LTC Reimbursement Network

As the first and largest Medicare Part D Network for independent LTC pharmacies, MHA is uniquely effective in delivering maximum value to our members through our multifaceted long-term care network:

Market-leading Value through Part D Partnerships

Our industry-leading Medicare Part D contracts and reimbursement rates are negotiated to appropriately recognize the value and services MHA members provide to Plan beneficiaries. As the largest network of independent long-term care pharmacies, we effectively advocate for LTC pharmacy needs with PBMs and CMS and offer the broadest coverage of LTC beneficiaries.

Generic Effective Rate (GER)

Exclusive to MHA, our Medicare Part D GER contracting provides reimbursement protection in two unique ways:

No PBM takebacks if GER is better than the contracted rate
PBM payments to pharmacies via MHA if GER is less than the contracted rate

Brand & Generic Reimbursement Rates and Dispensing Fees

Negotiated to cover the additional costs incurred by long-term care pharmacies in dispensing medications and providing services to their patients.

Consultative Field-based Engagement

Dedicated to our members growth and performance, our team is concentrated into centers of excellence, optimizing the MHA experience. Our mission is to provide proactive consultation and regional subject matter expertise to help our members leverage trends within the industry and navigate the dynamic reimbursement marketplace.

Account Support
Our account team schedules regularly occurring discussions to review forward-looking trends and opportunities in order to optimize your performance through GPO, Network, and technology solutions.

EFT Connectivity
Our network specialist team offers a single point of contact to guide you through the Electronic Funds Transfer (EFT) process. We know that setting up direct deposit across multiple locations and third-party payers can be complicated which is why our team is equipped with proprietary resources to support you through the steps needed to help you achieve reliable and faster funds availability.

Billing and Payer Consultation
Our analysts schedule regularly occurring meetings focused on best practices and payment reimbursement in order to help identify billing errors, missing payments, and underpayments. Also outlined are proactive steps to take to recover potential revenue and missing payments and how to apply those learnings moving forward. Available with certain Net-Rx services. Contact us for more information.

Innovative Performance-based Solutions

MHA is leading the market in bringing innovative performance-based solutions to our membership to help them achieve compensation that is aligned with the level of services and care provided to their patients.

Comprehensive Medication Review
Providing members with an opportunity to earn additional compensation for work already being done, MHA’s Comprehensive Medication Review (CMR) Program allows participating pharmacies to identify patients who are eligible for a review. Industry-leading tiered compensation structure is available for reviews completed at admission, in-stay and/or during transitions of care for specific covered beneficiaries. Contact us to learn more and enroll in the program.

Proactive Reimbursement Tools & Technology

Net-Rx, an MHA solution, is the recognized leader in pharmacy reimbursement, reconciliation, and business analytics. Net-Rx’s innovative software and services can help maximize opportunities, minimize risk, reduce operational costs, and increase profits along with other proprietary MHA technologies.

Reimbursement Management

Did you get paid enough? Our suite of reimbursement management solutions are designed to help ensure that you receive the maximum possible with several options to suit your needs.

Contract Assure

Did you get paid at the MHA negotiated rate? Contract Assure identifies claims not paid at the LTC Reimbursement Network contracted rate, helping members recover revenue.

Script-IQ® ^*

A pre-edit solution specifically designed for long-term care pharmacies, Script-IQ transforms the claim quality checking process by detecting and correcting errors before the transaction hits the switch or payer, helping to deliver improved reimbursements. Contact us for details and a demonstration.

EditRx ^*

Using proprietary analytics, this post-edit prescription claim editing service is designed to identify billing and database errors after claim processing has occurred. With the help of a dedicated Reimbursement Analyst, EditRx gives your pharmacy the ability to identify claims that could be corrected in order to recover revenue that might otherwise be lost. Contact us for details and a demonstration.

Revenue Cycle Management

Did you get paid? Our set of financial management solutions includes tools that allow you to select the options that work best for your business needs.

RecRx ^*

Achieving up to 100% third-party claims reconciliation, this solution automates the process of matching your third-party payments to pharmacy system claims, helping to save time and improve pharmacy cashflow. Contact us for details and a demonstration.

Aging Assist ^*

With support from an analyst, Aging Assist helps manage aging receivables, including unmatched, unpaid claims, and missing files, providing steps to capture outstanding payments, helping to improve days sales outstanding (DSO) and pharmacy cashflow. Contact us for details and a demonstration.

Third-Party Accounts Receivable ^*

The financial and total sales report tools provide clarity for the accounting monthly close process. You’ll have a helpful summary of third-party claim-level detail, payments, fees, sales, adjustments, receivables, and outstanding values. Contact us for details and a demonstration.

On-Demand Business Intelligence

Designed with our members’ needs in mind, our pharmacy analytic tools enable users to quickly connect to the information they need to benchmark performance, identify opportunities, and make informed business decisions.

MHA Member Portal

The MHA Member Portal is a gateway with anytime access to robust GPO and Network reports and member-specific dashboards designed to help inform key business decisions, provide increased financial insights, and identify optimization opportunities.

Metric-Rx^®*

This advanced pharmacy business intelligence platform combines multiple data sources to reveal KPIs and actionable insights on reimbursement, profitability, utilization, and trends, all laid out in easy-to-understand dashboards and reports. Contact us for details and a demonstration.

Key Industry Insights

Our proprietary Key Industry Metrics Report provides blinded and aggregated insights into key performance indicators from participating LTC pharmacies across the nation, enabling members to compare their pharmacy metrics against the industry as a whole.

*Solution powered by

Net-Rx, an MHA Solution, has specialized in providing operational and software-driven solutions exclusively for pharmacies for more than 20 years. Our innovative interlocking suite of software solutions includes claims reconciliation, insurance reimbursement optimization, and pharmacy analytics. Our market-leading solutions help customers maximize third-party reimbursement opportunities, minimize PBM audit risk, reduce pharmacy operational costs, and increase gross profits. For a demo and pricing information, contact us or email sales@net-rx.com.

The LTC Reimbursement Network offers multiple benefits:
– Industry-leading contracts with built-in reimbursement protections
– Deep industry and regional expertise offers forward-looking guidance to leverage trends and identify opportunities
– Diversified revenue streams through clinical activities and patient outcome performance programs
– Optimized reimbursement experience through advanced pharmacy data analytics

Contact us today for more information!

LTC Reimbursement Network

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