Get Your Money Faster Via Direct Pay Using TriNet

When it comes to being reimbursed for your pharmacy claims, there are two options: central pay and direct pay. One involves the inclusion of unnecessary middlemen who hold up your reimbursements, the other model sends payments directly to your pharmacy.

The central pay reimbursement model is popular among many PBMs. However, there are risks and pitfalls associated with it, which is why TriNet and EnsurePay insist on using a direct pay model to reimburse pharmacies.

Central pay is not necessarily faster

Thanks to the multiple “for profit” companies that handle your central pay reimbursement, there's real potential for periodic—even chronic—delays in payment to your pharmacy. And though some states have Prompt Pay laws, these laws do not apply to intermediary firms that may stand between you and your payment, including:

• The central pay administrator
• The bank or financial institution
• The reconciling firm

Central pay compromises accountability and control

Inherently, central pay arrangements require you to grant rights and authorities to third parties who may not exercise those powers in your best interests.

Sometimes, a central pay administrator may achieve a position of full financial control over your pharmacy - meaning they act as supplier in setting the payment terms for goods and services (buy-side leverage) while also having implicit rights and powers as central pay administrator to effectively demand payment by withholding your money collected and managed under the central pay arrangement (sell-side leverage).

Operational control is compromised and valuable time is lost when payment problems arise and you are faced with navigating through additional layers/companies to gain access to relevant support information and personnel.

Central pay can cost you money

One of the biggest risks in accepting central pay arrangements is the probable financial and operational costs to your pharmacy under such a model. When the companies that stand between the PBM and your pharmacy delay payments, these delays cost you money. Even when PBMs offer incentives in exchange for accepting central pay arrangements, those incentives fail to fully compensate you for your financial losses.

Finally, while efficiency in third party payment and reconciliation may require that you be willing to accept electronic payments and payment remittances, it does not require you to adopt a central pay model. Nor does gaining effective access to third party networks such as TriNet. Many PBMs have EFT payment capabilities, and all PBMs are required by law (HIPAA Sections 1171-1179) to provide electronic payment remittances.

We invite you to call 800-333-8097 or email us today to review the differences between these two payment methods with an EnsurePay specialist. Armed with the facts, we believe you'll see why TriNet and EnsurePay promote direct pay as the most pharmacy-friendly method for claim reimbursement.