Home Specialities Specialty Pharmacy
Specialty pharmacy handles some of the most expensive drugs in healthcare, where one denied claim is a substantial loss. Authorizations and documentation leave no margin.
Authorization: Approvals secured before dispensing so claims survive review.
Dispensing: Required documentation captured to back high cost drug claims.
Reimbursement: Denials appealed fast before the loss on a costly therapy sticks.
Specialty pharmacy handles some of the most expensive drugs in healthcare, where one denied claim is a substantial loss. Authorizations and documentation leave no margin.
Authorization: Approvals secured before dispensing so claims survive review.
Dispensing: Required documentation captured to back high cost drug claims.
Reimbursement: Denials appealed fast before the loss on a costly therapy sticks.
Accurate billing. Faster reimbursements. Stronger revenue cycle management for cardiology practices focused on exceptional patient care.
Our mission is to simplify cardiology billing workflows, reduce denials, improve collections, and maximize reimbursements while supporting better heart care.
Cardiology Practices Trust Us
Reduce denials and speed up approvals.
Improve cash flow and reimbursement cycles.
Secure and compliant cardiology billing process.
Specialty pharmacy billing operates under a completely different framework than retail or institutional pharmacy billing. Our team ensures every claim is accurate, compliant, and supported by the documentation needed to protect your reimbursement.
Coverage, specialty drug benefits, formulary tiers, authorization requirements, and documentation standards verified before dispensing medications
NDCs, HCPCS codes, quantity limits, specialty tiers, and formulary requirements managed accurately across payers
Authorization approvals, clinical notes, step therapy records, and enrollment documents reviewed for compliance before submission
Specialty formulary and authorization policies tracked while claims, requests, and updates receive direct payer follow-up
Specialty pharmacy claims tracked through payer portals with rejections and authorization expirations flagged promptly
Denied claims corrected and resubmitted with documentation addressing authorization, formulary, and quantity limit issues
We follow a structured, end-to-end workflow to ensure your specialty pharmacy billing is accurate, consistent, and set up for faster reimbursement.
Dispensing records, prior authorization approvals, prescriber clinical notes, and patient benefit information come in from your pharmacy through your existing workflow. Nothing in your operational process needs to change.
NDC and HCPCS codes, quantity limits, and supporting documentation are reviewed for formulary compliance and authorization validity before the claim is built. Issues are resolved before submission, not after denial.
Claims are submitted electronically to the correct specialty payer, Medicare Part B or Part D, Medicaid, and commercial plans based on their individual formulary policies and reimbursement schedules.
We identify why specialty pharmacy claims are denied and act quickly to correct, appeal, and resubmit them with the documentation needed to support payment.
Denials are worked within 72 hours. Prior authorization expiration dates and refill authorization timelines are monitored continuously. Aging accounts are followed up systematically.
Payments are posted and reconciled. Monthly reporting gives you a clear summary of collections, denial trends, top denying drug categories, and outstanding balances.
Multi-Provider and Hybrid Care Organizations
Specialty pharmacies requiring accurate NDC and HCPCS billing, prior authorization tracking, and consistent payer follow-up for high-cost specialty drug claims.
Specialty pharmacies requiring accurate NDC and HCPCS billing, prior authorization tracking, and consistent payer follow-up for high-cost specialty drug claims.
Pharmacies dispensing oncology drugs and specialty injectables requiring expertise in Part B billing, clinical documentation review, and payer-specific authorization management.
Pharmacies dispensing oncology drugs and specialty injectables requiring expertise in Part B billing, clinical documentation review, and payer-specific authorization management.
Multi-location specialty pharmacy operations requiring compliant billing and consistent reimbursement management across specialty payers, Medicare, and Medicaid.
Multi-location specialty pharmacy operations requiring compliant billing and consistent reimbursement management across specialty payers, Medicare, and Medicaid.
Health system pharmacies managing specialty drug dispensing requiring accurate coordination of benefits and specialty payer contract compliance.
Health system pharmacies managing specialty drug dispensing requiring accurate coordination of benefits and specialty payer contract compliance.
General billing services do not have the specialty knowledge specialty pharmacy billing requires. The result is NDC codes applied incorrectly, prior authorization documentation reviewed poorly, and quantity limit compliance missed entirely.
Our specialty pharmacy billing specialists improve authorization compliance, strengthen NDC and HCPCS accuracy, and help accelerate reimbursement for high-cost specialty drug claims.
Healthcare providers across the country rely on OneMed Billing to manage their revenue cycle with accuracy, consistency, and specialty-specific expertise. Here is what some of them have to say.
“We were losing revenue on oncology claims because prior authorization documentation was not being reviewed before submission. OneMed identified the issue, tightened our pre-submission review process, and those denials dropped significantly within 60 days. ”
“Part B billing for specialty injectables was creating constant reimbursement delays because our previous biller was not handling coordination of benefits correctly. OneMed corrected the process and our collections stabilized quickly. ”
“Quantity limit denials were draining our reimbursement on high-cost biologics. Since OneMed took over, every claim goes out within payer-specific limits and our A/R has tightened in a measurable way. ”
Yes. We handle Medicare Part B, Medicare Part D, Medicare Advantage, Medicaid, and commercial payer claims for specialty pharmacies across the US.
We work with most major specialty pharmacy management platforms. Our team adapts to your existing workflow without requiring system changes.
Absolutely. You receive regular reporting and have full access to your billing data at all times.
We review dispensing records and prior authorization documentation to ensure accurate code selection and quantity limit compliance on every claim.
We identify the gap, coordinate with your team and the prescriber to resolve it, and resubmit the claim with the corrected authorization documentation.
