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Debunking Myths about Reconciling Third-Party Claims in Your Pharmacy

With up to 95 percent of prescription revenue coming from third-party payers, reconciling pharmacy claims is a vital part of operating a community pharmacy. Despite its importance, many pharmacists still struggle to do it, or they simply don’t wish to invest their time in it.

Unfortunately, pharmacists that do not perform third-party claims reconciliation effectively are losing out on significant cashflow. Claims reconciliation can help pharmacists identify errors and pitfalls, prevent future issues, and ultimately optimize their finances. In this blog post, we will debunk some common myths about reconciling third-party claims in pharmacies.

Myth #1: Reconciliation rarely yields results, so why bother doing it?

This is a common myth about reconciliation that couldn’t be further from the truth. Performing claims reconciliation is the key to identifying billing and claim submission errors — errors that can result in denials, delay, or loss of payment. In addition, reconciling pharmacy claims enables you to identify and resolve issues early on, preventing them from becoming bigger problems down the road. The earlier you identify a problem, the easier and less expensive it is to fix.

Myth #2: Reconciling claims is unnecessary

Some pharmacists believe that if they submit claims and get paid, there is no need to perform any additional reconciliation. However, this is a dangerous mindset to have. Without having a system for reconciling claims, you could be over-billed, underpaid, or losing out on reimbursements owed to you. Moreover, performing claims reconciliation also helps identify incorrect payments, overpayments, and any errors that need to be corrected to maximize profits.

Myth #3: Claims reconciliation takes too much time

The third myth about claims reconciliation is that it’s time-consuming. This is true, but only when pharmacists or pharmacy technicians attempt to perform reconciliation manually. Fortunately, there is automated software available for claims reconciliation that makes the process faster, more accurate, and more efficient. With automated claims reconciliation software, pharmacists can quickly compare claim data to payment data, identify discrepancies, and resolve them promptly. By adopting automated software into your pharmacy, you can save time, improve accuracy, and ultimately, maximize profits.

Avoid financial disaster

Operating a pharmacy without reconciling third-party claims is a recipe for financial disaster. Reconciling claims can help pharmacists identify discrepancies, correct payment errors, prevent future issues, and optimize finances. Reconciling claims is an excellent way to stay proactive and get reimbursed correctly and promptly. To maximize your cash flow, we recommend reassessing your reconciliation practices and adopting automated software if you haven’t already. By doing so, you can optimize your payments and increase your profitability.


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FDSRX is now part of EnlivenHealth®