LibraRx Standard Reconciliation
The LibraRx Standard Reconciliation Program offers independent pharmacy "transaction
level" reconciliation and provides reimbursement audits similar to those
the chain pharmacies have employed since 1996. LibraRx compares data received
from the pharmacy's switched data (paid claims response) to electronic
remittance advice submitted by third party payers.
LibraRx supports reconciliation with all
third party payers that offer electronic claims remittance.
To participate in the LibraRx Standard 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.
LibraRx Standard 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.
- Daily reports identifying those third party payers that have not reimbursed 100% of the owed amount.
- 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, aging summaries and deposits.
2009 Success Stories!
Our reconciliation program identified the following payments that were not paid on time or otherwise paid incorrectly.
We recovered these funds on behalf of our member pharmacies and deposited the money directly into their bank accounts.
We will continue to scrutinize these payers as well as the other payers in our program to make sure that our
pharmacies are compensated correctly.
| Date |
Third Party |
Amount |
Pharmacies |
| 2009-09-28 |
HIP of New York |
$1,238,070.54 |
616 |
| 2009-09-23 |
HIP of New York |
$378,417.84 |
429 |
| 2009-09-11 |
Maxorplus |
$10,281.01 |
35 |
| 2009-09-09 |
Express Scripts |
$19,144.77 |
2 |
| 2009-08-24 |
Systems Excellence(SXC) |
$76,457.59 |
337 |
| 2009-08-21 |
Systems Excellence(SXC) |
$112,231.82 |
32 |
| 2009-08-17 |
HIP of New York |
$265,166.38 |
150 |
| 2009-08-14 |
Systems Excellence(SXC) |
$140,949.00 |
36 |
| 2009-08-05 |
Aetna |
$675.66 |
1 |
| 2009-07-10 |
Systems Excellence(SXC) |
$241,974.00 |
347 |
| 2009-07-03 |
Systems Excellence(SXC) |
$136,881.75 |
32 |
| 2009-07-01 |
Systems Excellence(SXC) |
$128,032.32 |
311 |
| 2009-06-30 |
HIP of New York |
$259,266.00 |
128 |
| 2009-06-24 |
Prescription Solutions |
$111.81 |
15 |
| 2009-06-24 |
Systems Excellence(SXC) |
$53.30 |
1 |
| 2009-06-24 |
US Script |
$69,922.91 |
76 |
| 2009-04-29 |
CVS CAREMARK |
$2,709.47 |
2 |
| 2009-04-08 |
Anthem Prescriptions |
$4,021.21 |
14 |
| 2009-04-06 |
Anthem Prescriptions |
$2,865.18 |
11 |
| 2009-04-01 |
National Medical Health Card |
$86,306.98 |
282 |
| 2009-03-25 |
Anthem Prescriptions |
$2,697.22 |
14 |
| 2009-03-11 |
HIP of New York |
$660,252.88 |
447 |
| 2009-03-11 |
Medimpact |
$23,678.98 |
48 |
| 2009-03-06 |
WHP Health Initiatives |
$309,891.03 |
288 |
| 2009-03-04 |
Anthem Prescriptions |
$3,185.87 |
12 |
| 2009-02-27 |
Medimpact |
$13,897.17 |
21 |
| 2009-02-04 |
MedTrak |
$237.60 |
1 |
| 2009-02-02 |
Medimpact |
$14,158.90 |
3 |
| 2009-01-28 |
Medimpact |
$17,383.07 |
23 |
| 2009-01-28 |
Rx Options (Medicare Only) |
$1,256.14 |
2 |
| 2009-01-14 |
Medimpact |
$1,112.05 |
5 |
| 2009-01-07 |
Medimpact |
$453.19 |
4 |
|
Totals: |
$4,221,743.64 |
3,725 |
Reconciliation Reports
The return on investment for participating in the LibraRx Standard Reconciliation Program can be
significant, and it is clearly stated on our reports.
It is not our intent to overwhelm our pharmacy participants with data. Once your pharmacy signs up with our program you
will be assigned a unique log-in and password that you can use to access your pharmacy’s specific reports.
DEPOSIT – Provides your deposit
history and the claim counts posted for each payer over the last 90 days. You can drill down to the claim
level on this report as well.
AGING – Claims identified on this report are
the claims captured from the switch that were not paid
in 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.
This report tracks these claims 0 to 30 days (current) and then at 31-60, 61-90, 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.
|
