Our benefits verification team is expert in handling all aspects of insurance coverage and will complete the process for physician, pharmacy, and patient. All outcomes from the benefit verification process are then communicated to the physician and patient to determine product delivery model that is best suited for each patient. In the event the patient needs additional assistance where coverage is limited, one of our experienced team members will assist the patient in selecting the appropriate patient assistance program.
We don’t just assist with the Prior Authorization, we manage it. P5 Connect will ensure and follow the prior authorization process from start to finish and proactively manage the renewal process to ensure there are no interruptions in patient therapy. A full database of coverage and criteria for each medication for each insurance is maintained to effectively collect the pertinent information from the physician that will result in higher approvals and quicker turnaround time.
We support physicians and pharmacies in all appeals. These appeals can occur for either billing issues or prior authorizations. All correspondence with the insurance companies and Prior Authorization process are documented within the HUB to assist in the appeal process.
All payer benefit coverage criteria for the medication and therapy is documented in the P5 Connect HUB system. This information is utilized to obtain all necessary data elements prior to requesting benefit coverage resulting in quicker approval time frames for coverage and prior authorizations. We also share the coverage criteria and partner with the Pharmaceutical Medical Affairs division to improve overall benefit coverage for their products.
Billing & Coding Support
We support the billing process for both the physicians and dispensing pharmacies. Our proprietary “How To Bill Document” is sent to the physician’s office for every administration and contains all the necessary information to assist the physician in the creation of the billing invoice.
Adherence & Clinical Services
P5 Connect develops customized adherence programs that centers around the patient needs. Through our risk assessment programs we identify the care plan and patient outreach program that will work best for the individual patient.
Our Clinical programs are designed to manage clinical pathways, therapy management and patient outcomes. All data is reportable and utilized in the communication with the physician and health care team.
Our clinical programs also provide Disease and Therapy educational materials for the patient, family and caregivers. Our clinical staff of Pharmacist and Nurses provide assistance throughout the course of therapy and become an extension of the patient health care team.
Patient Assistance Programs
P5 Connect team members are well informed of all programs that will provide patient assistance either through co-pay cards, co-pay assistance programs, free product, samples and/or free trials. In our Benefit Verification process we identify what the patient out of pocket will be per fill as well as the estimated amount out of pocket cost for the benefit year. This provides the patient with the financial information needed to determine if any patient assistance program will be needed throughout the course of the therapy and allows P5 Connect team members to be proactive in finding the patient the financial assistance they need to complete the therapy.