Conlin's Pharmacy Edit+ Implementation Case Study

This case study details the implementation of Edit+, an automated pre- and post-editing service for claims at Conlin's Pharmacy & Medical Equipment. The pharmacy faced challenges in ensuring that claims sent to insurance were fully accurate and reimbursable, particularly due to tight margins and scrutiny from audits. The introduction of Edit+ has allowed Conlin's to automate the correction of claim issues, leading to significant labor savings that have exceeded the cost of the service. Over a two-month period, nearly 500 edits were made to adjust Average Wholesale Price (AWP) or Usual and Customary (U&C) pricing, which contributed to improved reimbursements. Additionally, the service facilitated various financial and compliance edits, enhancing the accuracy of claims submitted. The Director of Pharmacy Services, Sandra Kalil, emphasizes the importance of maintaining a personal approach while modernizing workflows to remain competitive in the evolving market.