	First Health Rx	$67,687.34	336
2008-01-25	Netcard Systems	$18,034.76	68
2008-01-25	Web MD	$650.67	2
2008-01-09	Prescription Solutions	$1,416,032.39	318
2007-09-07	WHP Health Initiatives	$3,827.27	1
2007-03-15	National Medical Health Card	$174.09	2
2007-02-28	ProCare Rx	$61.40	1
2006-12-20	Catalyst Rx	$440,779.61	335
2006-12-15	ScripSolutions	$276.17	7
2006-06-02	Prescription Solutions	$5,722.10	7
2006-05-25	Express Scripts	$36,590.33	9
	Totals:	$2,268,496.78	1,891

Summary of Exception-Based Reports Through Libra Reconciliation Program
The return on investment for participating in the Third Party Station Libra Reconciliation Program can be significant, and it is clearly stated on our “exception-based” reports.  It is not our intent to overwhelm our pharmacy participants with data.  Therefore, you will only receive reports when there is a discrepancy.  We call these reports "exception-based" since the only claims you will find listed on them will be those with payment issues.  Exception-based reports are classified as follows:

POSTED – The posted report shows the claims that we were able to match as paid for the week. A history of match claims is available with this option.

EXCEPTION – Claims identified on this report are the claims captured from the switch that were not paid the full amount agreed to by the third party payer. While PARTIAL PAY claims tend to be small, these claims collectively can result in substantial amounts over time.  It is a good practice to examine the cause of PARTIAL PAY to rule out improper charges such as unauthorized transaction fees or improper network discount reimbursements.

WEEKLY AGING – Claims appear on this report when they remain unpaid over time. This report tracks these claims 0 to 44 days (current) and then at 45-90, 91-120 and over 120 day increments. You can drill down to the claim level detail to examine individual claims that have not been paid. 

DEPOSIT – Provides your deposit history and the claim counts posted for each payer for each reporting period. You can drill down to the claim level on this report as well.