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What You Need to Know About Pharmacy Billing Software

pharmacy billing software

For many pharmacists considering opening an independent pharmacy there can be confusion surrounding claims and billing.  Unlike other types of medical billing, pharmacy billing is done in real time—providing pharmacy owners with immediate adjudication responses from payers and more insight into the status of their prescription claims.  Pharmacy billing software is an essential part of your business and something that Datascan offers right within our dispensing software.

Why do we need a pharmacy billing software?

In order to be reimbursed for your prescription claims you must be able to adjudicate them to a PBM or third party payer.  When filling prescriptions for your patients they can choose to pay cash or use their insurance plan.  When patients opt to use their insurance, the pharmacy system must be able to transmit claims data to the third party in order to generate a patient pay amount, or copay.  In most pharmacy software systems billing happens at the end of inputting prescription information and provides the pharmacy with a breakdown of how they will be reimbursed.  This tells the pharmacy if they are making a profit on a prescription or potentially losing money.  The billing software makes sure you’re able to manage your pharmacy’s profitability.

Why use Datascan’s pharmacy billing software? How can you benefit?

Datascan’s pharmacy billing software is integrated directly into our dispensing system.  Billing is an automatic part of prescription filling in our system which makes it quick and easy to manage.  Once prescriptions are entered our pharmacy software will send the prescription claims through a switch to the PBM, allowing pharmacy staff to see if the claim is not only paid or rejected, but if it’s profitable.  Datascan’s billing software allows pharmacies to bill not only a primary insurance plan, but also secondary and even tertiary plans for patients with dual eligibility.  Our easy-to-use billing software also includes comprehensive reporting capabilities to easily analyze claims.  Reports can be customized for your pharmacies specific needs and can even be exported and saved to Excel, allowing you to easily analyze your data even further.

What information is provided?

Once claims are billed, Datascan provides a comprehensive explanation and breakdown of your reimbursements.  Each claim response is detailed, providing your pharmacy staff with the amount reimbursed by insurance and the amount of your patient’s responsibility or copay.  Our insurance responses will warn your staff if there is an underpayment, DIR fee, or potential flag for audit.  For prescriptions requiring Prior Authorization or PA, the authorization is sent directly from the response screen in the billing software.  Our intuitive billing software color codes prescription status and queues them to make it easy to manage pending claims.

Accurate billing software is arguably one of the most important parts of your pharmacy software system.  The simpler and more automated the billing software is, the easier it is for pharmacy staff to understand and use.  Our software provides pharmacies with the necessary tools to run a successful and profitable independent pharmacy.