Payer-Sponsored Medical Billing TIPs

Practice at the Top of Your License

Pharmacies have an exciting opportunity to expand their role in patient care and maximize revenue beyond traditional dispensing. With the expansion of provider status in many states, pharmacies can offer valuable clinical services, creating new streams of billable and sustainable income. These services not only support business growth, but also enhance patient access to care. By embracing these opportunities, pharmacies can strengthen their position in the healthcare landscape, increase profitability, and provide even greater value to their communities.

Payer-Sponsored Medical Billing TIPs are different than what your pharmacy may be used to. Outcomes contracts with the payer for a medical billing program, we identify the patients for you, and load TIPs into the Outcomes platform. This process makes it easier than ever to complete medical billing claims alongside your other MTM opportunities!

Step 1

Start the process to get credentialed and enrolled with the medical billing sponsor.

See details below.

Step 2

Fill out the following form to start the process to get set up for medical billing through Outcomes.

Medical Billing Service Agreement

Step 3

Program launches – guided TIP workflows are live in your Outcomes dashboard for qualifying patients. Contact patients to complete the TIPs.

Step 4

Outcomes submits medical claim transaction on behalf of your pharmacy. You receive payment directly from the medical billing sponsor.

Current Medical Billing Programs

Expand to view your options.

Highmark Wholecare

Outcomes now offers payer-sponsored TIPs for asthma education reimbursed on the medical side of the health plan leveraging pharmacist provider states in Pennsylvania.

How do I get started?

To start completing these TIPs, start with these two steps:

1. Enroll with Highmark Wholecare.

Start the credentialing and enrollment process here.

2. Set Up Medical Billing.

Complete this form to get your pharmacy set up for medical billing through Outcomes.

Conduent

Pharmacist Providers in Maryland are now eligible to complete medically billed Comprehensive Medication Reviews on Outcomes.

How do I get started?

To start completing these CMRs, start with these two steps:

Enroll pharmacist(s) with Maryland Medicaid as provider.
Start the process here.
Set Up Medical Billing.
Complete this form to get your pharmacy set up for medical billing through Outcomes.

What is the Medical Billing program?

An innovative payer-targeted program for pharmacists.

What do I need to do to get started?

You need to complete the credentialing process through the medical billing sponsor, or follow the steps above.

How is the program targeted?

Outcomes will be presenting the opportunities and patients for you via a traditional TIP.

How often will my patient(s) be targeted?

Outcomes will be targeting your patient(s) throughout the year for continued follow-up. Qualifying patient(s) could be targeted monthly.

How am I reimbursed for the service?

Upon successful completion of the asthma workflow, input of the patients' medical insurance, Outcomes will transmit a medical claim for the service provided. You will be reimbursed directly from the medical billing sponsor based on the fee schedule set forth by your state. Your medical billing claims will follow the payment method that is selected during that enrollment process.

Why am I seeing a $0 MTM intervention payment?

Payment will be provided through the medical billing sponsor after a successful medical claim.

What is the cost to the patient if this is billed on the medical side?

There is no cost to the patient for this service.

What other medical billing offerings are on the Outcomes platform?

Outcomes has a number of clinical workflows (e.g. COVID Test and Treat, Smoking Cessation, Medication Administration) to support medical billing in your state. These are available if you upgrade to the Premium offering for our Clinical Module. Learn more about Premium here.