Frequently Asked Questions
What services will I receive when I am a Quality Care Pharmacy NetwoRx member?
- Access to third party payer contracts that have been reviewed, negotiated and enhanced; whenever possible
- Assistance with direction and support in contracting with direct third party plans that require a contract with your clinic dispensary
- Full service credentialing and compliance program that will assist your clinic dispensary in HIPAA and FWA training and documentation
If I am a QCPN member, when should I contact Quality Care Pharmacy NetwoRx?
- MAC pricing issues: QCPN will assist clinic dispensaries in submitting MAC Appeals to "Contracted" third party payers by prompting them to enter appropriate information online. Each online form will be setup automatically as requested by each specific payer. Once the MAC appeal document has been completed, the clinic dispensary can submit the MAC appeal to the appropriate payer via preferred method requested by payer.
- Network Access: Questions regarding accessing networks available under QCPN can be directed to our customer service representatives. We will work with the third party payer to link your pharmacy to the network so that you may begin processing.
- General Third Party Communications: QCPN will communicate with "Contracted" third party payers on your pharmacy's behalf. Please contact us with general third party questions.
If I have a problem with a Direct Third Party Payer, should I contact QCPN?
Since Direct Payers usually prefer to communicate directly with your clinic dispensary, QCPN is limited in our ability to work with the payer on your behalf. If you have general questions and need direction on how to proceed with Direct Payers, QCPN can be available to you for assistance. Here are a few examples of how we may be able to offer additional assistance:
- Reviewing Direct Payer Addendums: As a QCPN member, you can forward addendums received from direct payers to QCPN for review. QCPN will respond to your clinic dispensary with direction. QCPN also communicates with all QCPN members in the form of a broadcast communication advising them on how to respond to the payer.
- MAC pricing issues: With the exception of Caremark, QCPN will assist your clinic dispensary in submitting MAC appeals to all direct-contract third party payers by use of our online MAC Appeal document generating system.
- Network Access: Questions regarding accessing networks available under Direct-Contract third party payers can be sent to your QCPN customer service representative. We will provide input on how your dispensary can work with the third party payer in order to link your location to the network so that you may begin processing.
If I am transitioning from another PSAO, what can I expect?
- If your clinic dispensary is transitioning from another PSAO, QCPN will obtain this information from you at the time of enrollment. You will be advised by a QCPN customer service representative as to when you should terminate your previous relationship.
How do I obtain my user name and password to access the Member's Section of www.QCPNetwoRx.com?
- Your login information for www.QCPNetwoRx.com will be available on the Information Sheet included in your Membership Packet. You can also obtain your login information by calling a QCPN customer service representative. Login information can only be sent via email to the primary contact listed for your pharmacy.
What tools are available on www.QCPNetwoRx.com?
- Your pharmacy can access several tools on QCPN's website. These tools include, but are not limited to:
- Payer Notifications - Notifications received from third party payers will be displayed on the website.
- Third Party Websites Links - Links to each third party’s website are included in the third party payer list.
- BINs and Plans - Our third party payer list includes BINs and plans associated with each third party contract.
- Network Manuals - If the third party payer has a network manual, it is displayed on the website for your retrieval.
- Transaction fees - If a third party charges transaction fees, and this information is available, their fee is listed in the third party payer list section on the website.
- Interventions - When a QCPN customer service representative is working on an open issue for your clinic dispensary, they will log notes regarding the details and their progress towards resolving the issue. This "Intervention" detail is displayed on the website for your convenience.
- Online MAC Appeal - QCPN makes an online MAC appeal tool available via the member’s section of our website.
- Special Network Information – QCPN provides detailed information such as plan names, PCN, BIN, Help Desk phone numbers and reimbursement rates for Medicare Part D Networks and other special networks.
If you have any questions regarding how to access these tools or any additional features available on our website, please contact a customer service representative.
How does my clinic dispensary benefit from joining a PSAO?
- Strength In Numbers - By joining our PSAO, you inherit the leverage already available to large chain pharmacies and independent pharmacy groups.
- Time Savings - QCPN customer service representatives will work on your behalf to communicate with contracted third party payers regarding network access issues and any additional inquiries pertaining to your third party payer contracts.
- Financial Savings - QCPN has been successful in working with contracted third party payers to enhance one out of every three contracts to financially benefit your clinic dispensary. These enhancements lead the industry when compared to any other PSAO in the country.
If I am a network member, what type of communications will I receive from QCPN?
- QCPN will broadcast timely news to network members regarding critical information about contracted third party payers. The preferred form of communication is email. Please be sure to provide a valid email address to QCPN at the time of enrollment.