When you file a claim, what happens to it? The answer may be more complicated than you think.
| UPDATE: Federal law is beginning to move towards a solution to high prescription drug prices. The U.S. Supreme Court will soon take up a case on whether states can regulate certain aspects of prescription drug reimbursement, essentially taking on pharmacy benefit managers (PBMs) and protecting pharmacies from below-cost reimbursements. In addition, the “Lower Costs, More Cures Act” was introduced in December with the aim to lower out-of-pocket spending, protect access to new medicines, and strengthen transparency, accountability, and competition. This act has considerable bipartisan support, making it likely to pass. Today's post is from our broker blog, AllWays Insider, which is exploring pharmacy cost trends in a series of posts. Because many of the dollar amounts reported on cost increases are so staggering, health plans and pharmacy benefit managers (PBMs) are working together to address increasing drug costs. Here are four measures aimed to control premium and out-of-pocket insurance costs and help manage prescription drug costs. |
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Starting on January 1, the AllWays Health Partners provider portal became your single-stop for claims and eligibility checks. On the portal, you can check these in less than a minute. Previously, it could take up to 10 minutes to check claims and eligibility by phone.
Not sure how to check claims and eligibility or — gasp! — not registered for the provider portal? Check out our three new demos. All three are concise, informative, and easy-to-follow for your convenience.
As National Immunization Month — and summer — wraps up. Here are a few reminders about how to bill for vaccinations, along with some news about HPV vaccine coverage.
Recently we published an article about the anatomy of a CPT code. In it, we explained how these digits keep everything clear and consistent for payers and providers. But what about unlisted codes? Some payers have stopped accepting them altogether. Here's why.
Topics: Claims, Doing business with payers
