Long-Term Care Service
Insurance & Billing
Long-term care billing handled. Residents and families never see a surprise bill.
We handle Medicare Part D, MassHealth, and most private plans — residents and families never see surprise bills.
What this looks like in practice
LTC pharmacy billing is its own specialty. Medicare Part D plans, MassHealth managed care organizations, private commercial insurance, hospice benefits, secondary supplemental coverage — each with its own formulary, prior-authorization requirements, and copay structure. Getting it right takes a dedicated billing team and the systems to back them up.
We bill all of these directly. Co-pays are reconciled through your facility's resident trust account so families never receive surprise pharmacy bills. Prior authorizations are handled by our team, including the back-and-forth with prescribers when formulary substitutions are needed. Audits — we respond.
Your DON sees clean monthly statements showing what was billed, what was paid, and what's outstanding by resident and by payor. Your business office sees the same view. Family conversations about pharmacy charges become rare instead of routine.
What's included
- Medicare Part D, MassHealth, MCO billing
- Resident trust account reconciliation
- Prior authorization handling
- Audit response support
All
Major payors billed directly
Real-time
Insurance verification at fill
Monthly
Reconciliation reporting
What You Get
The benefits in detail.
All Payors Billed Direct
Medicare Part D, MassHealth, MCO, commercial, hospice — all billed directly by us, no facility involvement required.
Prior Auth Handling
When PA is needed, our team handles the back-and-forth with prescribers, including formulary substitutions when appropriate.
Trust Account Reconciliation
Resident co-pays reconciled through your facility's trust account. Families never see surprise pharmacy bills.
Audit Response
Insurance audits, state audits, federal audits — we respond on your behalf with full documentation.
Who It's For
This is especially helpful for…
- Skilled nursing facilities (high billing complexity)
- Assisted living with mixed payor mix
- Memory care and hospice programs
- Facilities frustrated with current pharmacy billing accuracy
How It Works
Three simple steps.
Resident insurance setup
Each resident's complete insurance profile entered and verified. Primary, secondary, and supplemental coverage all captured.
Real-time billing
Each prescription filled triggers real-time insurance check. Co-pay calculated and reconciled through the resident trust account.
Monthly reporting + reconciliation
Monthly statements to your business office. Quarterly billing review meetings to address any outliers.
Common Questions
Frequently asked questions.
What about residents with no insurance?
Cash-pay residents get our most-favored pricing — usually 30–50% less than chain pharmacy cash pricing. We can also help residents enroll in Medicare Part D Extra Help and other assistance programs.
How do you handle hospice transitions?
When a resident transitions to hospice, billing automatically flips to the hospice's Part A benefit for hospice-related medications. Non-hospice meds continue under their existing coverage.
What if Medicare Part D denies a medication?
Our team handles the prior auth and appeal process directly with the prescriber — including drafting the medical necessity letter. If denied even after appeal, we'll work with the prescriber on a covered alternative.
Are there any billing fees to the facility?
No facility-side billing fees. We make our money from insurance reimbursement on medications we dispense — not from billing services to the facility.
Explore More
Other LTC services
Blister & Compliance Packaging
Pre-sorted blister packs and pouches organized by date and time, so caregivers can administer with confidence.
Free Local Delivery
Reliable on-schedule delivery to your facility — including STAT and after-hours runs.
eMAR Integration
Direct integration with leading electronic Medication Administration Record (eMAR) systems.