Medical Billing Auditing

Managed Contracting Service

ClaimPay’s managed contracting service encompasses more than 100 contracts. We aggressively negotiate each contract, handle provider enrollment, and perform all necessary maintenance to keep each enrollment active. More comprehensive management of the contracts can be provided when combined with ClaimPay’s cash management and claim-by-claim reconciliation services.

We collectively bargain with pharmacy benefit managers (PBMs) to obtain the most favorable contract language for each pharmacy or practice. We also process the claims/billing information on behalf of independent pharmacies or practices. Throughout this process we have benchmarks, and monitoring tools in place to ensure compliance with contract terms, and to identify any specific claims which are not being processed in compliance with contractual terms.

  • ClaimPay provides a professional review of each PBM contract to ensure that pharmacy provider rights are protected, while abiding by the professional obligations of each PBM Contract.
  • ClaimPay negotiates, modifies, updates, and enrolls individual dispensing locations into our network.
  • ClaimPay will monitor and make their best effort to ensure timely payments from the PBM’s relative to the adherence by the PBM to their own payment processing cycles.
  • ClaimPay can review and evaluate PBM contracts not currently held by MDSRx on your behalf.