Drug claims need a process, not a person
Authorization, billing units, wastage documentation, and payer-specific drug policies all have to line up before a claim is submitted. When one piece is missing, the denial is large and the appeal is slow.
We build a pre-submission checklist for drug claims and track authorization status by patient and regimen, so nothing is discovered after administration.
- Prior authorization and regimen-specific payer policies
- Unit calculation and wastage documentation
- J-code selection and supporting records
- Clinical trial and off-label coverage considerations
Supporting the whole care team
Oncology practices coordinate physicians, infusion staff, pharmacy, and financial counselors. Billing has to fit into that flow rather than interrupt it.
Reporting focuses on what the team can act on: authorizations expiring, claims awaiting records, and denials by payer policy.