Helping patients begin therapy faster and reducing patient drop off once on therapy,  we work with payers to confirm the patient’s coverage status, determine the best benefit and identify any potential hurdles to access

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ActiveKey reimbursement services provide a variety of prior authorization support reducing administrative hassle in accessing. We have got hub experience in specialty pharmacy eliminating any risk of prescriptions “falling through the cracks” while our non-dispensing pharmacy status ensures seamless prescription fulfillment. With robust appeals support, physicians are more independent focusing on the patient instead of tracking down delayed or denied claims reimbursement.

Making it Easier on The Practice

Our site coordinators help to become an extended arm to provider’s team, with a single point-of-contact case management approach that streamlines the process.

Working closely with your field teams, our site coordinators develop strong relationship with practices and establish regional expertise around payer trends. Hotline services can be customized to work the way the practice works, with preferences such as phone vs. fax contact and the need for specialty pharmacy triage.

Patient Support

ActiveKey team members are well trained on all areas relating to product support to address all needs of a patient through a single call. Each counselor is required to attend different trainings as customer service, disease-sensitivity and product-information training ensuring readiness for launch.

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Benefit Verification

ActiveKey reimbursement counselors are benefit verification experts, well trained for techniques of performing a thorough benefit verification. Using ActiveHubTM to ensure comprehensive benefit verification, our counselors examine and detail everything from coverage requirements to payment levels.

Prior Authorization

Our goal remains to remove all the potential hurdles in the product access as in the process and our ActiveKey reimbursement counselors facilitate the prior authorization process on behalf of patient, supporting them through any required administrative paperwork.

We provide parameters of the authorization referral process, required forms and clinical criteria. And we facilitate communication between the provider, patient and payer.

Billing and Coding

Our reimbursement counselors can provide reimbursement tools such as coding tip sheets, sample claim forms and billing guides. Facilitating inbound inquiries regarding billing, coding and claim submission process is a core ingredient of our reimbursement support programs.

With the ability to develop content for these tools, ActiveHubTM provides information regarding coverage and payment for Medicare, Medicaid and private payers.

Appeals Management

Basic front end counseling is very important in preventing denials, ActiveKey also offers support in a claim denial situation. Many of our reimbursement counselors have years of healthcare experience, including advanced graduate degrees or direct clinical experience. The amalgamation of education and experience, along with strong communication skills and technical writing abilities, lends itself to a successful appeal.

Researching requirements for patients whose claims have been denied are done by our Reimbursement Counselors and are ensured that payer forms are complete. We also follow up on submitted appeals until claim resolution.

Payer Policy Research

We can help providers research basic coverage information about key payers with which they work frequently. This research provides information around general payer policy on a specific product.

Surveillance

Our reports allow you to identify which payer accounts require communication, mentioning areas that are disconnecting, where the system is not considering claims that should be approved and where further payer education may be necessary.

Specialty Pharmacy Coordination

Our pharmacy license allows ActiveHubTM to seamlessly support the specialty pharmacy process. With extensive experience across multiple programs, we can review incoming requests and triage to the appropriate specialty pharmacy based on manufacturer-desired business rules.

Patient access can be confirmed through reconciliation, and referrals can be verified through two-way electronic interchange with specialty pharmacies. Dedicated program facilitates complex cases such as carve-outs, transfers, etc.

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