CASE STUDY:
Claims Reconciliation and Receivables Management
for a Fortune 100 Pharmacy Chain
The Client:
A large Fortune 100 pharmacy chain with more than 400 stores. This chain processes more than 14 million claims per year with a value of more than $350 million.
The Challenge:
The client managed its pharmacy claims in-house, but the high volume of claims was adding cost and complexity. The client was unable to identify specific claims that were unpaid, underpaid or overpaid, and could not reconcile claims with payments due to payer-specific adjustments and fees. 
Reconciliation was complex, time-consuming and expensive, and there was not a system for claim-level tracking or claim-to-payment reconciliation in place.
The Objective:
The client wanted to bring in a partner with expertise in third party reconciliation that could “systematize” the receivables collection operation with a flexible, technology-based solution. They wanted to improve the accuracy of their operation and provide an audit trail.
The Results:
To date, our management of the chain’s pharmacy receivables has achieved the following results:
- Write-offs were reduced from 1.5% of receivables to 0.3% of receivables
- Days Sales Outstanding (DSO) was reduced from 45 days to 21 days
- Aging receivables over 90 days were reduced from 8.5% of all receivables to 0.75% of all receivables
- Unapplied cash was reduced from 14% of all cash to 0.18% of all cash
Read the entire Pharmacy Chain Reconciliation & Receivables Management Case Study (PDF)
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