QFLD · SVC-003
Know exactly what your payers owe you and where the gaps are
Monthly reconciliation of insurance and program payments against submitted claims — underpayments surfaced, denial patterns identified, and outstanding receivables organized clearly by payer.
THE PROMISE · QFLD-P01
A clear picture of what third-party payers have and haven't settled
For most independent pharmacies, a significant share of revenue passes through insurance companies, Medicare, Medicaid, and other third-party programs. That revenue is only fully yours once it's actually been received and confirmed — yet the gap between what was submitted and what arrived often goes unexamined month to month.
This service closes that gap. Each month, submitted claims are compared against received payments, payer by payer and program by program. Underpayments are identified. Denials are noted. Outstanding receivables are summarized by age. You get a complete picture of your collection position rather than an approximation.
What you can expect
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Claims matched to payments by payer
Each month's submitted claims are reconciled against received payments at the payer and program level, giving you a factual basis for understanding your actual collection rate.
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Underpayments and denials identified
Amounts paid below the submitted claim are flagged. Denied claims are noted separately with the denial reason where available, so patterns across payers become visible over time.
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Aging summary of outstanding receivables
Outstanding receivables are organized by payer and age bracket each month, so you know where collections are moving at a reasonable pace and where they're sitting too long.
THE SITUATION · QFLD-P02
Payer discrepancies tend to accumulate quietly rather than announce themselves
Insurance companies and government programs don't always pay exactly what was submitted, and the difference isn't always obvious from bank deposits alone. A payer might consistently reimburse at a slightly lower rate than contracted, deny a particular claim type without a clear pattern, or let receivables age past reasonable settlement windows without triggering any automatic alert.
None of these issues are large in isolation. Together, across multiple payers and several months, they represent a meaningful gap between the revenue your pharmacy earned and the revenue it actually collected. Catching them monthly — rather than during a quarterly review or a year-end reconciliation — is considerably less disruptive.
Common patterns that go undetected
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Systematic underpayments from a single payer that are too small to catch individually but meaningful in aggregate
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Denials that repeat for the same claim type across multiple billing cycles without resolution
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Receivables aging past 90 days with a payer that hasn't communicated a dispute or denial
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True collection rate by payer unknown because submitted and received amounts have never been systematically compared
THE APPROACH · QFLD-P03
Monthly reconciliation at the claim and payer level
The reconciliation process works through submitted claims, received payments, and outstanding balances systematically — producing a written monthly report rather than a general impression of where things stand.
Claims-to-payment matching
Submitted claims from the period are matched against received remittance data, payer by payer. The comparison identifies what was paid in full, what was paid short, and what wasn't paid at all — with the amounts documented clearly rather than estimated.
Denial and underpayment reporting
Denied claims are listed with their stated denial reason. Underpayments — where received amounts fall below submitted amounts — are summarized by payer and program. Patterns that repeat across periods are noted in the monthly report.
Aging summary of receivables
Outstanding receivables are organized by payer and age bracket — current, 30–60 days, 60–90 days, and over 90 days. This gives you a straightforward view of where collections are progressing and where follow-up may be warranted.
THE ENGAGEMENT · QFLD-P04
What working together looks like
The reconciliation process runs on a monthly cycle. Setup is a one-time process that maps your payer relationships and claim data sources so the ongoing work is consistent and thorough.
Payer mapping
We start by mapping your payer relationships — insurance contracts, government programs, and any other third-party arrangements — along with how claims are submitted and how remittances are currently received and organized.
Reconciliation setup
The matching framework is set up around your specific payers and claim types. Historical data is reviewed where useful to understand any existing aging receivables that need to be carried forward into the ongoing reconciliation.
Monthly reconciliation
Each month, submitted claims are matched against received payments. The report includes underpayments and denials by payer, an updated aging summary, and any patterns or observations worth noting for your follow-up.
Ongoing tracking
The reconciliation builds over time. Patterns in denial rates, payer timing, and collection performance become clearer across quarters, giving you a more informed basis for managing payer relationships.
THE INVESTMENT · QFLD-P05
$350 USD per month
This covers the complete monthly reconciliation process — claims-to-payment matching across all active payers, underpayment and denial reporting, and an aging summary of outstanding receivables organized by payer and bracket.
