LTC NETWORK
LTC Network
Our LTC Network is Designed to Enhance Your Reimbursements and Growth
GeriMed’s widely recognized Medicare Part D network can help ensure that your pharmacy obtains reimbursements and contract terms that benefit your bottom line and empower you as an independent LTC pharmacy provider
Network Contracting
GeriMed is contracted with Medicare Part D plan sponsors and the pharmacy benefit managers (PBM) that process Part D claims. Among them are:
• CVS Caremark
• DST
• Express Scripts
• Elixir
• MedImpact
• Optum Rx
• Prime Therapeutics
• CVS Caremark
• DST
• Express Scripts
• Elixir
• MedImpact
• Optum Rx
• Prime Therapeutics
GeriMed is contracted with commercial plan sponsors and the pharmacy benefit managers (PBM) that process commercial claims. Here is a partial list:
• Capital Rx
• DST
• Elixir
• Gateway
• MaxorPlus
• MedImpact
• MedOne
• Optum
• PerformRx
• ScriptCare
• Capital Rx
• DST
• Elixir
• Gateway
• MaxorPlus
• MedImpact
• MedOne
• Optum
• PerformRx
• ScriptCare
GeriMed is contracted with Managed Care Medicaid (MCM) plan sponsors and the pharmacy benefit managers (PBM) that process MCM claims, such as:
• Navitus
• Optum Rx
• RxAdvance
• Navitus
• Optum Rx
• RxAdvance
Audit Compliance & Resolution
GeriMed has a proven track record of preventing recovery of legitimate payment from pharmacy audits and restoring valid payment that has been taken by the payer after a final determination of an audit.
ACRS includes, but is not limited to, the following:
• Appeal letter and attestation templates
• Documentation review
• Audit manual template
• Appeal to payers
• Regulatory research
• Appeal letter and attestation templates
• Documentation review
• Audit manual template
• Appeal to payers
• Regulatory research
Pre- and Post-editing & Reconciliation Services
• Edit review claims prior to submission
• Properly administer new NCPDP codes
• Overcome staff training issues
• Over 60 pharmacy claim edits
• Edits unique to long-term care
• Reporting: What pharmacies need to know
• Edits are flexible, custom & point of sale
• No software necessary to delay in claims processing
• Properly administer new NCPDP codes
• Overcome staff training issues
• Over 60 pharmacy claim edits
• Edits unique to long-term care
• Reporting: What pharmacies need to know
• Edits are flexible, custom & point of sale
• No software necessary to delay in claims processing
• Stop under-billed claims and under-paid claims
• Stop chasing pharmacy reimbursement
• Get a guaranteed return on investment
• Reduce the number of times claims are touched
• Save money on switch fees and payer processing fees
• Stop chasing pharmacy reimbursement
• Get a guaranteed return on investment
• Reduce the number of times claims are touched
• Save money on switch fees and payer processing fees
Other Services
Today’s LTC pharmacy needs a network that provides assistance with third-party claims, timely industry news, reports that audit accurate rate payment and an 835 data warehouse. GeriMed’s staff will support pharmacy personnel in managing the administrative functions of the pharmacy.
Health plans must provide a remittance advice which identifies all claims paid within a cycle and corresponds to pharmacy payment. The electronic remittance advice is called an 835. GeriMed will work on behalf of pharmacies to retrieve the 835 from the health plans and make them available to pharmacies on a secure FTP site. Pharmacies may then access all 835s, from one location, for the health plans they submit claims to for payment.
• Secure FTP site
• One location for all 835s
• 835 support
• Software to locate 835s
• Secure FTP site
• One location for all 835s
• 835 support
• Software to locate 835s
GeriMed wants to ensure pharmacies receive the contracted rates for claims billed by the pharmacy. To do this, we will perform audits of pharmacy claims and send reports to the pharmacy for any claims that did not pay according to GeriMed contract rates.
• Receive monthly reports
• Detailed by payer
• Identifies underbilled/underpaid claims
• Capture additional payment
• Receive monthly reports
• Detailed by payer
• Identifies underbilled/underpaid claims
• Capture additional payment
Below are some of the many ways GeriMed provides solutions for LTC pharmacies.
• Third-party claim support
• Prior authorizations
• Claim overrides
• Rejections
• Short cycle dispense
• Claim re-work
• Part B vs. D
• Hospice claims
• Best available evidence
• Low income cost share.
• Third-party claim support
• Prior authorizations
• Claim overrides
• Rejections
• Short cycle dispense
• Claim re-work
• Part B vs. D
• Hospice claims
• Best available evidence
• Low income cost share.
GeriMed is dedicated to providing our pharmacy members with timely and relevant information which results in operational and financial success. The Weekly Dose is used to communicate Medicare Part D plan information, CMS requirements and news, Contract Rates & Obligations and LTC industry information. Every Monday, the Weekly Dose is emailed to pharmacy owners, billing staff, pharmacy operations managers and pharmacists. As a member of the GeriMed LTC Network, pharmacies will automatically receive the Weekly Dose.
800-456-4374
502-339-1417