Question 1

What is electronic claims reconciliation?

Accepted Answer

Electronic claims reconciliation is the process of automatically matching third-party claims payments to your billing data.

Question 2

How do I know if I have unpaid or partially paid claims?

Accepted Answer

Net-Rx reporting keeps you up-to-date on claims that have not reconciled - whether it is due to non-payment, partial payment, or payer take backs.

Question 3

Do I need a Central Pay to participate in the RecRx program?

Accepted Answer

Central Pay is not required. Net-Rx is vendor neutral; we can reconcile all third-party claims, regardless of your participation with a Central Pay.

Question 4

Can I get electronic explanation of benefits (EOBs) for all payers?

Accepted Answer

Yes, Net-Rx can obtain electronic EOB files from any payer that offers them, including state Medicaid.

Question 5

Am I able to reconcile claims for payers who don't offer electronic EOBs?

Accepted Answer

Yes. You can enter your remaining paper remittances, and RecRx will convert them into electronic files to achieve 100% third-party electronic claims reconciliation.

Question 6

How will I know how much money I am owed at the end of the month?

Accepted Answer

The Net-Rx RecRx service allows you to access your third-party claims information and identify missing and/or short paid claims. In addition, Net-Rx offers a Third Party Accounts Receivable service to help you balance your month-end process.

Question 7

How do I know when to expect payment from a payer?

Accepted Answer

Net-Rx's Days Sales Outstanding (DSO) report identifies the average number of days between claim transaction dates and their payment dates, giving you payment timeline trends by payer.

Question 8

Am I able to track DIR fees (Direct and Indirect Remuneration fees) and other adjustments?

Accepted Answer

Yes. Net-Rx's RecRx Fee/Adjustment report allows you to quickly and easily identify and quantify adjustments made to payments, including DIR fees, at the claim and check level.

Question 9

How can I track claims that are part of a payer audit?

Accepted Answer

Net-Rx’s RecRx Fee/Adjustment report allows you to quickly and easily identify and quantify adjustments made to payments at the claim and check level. If a previously paid claim is reversed as part of an audit, a record of the adjustments can be found on this report.

Question 10

How long does it take to get my pharmacy setup on RecRx?

Accepted Answer

Typically, setup takes 2-4 weeks to complete. Our RecRx service includes a manual remittance entry tool that allows you to manually enter paper remittances received during your setup period to ensure complete third-party reconciliation. We perform periodic payer reviews to proactively identify and set-up any outstanding payers.

Question 11

How do you collect my prescription claims and payment data?

Accepted Answer

Net-Rx works with all major third-party payers and software vendors to collect your EOB remittance data and dispensing data through a secure FTP connection.

Question 12

Is my data secure?

Accepted Answer

At Net-Rx, data security is our top priority. All of our solutions require authentication to use; we have firewalls to deny unauthorized access. We perform regular vulnerability assessments and our employees participate in regular HIPAA and security certifications.

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