Medication Therapy Management Services

Medication Therapy Management Service(s) (MTMS) describe face-to-face patient assessment and intervention as appropriate, by a pharmacist.  MTMS is provided to optimize the response to medications or to manage treatment-related medication interactions or complications.
Recent changes to MTMS programs allow pharmacists to bill a patient's insurance benefit directly, and no longer require a referral from the prescribing physician.

Program Components

Direct reimbursement doesn't have to be complicated, but the process of getting to a paid claim can be tedious, and that's what we are attempting to simplify.  You need a contract with the carrier, a properly submitted claim against an eligible patient, and a system that complies with the documentation and communication requirements associate with the service you have performed.

Credentialing

Payer credentialing is the first step to getting reimbursed for providing MTMS to eligible patients.  APRXS has partnered with Credential Engineers to help our members navigate this process.

Billing Support

Billing for MTMS can be complicated dependent upon the patient, location and payer.  Members receive reimbursement support to ensure program success based on those criteria.

Software

Some states allow for patient encounters to be done utilizing a tele-health platform.  APRXS has negotiated favorable rates with various systems, and monitors changes to state and federal law

 

WHO CAN Participate?

 APRXS represents the emerging Precision Medicine industry and its practitioners with a special focus on independent Pharmacies, Pharmacists and PharmD's.  We also support membership for CLIA Labs, and the software and service companies that support the needs of these providers.  We do not accommodate student membership at this time.

HOW DOES IT WORK?

  •  Create Your Optimized CAQH Profile According to APRXS Guidelines:
    • Your profile will also be utilized for applications that do not use CAQH, but where similar information is required.
    • Identify and submit for contracts according to APRXS guidelines (APRXS only submits contract applications on behalf of members for sponsored programs, see below)
    • Applications to federally funded plans depend on the plan.  APRXS works diligently to educate plans as to how they can provide direct compensation to our members, but we rely on our members to assist in identifying plans that are important to their MTM business.
    • APRXS will fully credential a member for an additional fee, inquiries are taken after sign up.
  • Identify Eligible Patients (non-federal) for Out-of-Network Consultations
    • APRXS assists with both eligibility criteria and patient-facing educational content when applicable
  • Educate Eligible Patients, and Perform Consultations (claims billed through APRXS)
    • Out-of-network claims processing is tedious, your membership includes initial claims processing and support up to the first 25 claims.
    • APRXS will provide documentation and billing protocols, as well as training and support as you file your first claims
  • Participation in Sponsored Programs
    • APRXS works directly with payers who are willing to provide contracts to our members, and assign patients directly.
    • These programs may utilize software and services not included in basic membership.
    • Program eligibility is based on individual payer requirements, as well as member competency and availability
    • Priority is given to members who have completed both the credentialing process and initial patient encounters