The service can be used on its own or alongside the broader Pharmacy & Dispensary Accounting service. For pharmacies where payer reconciliation is the primary gap in their current accounting setup, it works as a standalone engagement without requiring any other service changes.
The initial conversation includes a look at your current payer mix and claims data so the scope and monthly process are clear before anything begins.
What's included
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Monthly claims-to-payment matching across all active payers and programs
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Underpayments identified and summarized by payer with amounts
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Denial reporting with reason codes where available from remittance data
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Aging summary of outstanding receivables organized by payer and time bracket
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Collection rate by payer tracked and reported each period
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Recurring denial or timing patterns noted across periods where they emerge
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Written monthly report delivered on a consistent schedule each period
THE FRAMEWORK · QFLD-P06
How the reconciliation works and what it produces
The process covers three distinct aspects of third-party payer accounting, each producing its own output in the monthly report.
Matching layer
Claims against remittances
Submitted claims are compared against remittance advice from each payer. The match identifies full payments, partial payments, and unpaid claims. The result is a factual account of what each payer has settled — not an estimate based on deposit totals.
Completed monthly · Per-payer breakdown
Exception layer
Underpayments and denials
Claims that were paid below the submitted amount are flagged with the variance noted. Denied claims are listed with the stated reason. Where the same denial reason appears repeatedly with a payer, that pattern is highlighted in the report — it's more useful than a single-period count.
Reported monthly · Pattern tracking over time
Receivables layer
Aging and collection rate
Outstanding receivables are categorized by payer and age. Collection rate by payer — the share of submitted claims that have actually been paid — is tracked period over period. This gives you a concrete measure of how each payer relationship is performing financially.
Updated monthly · Cumulative trend visible
OUR COMMITMENT · QFLD-P07
Useful reporting each month, with a clear scope from the start
The initial conversation carries no obligation. We ask about your payer mix, how claims are currently submitted, and what your current remittance tracking looks like — then tell you plainly what the reconciliation process would involve for your operation and what the monthly output would look like.
Once the engagement begins, the monthly report is delivered on a consistent schedule. If the reconciliation surfaces something that warrants your attention — a payer that's significantly behind, a pattern of denials that suggests a claims issue — that's communicated directly, not buried in a footnote.
What you can count on
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Initial consultation at no cost and with no commitment required
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Written scope before any work begins — what's covered and how
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Monthly delivery on schedule — reports aren't delayed or batched
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Direct communication when the reconciliation finds something worth your attention
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Consistent format across periods so trend data accumulates in a readable way
NEXT STEPS · QFLD-P08
How to get started
Getting started requires very little at this stage. A short description of your situation is enough for us to have a useful initial conversation.
Send a brief message
Use the contact form on the main page. A short description of your pharmacy, your payer mix, and how your claims reconciliation currently works — or doesn't — is enough to get started. No formal intake at this point.
Payer review conversation
We'll follow up with a few questions about your specific payers, how remittances are currently received, and what your claims data looks like. This shapes the setup process and confirms that the service fits your situation.
Written scope and timeline
Before the engagement begins, you receive a written outline of what the reconciliation covers, how the monthly report is structured, and what the setup process involves. The first reconciliation follows after setup is complete.
GET STARTED · QFLD-P09
Ready to understand what your payers actually owe you?
Send a brief message using the contact form. A short description of your payer mix and current reconciliation setup is all we need to begin a useful first conversation.
Send a messageOTHER SERVICES · QFLD-P10
Explore related services
This service works alongside the broader pharmacy accounting service and the controlled substance inventory add-on. Each addresses a distinct layer of pharmacy financial management.
Pharmacy & Dispensary Accounting
Complete monthly accounting for independent pharmacies and dispensaries — prescription revenue, reimbursement reconciliation, gross margin analysis, and regulatory documentation. The broader service that this one often complements.
Controlled Substance Inventory Accounting
Specialized financial tracking of controlled substance inventories — acquisition cost recording, perpetual inventory maintenance, periodic count reconciliation, and discrepancy documentation for regulatory inspection.