Pharmacy Revenue Cycle & Reporting

Automate your critical backoffice workflows associated with pharmacy claims, pharmacy CMS reporting, eligibility, and reimbursement reconciliation.

Overcoming challenges

AI-powered Pharmacy Revenue Cycle and Reporting Automated

Challenge #1

Reactive and Manual CMS Pharmacy Reporting

Many healthcare organizations are required to report their pharmacy data to CMS and other entities on a regular basis. This involves wrangling disparate, messy data sources and it consumes significant time from employees across departments. Preparation for ad hoc submissions can take months, and valuable insights and optimizations are often overlooked due to the reactive nature of the reporting process. Critical institutional knowledge regarding the entity's specific reporting needs resides in employees' heads, creating a key person risk across various steps.

Our solution

Plenful’s Pharmacy Reporting solution enables organizations to use one system to support their reporting needs, while also allowing for continuous real-time monitoring and insights to be flagged within its underlying data. Proactively address reporting issues through Plenful’s highly configurable flags and notifications, optimizing the capture of opportunities within your datasets.

Challenge #2

Eligibility Management is Manually Burdensome

Many healthcare organizations face hourly, dynamic, and disparate changes to eligibility that must be monitored and processed for downstream vendors and reports. Managing this data is critical for business operations and patient care, but its manual and ever-changing nature imposes significant workflow and staffing burdens on operations and IT teams. The lack of consistency and the volume of data also prevent the ability to holistically view, analyze, or trend the data.

Our solution

Plenful’s Eligibility Solution enables teams to fully automate their eligibility data and reporting processes. Our highly flexible data translation layer allows organizations to configure rule sets and automation cadences based on their business needs. No more manual work is needed for your eligibility or similar workflows. Process tens of millions of rows of data seamlessly and deliver data exports tailored to your specific requirements

Challenge #3

Part D Claims are Scattered

Given evolving CMS requirements, processing pharmacy claims involves significant manual work, largely handled by IT and operations teams. Reactive claims processing also poses substantial compliance and business risks due to potential inaccuracies in claims statuses. Conversely, the inability to process all potential claims at scale results in substantial missed financial opportunities, amounting to millions of dollars per year for an organization.

Our solution

Healthcare organizations, including Medicare Advantage plans and Pharmacy Operations teams, utilize Plenful’s Part D Solution to support their Part D claims reconciliation and opportunity identification processes. Plenful audits 100% of their claims using relevant datasets and unlimited entity-specific crosswalks to provide an AI-searchable system of record, required reporting data exports, and proactive human-in-the-loop flags within the platform for identified opportunities.

Solutions

Your Team’s Robust Tool to Support your Automated Pharmacy Revenue Cycle and Reporting

Automated Pharmacy Reporting Requirements

Real-time processing and issue identification of your required pharmacy external reporting to CMS, manufacturers, and other entities. Eliminate manual work, ensure compliance, and proactively monitor.

Optimized Part D Claims Processing

Process 100% of your Part D claims and automate the claims reconciliation and opportunity identification process. Unlimited crosswalks and rules across your claims volume.

Streamlined Eligibility Data

Eliminate manual work associated with dynamic eligibility data and deliver outputs in the exact required format to downstream critical endpoints. Proactively monitor for issues and trends.

“Integrating Plenful into our operations team’s workflow has unlocked our team’s potential by freeing them up to focus on more meaningful aspects of their work. Through complementing the systems we already use in our operations and utilizing Plenful’s intuitive automation platform, Plenful has been a seamless adoption process and we are excited about the direct value add of the platform.”

Dr. Peter Chang, Vice President of Healthcare Design

Tampa General Hospital

Resources