Cardinal Health expands managed care network

DUBLIN, Ohio Cardinal Health announced Wednesday it has enhanced its suite of managed care services, which provide an array of tools to help pharmacies improve prescription reimbursements.

At the helm of Cardinal Health’s comprehensive managed care offering is LeaderNET, which manages network contracting and plan administration for community pharmacies in the United States, Puerto Rico and the Virgin Islands. The company has recently added contracts for niche markets including immunizations and 90-day medication supply programs. Cardinal Health also offers participating pharmacies access to a call center support team that can provide audit assistance and answer managed care, reimbursement and other general questions.

“One of the key reasons why a growing number of independent pharmacies use our managed care services is that they consistently deliver tangible results,” said Steve Lawrence, SVP independent sales for Cardinal Health. “Customers who use all of our managed care services experience an average annual savings of $42,000 to $70,000 per year. With returns like that, pharmacy owners realize that they can’t afford not to take advantage of the expertise they can get from Cardinal Health.”

There are nearly 3,000 independent pharmacies participate in Cardinal Health’s managed care network, the company said.

Key features of Cardinal Health’s comprehensive managed care offering include:

  • Automated Prescription Claim Editing: By electronically pre-editing prescription claims before they are sent to payors, Cardinal Health’s automated pre-adjudication editing tool helps pharmacies improve profitability by maximizing reimbursements paid by third parties. It seamlessly adjusts claims to make sure they contain accurate pricing information and are properly coded. It also provides financial, administrative and regulatory compliance reviews on prescriptions, helping to reduce the likelihood of third-party audits, underpaid claims and billing errors.
  • Electronic Payments from Payors: LeaderNET members receive prescription reimbursements faster and more efficiently through direct deposit. This service also saves pharmacists time by removing the time-consuming step of having to deposit and track hundreds of checks into an account.
  • Reimbursement Reconciliation: Even when prescription claims are properly submitted to payors, many can be underpaid – or worse – they can go completely unpaid. Unfortunately, the process of making sure that every individual claim is paid in full can be very time consuming, taking pharmacists’ time away from patients. Cardinal Health analyzes dispensing data, and then contacts payors directly to resolve outstanding payment issues. Participating retailers receive customized reports letting them know which reimbursements are still outstanding and which have been recovered by the service.
  • Customized Reimbursement Consulting Services: Cardinal Health offers independent retail pharmacy owners one-on-one consultations with an experienced managed care expert who can identify additional opportunities for revenue growth and profitability through customized analytics of each customer’s pharmacy dispensing data. 
  • Audit and Reimbursement Assistance: Professional audit assistance is also available to help independent pharmacists understand how to improve prescription claim compliance and reduce the likelihood of audits. The company also provides an online tool for independent pharmacies to submit – and receive prompt responses to – reimbursement questions and issues.

Independent pharmacies interested in learning more about how Cardinal Health’s comprehensive managed care offering can visit www.cardinalhealth.com/improvingreimbursements.