NCPDP - Real Time Adjudication
Real-time adjudication allows you to submit claims as your pharmacists fill prescriptions, ensuring accurate co-payments and timely payment. HomecareNet takes advantage of the latest technology so you can focus on patient care and accept patients covered by Medicare Part D.
Billing prescriptions is easier than ever with HomecareNet’s real-time adjudication functionality. HIPAA standard NCPDP 5.1 adjudication is fully integrated with HomecareNet’s robust home infusion billing software functionality, enabling your organization to focus on what matters most: your patients.
With real-time adjudication, your organization benefits from immediate response from Medicare (Part D), Medicaid and other insurance plans that you rely on for payment. HomecareNet provides immediate access to coverage information, reimbursement rates and co-pays. The immediacy of the NCPDP format allows your organization to instantaneously reserve one of a limited number of prescriptions permitted each month by certain Medicaid programs.
Save Time and Money
HomecareNet’s real-time adjudication saves your organization money in a number of ways. The time savings is most significant, as the home infusion billing process can be handled directly in the Order Entry portion of HomecareNet, where your pharmacists process prescriptions. An adjudicated claim can go directly into A/R without any biller intervention if you so choose. Eligibility is also verified instantly, with no phone calls or re keying of patient data into another system. In addition, clearinghouses charge less per claim for NCPDP transactions than for traditional claims.
HomecareNet allows you to automatically split billing between payers for different services. Products and services covered by certain payers (e.g. Medicare Part D) can be billed in real time, while the remainder of products and services in a given order can be billed through traditional electronic or paper claims. Once split-billing rules are set up, HomecareNet automatically applies them, without any intervention from you.
The Adjudication Process
HomecareNet has streamlined the adjudication process, providing your employees the facts they need at their fingertips. You can check a patient’s eligibility to determine the plan name, patient ID and group number. A claim can be submitted immediately after a pharmacist has initiated a prescription with or without reimbursement staff review (at your discretion). Claims are automatically submitted to a clearinghouse (Relay Health) via secure web connection* and responses are received directly in HomecareNet. This allows your staff to make more informed decisions about whether or not to fill prescriptions. The online response also allows you to capture patient co-pay amounts, facilitating collections and secondary billing.
*Alternatively, you can import claims into Day Tech’s CE2000 software.
Correct Errors Proactively
HomecareNet’s real-time adjudication feature enables you to quickly identify claims’ status and make corrections. Orders can be cancelled if claims have errors or insufficient reimbursement—before the prescription is filled. Plus, claims can be corrected and resubmitted immediately.
An Enterprise Solution
HomecareNet’s real-time adjudication benefits your organization across the enterprise, from responsiveness to patients all the way to the bottom line. Your employees will be more efficient and your organization will be streamlined, enabling you to focus on your business, not cumbersome paperwork and phone calls.
For More Information
Call us at (800) 738-8850 to find out about HomecareNet’s fully integrated solutions for home infusion, HME and home healthcare, specialty pharmacy and hospice providers.