Off-label use of claim editing
I remember the first time I worked in a pharmacy like it was yesterday. Not only was it fast-paced and exhilarating, the work also was meaningful and beneficial to the community. I can hardly believe it’s been close to 20 years since I began behind the counter. Today, my work is still in the industry, helping to build products and services for all types of pharmacies – chains, independents, grocers and everything in between. In this rapidly changing healthcare environment, pharmacies must utilize all of the tools at their disposal to not just remain financially viable but thrive as a provider of healthcare.
One of those tools is switch-based claim editing. And yes, my last sentence may well have caused a collective eye roll. But please keep reading. Claim editing has been around for decades but it’s not just for AWP and DAW updates any longer. Today’s editing platforms are flexible and scalable and when fully leveraged can help drive pharmacy success. The following are just a few examples of the “off label” uses for claim editing that can help your business.
Recalls and Discontinued Products
By continuously monitoring FDA communications, a claim editing tool can activate real-time edits to notify pharmacy employees of recalls and discontinued products at point of fill. While both wholesalers and software vendors also provide these updates, the ability of claim edits to trigger notifications within hours of the alert right at point of dispensing is important, especially for recalled products.
Claim editing is no longer one size fits all. Savvy owners and chains are using customized messages to drive unique business goals.
• Inventory Management
Whether it’s because of excess inventory or better acquisition costs, pharmacies often have preferred products. Claim messages triggered when a non-preferred NDC is utilized can encourage staff to consider your preferred alternative. The significant impact inventory management has on the bottom line makes it a great area to consider customized editing.
• Loyalty and Customer Engagement
Pharmacies are competing for market share for prescriptions, front of store sales and healthcare services. Because of this many of them have carved out niche programs for a variety of health conditions for humans and even pets. Triggering immunization reminders based on payer or alerting a diabetic patient receiving insulin of additional support services are just a few examples. The possibilities for how customized claim editing can help drive these programs are endless.
• Automated Field Population
We all have those special circumstances that require rare claim fields to be populated. Claim editing is a great way to automate a process that might otherwise require numerous key strokes or toggling to infrequently used fields and screens. For instance, you can automate the entry of incentive fees on immunization claims or auto populating unique field requirements for state specific Medicaid claims. Again, when you find yourself or your staff losing efficiency, revenue or time due to unique claim requirements, consider that claim edits could help.
These are just a few examples of the numerous possibilities for claim editing as a solution to pressing industry challenges. Hopefully, by scratching the surface of available and evolving claim editing options, you can consider other ways to better leverage claim editing for your business.
About the Author
Jonathon Kopf is a pharmacy product manager for Emdeon, a leading provider of healthcare revenue and payment cycle management and clinical information exchange solutions in the U.S. healthcare system. He has worked in the pharmacy industry for more than 15 years, starting in the trenches as a pharmacy technician. Prior to joining Emdeon, Jonathon has held various roles in both retail pharmacy and pharmacy benefit management. He holds a bachelor’s degree in management with a health organization focus from Texas Tech University.
Incoming NACDS chairman John Standley of Rite Aid takes stage at Annual Meeting, emphasizes partnership
SCOTTSDALE, Ariz. — Taking the stage as the newly elected National Association of Chain Drug Stores chairman during Tuesday morning’s business program at NACDS Annual in Scottsdale, Ariz., Rite Aid chairman and CEO John Standley stressed the value NACDS provides its members and emphasized the importance of partnership throughout the industry.
“This is a critical point in time for the chain drug industry. Healthcare delivery is undergoing historic change, placing unprecedented demands on our business while presenting enormous opportunities to grow,” Standley said after accepting the gavel from Bob Narveson, president and CEO of Thrifty White Pharmacy, who concluded his one-year term as NACDS chairman. “As our individual companies deal with these dramatic changes, my objective today is to ensure that everyone — especially our associate members — understands and appreciates the valuable role that NACDS plays in helping us navigate this new healthcare landscape.”
