Question 1

Will you help us get contracted with commercial insurances?

Accepted Answer

Yes. We handle both credentialing and contracting with medical payers. As part of our network, we will also advocate for the highest reimbursement possible. FYI, billing services to the medical benefit has the potential to pay a higher reimbursement while avoiding other prescription benefit fees.

Question 2

If I have a payer set up on the prescription side, does that make them "In-Network" on the medical side?

Accepted Answer

No. Although they may be owned by the same parent company, medical and prescription payers are not the entity. You will need to be contracted with each medical payer to which you would like to bill services in order to receive reimbursements for the clinical services you are performing.

Question 3

How long does it take to fully credential, negotiate, and contract on the medical side?

Accepted Answer

The time depends on the payer and is subject to change. Some payers might take only 2 weeks to contract, and some that might take up to 9 months. However, our pharmacies are able to begin billing to their first payer within 60 days (on average).  We stay on top of each payer contract to ensure they are being completed as quickly as possible. We will also stay in constant communication with you regarding the status of your payer enrollments.

Question 4

I’m already contracted with Medicare. Will that allow me to bill for services for my Medicare Advantage patients?

Accepted Answer

No. A traditional Medicare PTAN (Provider Transaction Access Number) is not enough to bill and receive reimbursements from Medicare Advantage plans. You need to be directly contracted with each medical benefit payer that executes whichever Medicare Advantage plan you would like to bill to. Provider CSAO opens reimbursement access to commercial and Medicare Advantage patients.

Question 5

Do I need to be contracted with the commercial side of a Medicare Advantage plan to receive reimbursement?

Accepted Answer

Yes. A traditional Medicare PTAN is not enough to bill and receive reimbursement from Medicare Advantage plans - you need to be directly contracted on the commercial side in order to bill those plans. At Provider CSAO, we are able to open reimbursement access to your commercial and Medicare Advantage plans through inclusion with those networks.

Question 6

Are vaccine reimbursements really that much higher?

Accepted Answer

Yes! Our pharmacies were used to billing to the prescription benefit. After switching to billing the medical benefit, some of our pharmacies have seen their reimbursements increase by up to 600% (depending on the payer, claim, and region).

Question 7

How many clinical services can I offer other than vaccines?

Accepted Answer

Depending on your location, a lot! We have helped our pharmacies to become contracted to bill for dozens of different services, including DSME, smoking cessation, MTMs, E&M codes, and more! Service availability varies across regions and payers. Contact our team to find out what services you can offer in your area.

Question 8

How can I start working with you?

Accepted Answer

Great question!! Feel free to submit a form below by clicking “Contact our team” or shoot us an email to info@providercsao.com and we will reach out.

Frequently asked questions