Pharmacy professionals are familiar with existing pharmacy dispensing processes. In general, patients provide pharmacy professionals with their prescription(s). Pharmacy professionals obtain patients’ insurance and demographic information and submit pharmacy claims to the Pharmacy Benefits Manager (PBM). In a matter of minutes, pharmacy professionals can determine coverage, patients’ copayment and their reimbursement. Once patient counseling occurs, patients pay the appropriate copayment and the pharmacy is reimbursed by the PBM. In the pharmacy dispensing environment, most of these activities occur close to real-time while patients are in the pharmacy.
Submitting medical claims, however, are significantly different than submitting pharmacy
Submitting medical claims, however, are significantly different than submitting pharmacy