Reimbursement Management
Smarter Reimbursement Control
Our reimbursement management services focus on tracking payments, identifying underpayments, and improving revenue visibility. We help pharmacies maintain consistent reimbursement flow while reducing delays and maximizing financial performance.
REIMBURSEMENT MANAGEMENT
Maximize Every Prescription Reimbursement.
We analyze your PBM contracts against actual paid rates, identify underpayments and DIR fee patterns, and build the documentation needed to challenge unfavorable contract terms at next renegotiation.
Pharmacies that engage CoreMedX reimbursement management recover an average of $4,200 per month in previously undetected underpayments.
DIR FEE MANAGEMENT
DIR Fees Tracked. Challenged. Reduced.
We analyze your DIR fee statements against PBM contract language, identify calculations inconsistent with your performance metrics, and prepare formal dispute documentation where discrepancies exist.
We also track your star ratings, adherence rates, and CMR completion in real time so you can improve the scores that drive DIR fee reduction before the assessment period closes.
CONTRACT OPTIMIZATION
Better Contracts. Better Margins.
CONTRACT OPTIMIZATION
Better Contracts. Better Margins.
We benchmark your current PBM contracts against market rates for your pharmacy type, geography, and dispensing volume identifying specific drug categories and payer relationships where your rates fall below market.
Pharmacies that go through CoreMedX contract optimization average a 3.2% reimbursement rate improvement translating to $68,000 to $140,000 in additional annual revenue.
