Financial viability through comprehensive reimbursement support.
In today’s specialty drug landscape, roughly 72% of payers use prior authorizations as a primary tool for cost management, often creating delays in access to therapy. RxTouchpoints, delivered through BDI Pharma subsidiary Radius Specialty Solutions, is a unique, HIPAA-compliant service providing support to specialty pharmacies for prior authorizations as well as billing and coding, appeals and complex case management for specialty product reimbursement. Our experts provide guidance from start to finish, alleviating many of the barriers that can lead to delays for both the patient and the specialty pharmacy.
Coding & Billing Assistance
ICD-10, HCPCs, CPT and coding assistance to aid with accurate filing of payer specific claims and correct use of modifiers for individual claims.
RxTouchpoints performs complete benefit investigations including the patient’s out-of-pocket responsibility, coverage limitations, requirements or other restrictions associated with the patient’s benefits which may adversely impact reimbursement.
Prior Authorization & Pre-Determination
RxTouchpoints gathers the payer’s requirements for obtaining a prior authorization or predetermination and will provide guidance in the preparation of materials if written documentation is required by payer.
RxTouchpoints can identify claims issues based on deep knowledge and expertise — specifically in claims for Factor products. As part of this service we will review a claim for administrative accuracy prior to submission to the payer, identify high level errors including missing fields when submitting a claim and verify that the claim meets the payer’s individual filling guidelines.
Coordination with Patient Assistance Programs
RxTouchpoints will research all available manufacturer programs and foundations for product access for the uninsured and underinsured patients. Patient Assistance Programs provide medications at no cost or at a discount to patients who qualify. Additionally, RxTouchpoints will research which foundations may also provide assistance programs that help with the costs of specific therapies including co-pays and insurance premiums.
Alternative Coverage Searches
Searches often include a review of benefit eligibility that may be available through services such as Medicaid, veterans’ benefits and Medigap (Medicare supplement). RxTouchpoints will also attempt to identify additional resources which may be outside the scope of the individual’s actual healthcare benefit such as transportation help and support for utilities and food.
Appeals & Denied Claims
RxTouchpoints will support the appeals of denied prior authorization requests and denied claims. We will provide sample appeals templates and coach through the appeals process if an appeal is warranted. We will support up to and including three (3) levels of appeal as available by the payer.
RxTouchpoints supports reimbursement training through web based education as well as in person training for your staff. Content focus will be developed in partnership with you.