Specialty Pharmacy
Prior Authorization and RCM

From initial order processing through reimbursement support to developing protocols that suit every situation, we provide the blend of advanced, AI-driven automation and third-party partnership that crystalizes your operations.

Specialty Pharmacy Prior Authorization and RCM
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The Challenge

Specialty pharmacies bring unique challenges through the handling and distribution of a diverse and complex menu of specialty pharmaceuticals and medicaments. With an ever-increasing menu of pharmaceutical options, specialty pharmacies are growing and expanding with a corresponding operational escalation that would benefit from expert support.

From cancer treatment to organ transplant to infertility and growth hormone treatments, specialty pharmacies require precise and accurate processes to guarantee maximum reimbursement. Health plans and PBMs, as well as providers and patients, look to your specialty pharmacy for expert service and support — look to our pharmacy operations experts to fulfill your business support services using advanced automation and human intelligence.

Infinx-is

Infinx is there with 24/7 support that ensures streamlined business
operations and maximized reimbursement allowing you to focus on patients.

Specialty Pharmacy Solutions Include:

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Order Processing & Support

Our expert team will perform accurate and timely data entry for both new orders and all necessary refills. Working within your organizational parameters, orders will be processed based on pharmacy-specific priority and run times so your entire system runs at top-level efficiency.

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Protocol Development

Our team understands providing advanced pharmacy services and can assist your organization in developing protocols for special handling, storage, and distribution that meet or exceed accreditation requirements. We can guide you through NABP, JCAHO, ACHC, and URAC accreditations, either for initial or triennial certification.

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Reimbursement Support

We ensure highly proficient reimbursement management that lifts your organization’s bottom line. Our expert team provides patient access and prior authorization processing that ensures specialty pharmaceutical protocols are met. And our skilled billing experts are equally essential when managing timely claims and A/R optimization so that every dollar available is collected.

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Authorizations and Reauthorizations

In specialty pharmacy, prior authorizations and reauthorizations are required on almost 100% of the pharmaceuticals prescribed. Infinx’s Prior Authorization Plus software provides consistent and accurate processing and follow-up for all medications. Our streamlined dashboard displays real-time prior authorization information 24/7.

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Intake Support

Let our team of experts provide comprehensive new patient setup and benefits verification that will ensure precise billing and maximize reimbursement. We understand the need for exact care details, like diagnoses and allergies, but also the importance of verifying insurances, copays, out-of-pocket maximums, secondary coverages, and related plan details.

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Technology

Our experienced in-house software team builds custom, scalable solutions to meet your highly specific business needs. With advanced automation options that feature Artificial intelligence (AI) and machine learning capabilities, we offer proprietary QA, workflow, and tracking software that deftly manages specialty pharmacy reimbursement. In addition, our technology suite provides the actionable analytics required for outstanding business results.

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24/7/365 Expert Support

Infinx has been serving pharmacies for 15+ years and is proud to offer subject matter expertise overseen by US-Licensed Pharmacists and Pharmacy Technicians. We provide the specialty pharmacy management services you can rely on 24/7/365. Our team is available around the clock to ensure your information is ready on time, every time.

Our Results

300k
refills processed
monthly
150k
new orders
processed monthly
100k
new admissions
processed monthly

Let us support your specialty pharmacy with expert business and reimbursement support. Contact us to learn more.

Speed Up Prior Authorizations Using Automation and Artificial Intelligence

Accelerate your approvals, collect more revenue, and improve the patient experience

Schedule a Demo