Pharmacy Billing & RCM
Pharmacy billing and revenue cycle, 50-state coverage.
Pharmacy billing and revenue cycle services from ASP-RCM Solutions. 108,949 NPPES pharmacy billing providers across all 50 states + DC. BHCOE channel partner. HIPAA + SOC 2 Type II compliant. Senior partners on every account.
What good pharmacy billing execution looks like.
The operating discipline we install on every pharmacy billing engagement.
- Specialty pharmacy prior authorization workflowSpecialty drugs require payer PA with clinical criteria. your state specialty pharmacies need PA automation and dispense-decision workflow integrated with the PA outcome.
- 340B inventory + claim modification340B-eligible pharmacies (FQHC, DSH hospital, RWHAP) need precise 340B inventory tracking and TB modifier application on Medicaid claims to avoid duplicate discount.
- DIR fee management and Star RatingsMedicare Part D Direct and Indirect Remuneration fees impact pharmacy profitability significantly. your state pharmacies need DIR tracking and PSAO performance management.
- Compounding billing accuracyCompounded drug billing requires precise NDC reporting, ingredient-level pricing, and payer-specific compounding rules. Frequent audit target.
- MTM + clinical pharmacy services billingMedication Therapy Management (G0270, G0271, 99605-99607) and clinical pharmacist services bill under specific codes when documentation supports.
- Patient assistance program coordinationyour state specialty pharmacies coordinate manufacturer patient assistance programs, copay cards, and foundation grants for high-cost drug access.
Top pharmacy billing markets by NPPES org count.
State-level RCM guides for the largest pharmacy billing markets in the U.S.