As part of the pharmacy workflow, VerifyRx processes millions of transactions a day, updating comprehensive prescriber data in real-time, including Drug Enforcement Administration (DEA), State data (when available) and daily National Technical Information Service (NTIS) data.
This highly configurable and responsive tool provides real-time sub-second response on multiple compliance checks for all prescription transactions before transmission to payers, helping retail and specialty pharmacies reduce regulatory risk. VerifyRx identifies potential claims submission errors prior to dispensation and helps Pharmacy Benefit Managers (PBMs) increase the percentage of paid prescription claims.
Inconsistent and erroneous or outdated data remains a major challenge for retail pharmacies nationwide. Many pharmacies invest a lot of time and effort trying to solve this growing problem, dealing with the fallout of compromised quality and poor resource allocation. Manually checking provider data on federal and state websites takes multiple steps, leaving room for error and inefficiency. It’s also a very reactive approach to managing information-powered functions. Payer payment recoveries can also happen in case of errors, creating an additional negative financial impact on pharmacy operations.
An alternative approach to manual verification is automating verification and monitoring of healthcare provider licensing and credentials. Comprehensive batch and real-time technology solutions can streamline a variety of provider verification searches and ongoing monitoring options. They can also provide automatic red flag alerts for a wide range of high-risk indicators.
The scope of the challenges pharmacies face when using poor provider data is significant. It’s a frequent area for mismanagement which often results in both fraud and improper payments. Provider Data Enhancements offers pharmacies not only data-handling cost efficiencies but also workflow time savings when operating with correct, current and comprehensive healthcare provider data.
Provider Data Enhancements reduces the IT burden associated with ongoing data management efforts and makes claims processing more efficient through increased auto-adjudication. By identifying and replacing inaccurate, duplicate, and incomplete records, pharmacies can ensure they have the most current provider data to enable quick and efficient prescription claim processing.
As retail pharmacies increase their visibility in the community, they have enormous potential to improve health outcomes and expand their role within the patient care team. By employing social determinants of health, pharmacies can better understand their patients’ struggles, motivations and limitations, enabling them to better engage with each patient in a way that improves their care while solidifying the role or the pharmacy in driving community health.
Socioeconomic Health Attributes insights can help provide insights on the conditions that affect patient health – the environments in which patients live, learn, work, and play. Having this granular view of patients’ lives is essential for the pharmacists and other clinical care providers to address possible barriers that stand in the way of optimal treatment.
It all comes down to embracing a holistic model of patient management. The time has come for a transformation in how pharmacies think about care: from a reactive or symptom-based set of responses to a proactive path that leverages data-driven engagement with individuals. By building a corporate strategy that’s based on wellness, pharmacies can establish a welcoming environment that values lifestyle management for each patient.
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