Incoming NACDS chairman John Standley accepts the gavel from Bob Narveson, president and CEO of Thrifty White Pharmacy, who concluded his one-year term as NACDS chairman
In outlining some of the opportunities facing the industry, Standley talked about how Rite Aid, for example, is focused on transforming the company from a traditional drug store chain into a retail healthcare company.
“Those are carefully selected words — retail healthcare company. Other chains here would state their mission in similar terms. These words reflect the expanded role that community pharmacy is already playing through expanded services like immunizations, retail clinics and medication therapy management,” Standley said. “But these words also reflect a vision for the future that redefines what a drug store can be and how we can find new ways to provide care beyond prescriptions.”
Standley discussed how the rapidly changing healthcare environment has forced pharmacy retailers to think differently about core business models, and how to best support the needs of customers and patients.
At Rite Aid, for example, this has resulted in the Rite Aid Health Alliance program, which provides one-on-one interventions with patients.
“What is unique about this program is how pharmacists, in-store care coaches and local physicians work together to support the patient in achieving his or her wellness goals. This team-oriented approach provides additional support to patients between doctor’s visits and further motivates them in taking steps to improve their health,” Standley said.
Aside from emphasizing company initiatives that include partnerships with other local healthcare providers, Standley also noted partnerships with suppliers of pharmacy and front-end products.
Standley said that NACDS is “leading the way in educating policy-makers about the expanded role of community pharmacy and making sure that our voice is heard during key policy debates. … And if you think about it, these issues fall into one of two categories: maintaining our current business model for pharmacies and setting the stage for our business model of the future.”
He described NACDS efforts to advocate for fair Medicaid pharmacy reimbursement, for “provider status” for pharmacists and for improved access to medication therapy management services, among other issues.
Beyond government affairs, Standley described the value of NACDS meetings and conferences to the industry’s evolution, such as the Regional Chain Conference in February, the Annual Meeting and the Total Store Expo in August. Also, later in the year, there’s NACDS Week in New York City.
During his remarks, Standley acknowledged Caitlin Pappas, VP, U.S. consumer sales, Johnson & Johnson Family of Consumer Cos., who supported and also spoke at Tuesday morning’s NACDS Annual Meeting business program.
During her presentation, Pappas shared some of the struggles and learnings that J&J has encountered in this new healthcare environment.
“What we’ve learned is, first and foremost, hire someone who really understands the Affordable Care Act and use them to rip it apart and help you find opportunities to grow your business and improve health outcomes in the United States. … Be open to new ideas for Millennials; they are a big consumer group who want very different things to improve their healthcare. And technology is great, particularly if it can save consumers time and increase healthcare compliance,” Pappas said.
Steve Anderson of NACDS talks with former Secretary of Defense Leon Panetta.
Wrapping up Tuesday’s program was a keynote address by former Secretary of Defense Leon Panetta, who also served as director of the Central Intelligence Agency, chief of staff to President Bill Clinton, director of the Office of Management and Budget, and a member of the U.S. House of Representatives and chairman of the House Budget Committee.
New Tic Tac mints evoke summertime memories
SOMERSET, N.J. — Tic Tac mints, a brand from the Ferrero Co., on Tuesday announced the debut of limited edition Summer Ice Pop Tic Tac mints. The combination of blue berry-flavored pills, red cherry-flavored pills and white lime-flavored pills aims to offer consumers a nostalgic reminder of summertime, the company said.
“We’re excited to launch this new, unexpected flavor that brings back a lot of great memories for our fans,” said Todd Midura, marketing director for Tic Tac mints at Ferrero U.S.A. “The new Summer Ice Pop Tic Tac mints capture the refreshing taste of a classic summer treat and give us a chance to create new memories.”
To celebrate the latest flavor, the brand will treat fans and followers of the Tic Tac USA Facebook and Twitter pages with free sample. The brand also will take to the streets of a few major cities this summer to share samples.
Summer Ice Tic Tac mints can be purchased at select convenience and grocery stores for a limited time throughout the summer season.