Online Live
Adjudicated Claims
what
does that mean to me?
Background:
When you go to the pharmacy to fill
a prescription for say an antibiotic chances are the
pharmacist transmits the claim for your prescription using
an Online Adjudicated Live process. The pharmacist knows
immediately if your covered, if the item is covered for
your plan and diagnosis and a host of other drug / plan
related issues. If its covered you pay a copay, if its
not covered you pay for the whole prescription.
Pharmacies have been doing online claims for over 10
years.
When you send a claim to Medicare
DMERC it is always send in a Batch (i.e. a group of claims
sent at one time). Then you wait one day, two days maybe
more for the DMERC feedback reports only to find out it
was R rejected by DMERC's front end edits.
Or if the claim was A accepted by
DMERC's front end edits only to be rejected when you get
the EOB's. Thus no payment!
The Solution:
DMEFree LLC has teamed up with
Allwin Data systems (www.allwin.net)
to offer THE FIRST MULTI-USER HME DME BILLING SYSTEM WITH
ONLINE ADJUDICATION BUILT IN.
Sure pharmacies have been sending
DMERC claims for diabetic supplies for some time, but any
pharmacy or HME supplier doing substantial volume needs
Online Adjudicated billing AND a Multi-user HME Management
software program.
Click
here to review just some of the edits performed...
DMEFree LLC and Allwin Data are
sending over 200,000+ DMERC ONLINE ADJUDICATED claims a
month!! For over 7000+ pharmacies.
DMEFree LLC / PCSolutions is the
ONLY HME SOFTWARE VENDOR TO OFFER ONLINE ADJUDICATION.
200,000+ DMERC claims a month
can't be wrong!
IT'S THE WAY
TO GO!!!
Take a look at some of these errors
caught on-the-fly!
 |
INVALID DOCTOR'S UPIN |
 |
INVALID CARDHOLDER # |
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DIAGNOSIS IS NOT PAYABLE FOR THIS
PROCEDURE CODE |
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QUANTITY RESTRICTIONS BASED ON
PROCEDURE CODE |
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Cmns are checked for validity
against the claim (RX= transaction) |
 |
In addition to claims Narratives
(ha0 record) are submitted with the claim and
verified |
 |
Plus Cmn's are able to be submitted
with the claim and put through an extensive series
of checks! |
| And you can do online
reversals as well! |
|
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|
 |
Every transaction Claim, Narrative,
CMN and Reversal return a response message to keep
you informed. |
| And here is a PAID CLAIM! |
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Pricing:
| SERVICE PROVIDED |
PER CLAIM FEE |
Additional information |
| Online submission per Claim |
$.65 |
A claim is billable
when reported as Payable or Rejected |
| Rejected Claims |
$.65 |
Rejects are Billable,
its worth $.60 to find out a claim would be
rejected! |
| |
|
|
| Online submission of Narrative |
$.65 |
Optionally submitted
Online with Original claim to assist DMERC
evaluation. Used for Misc codes, Doctors notes etc. |
| |
|
|
| Online Submission of CMN |
$.65 |
Completed by Doctor.
Then submitted Online with initial claim for DMERC
specific procedure codes and items. |
| |
|
|
| Reversal Charge |
$.65 |
Fee to cancel a claim
in our system PRIOR to DMEFree sending it to DMERC |
| |
|
|
| Monthly Minimum |
$25.00 |
Do 25 claims a month
and you break even. |
* Current available for DMEFree software ,
development is underway for RxDME2000.
ORDER Online NOW!
Click here to enter our Secure Online Purchase page
SOME OF THE
EDITS WE PERFORM:
Assignment
accepted by pharmacy or patient and payment remitted to
pharmacy, corporate office, or patient.
Coordination of benefits handled whether Medicare is the
primary or secondary insurer. Other insurance amounts
automatically reported to participating secondary insurer.
 |
·
Doctor DEA / UPIN number and demographic verification.
|
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·
Patient ID and demographic verification.
|
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·
Product NDC / HCPCS code coverage and automatic modifier
determination.
|
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·
MAC
price, minimum/maximum quantity verification.
|
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·
Diagnosis code verification.
|
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·
Coordination of Benefits, and patient/pharmacy
assignment.
|
|
·
Maximum utilization edits and patient annual deductible
verification |
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