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Net-Rx Recent News

Have you ever wondered why payers will reject some claims, adjudicate others with profits, or respond on some with losses? The answer may lay with whether the medications’ NDC (National Drug Code) is on the payer’s formulary list.  If it is on the list, what tier is it on and is it a preferred medication? The answer may affect the reimbursement amount and patient copay assignments.

The outbreak of the Coronavirus (COVID-19) has taken its toll on your patients, employees, families, and businesses. During times like these, it can be easy for changes in claim volume, medication shortages, and coding errors to go unnoticed. In this article, we share some best practices to help you get ahead of these challenges.
The vast majority of reimbursement issues (and the corresponding revenue) are associated with the Average Wholesale Price (AWP). In this article, we will review some of the ways the AWP can get outdated, and best practices for keeping it updated. Finally, we discuss how you can identify and reconcile prescriptions filled with an incorrect AWP.
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