PROGRAM PAYS PHARMACY CLAIMS IN 24 HOURS

CAROL ANGRISANI

NEW YORK -- Buehler Foods and Edward's Super Foods are using a service that gets their third-party prescription account receivables paid overnight.

"It gives chains, especially the smaller ones, a fighting chance," said Lou Giannotti, chief pharmacist, northeast region, Edward's, Windsor Locks, Conn. Rapid RxEmit, a computerized reconciliation and bill-paying system created by the Pharmacy Fund here, pays participating pharmacies within 24 hours for 100% of all approved adjudicated claims submitted each day. Reimbursement usually takes 30 to 45 days. The money is deposited directly into the pharmacy's bank through an electronic funds transfer. The Fund, in turn, keeps about 2% of the claim.

Fred Tarter, the Fund's chairman and chief executive officer, underscored the simplicity of Rapid RxEmit. "There's no new technology; the pharmacy doesn't have to install any new programs or software," he said. The system works through the National Data Corp., Atlanta, a pharmacy claims processor, that exchanges information with pharmacists and third-party payers. The Fund has linked a software system to NDC's network, which enables it to monitor transactions and collect data necessary to buy receivables from participating retailers.

A similar system, OmniLink PaySystems, is being tested by McKesson Drug Co., San Francisco. The McKesson system is connected to Envoy, Nashville, Ga., another pharmacy claims reconciliator.

Rapid RxEmit is currently in use at Buehler Foods, Wooster, Ohio, and at 12-in-store pharmacies formerly owned by Mayfair Super Markets, Elizabeth, N.J., which was purchased by Ahold USA, Zaandam, Netherlands, and became part of Edward's Super Foods this year. Giannotti has recommended Edward's roll out the program chainwide, but a decision hasn't been made yet.

Rapid RxEmit debuted at Mayfair's 12 in-store pharmacies in December, 1994, as part of a three-year contract. Before Rapid RxEmit about 4% of its third party claims, which account for 70% of prescriptions, went unpaid, according to Giannotti. "The time and expense was a nightmare," he said. "We spent an incredible amount of time chasing claims that had to be recoded and resubmitted."

Rapid RxEmit completely overhauled the department. "We now get our hands on money quickly," he said. Buehler Foods, which launched Rapid RxEmit this year, also lauded the program. "It has improved our cash flow," said Roger Buehler, pharmacy supervisor.

Buehler declined to say exactly how much the Fund is charging it, only to say that it is significantly less than what the retailer was losing by managing third-party claims on its own.

Save Mart, Modesto, Calif., piloted Rapid RxEmit in 1994, and used it throughout last year. But it currently is not participating, according to Bert Lee, the retailer's former pharmacy director. Lee, who has praised Rapid RxEmit in published reports, left Save Mart this month to become vice president, operations, for OmniLink PaySystems reconciliation program. Michele Snider, acting pharmacy director, Save Mart, was unavailable for comment.

Smith Barney, has raised $80 million of an anticipated $500 million for the Fund, which had its first transaction 18 months ago.Tarter said between 200 and 500 pharmacy units using the system. Supermarkets account for about 20% of its customers. One of the greatest advantages to pharmacies is that all claims are paid. The fund assumes responsibility to reconcile and chain incorrectly paid or unpaid claims.

"This is an opportunity for the supermarket pharmacist to outsource his account receivable management without it placing a drain on his capital," Tarter said.