Can payers deny payment for pharmacy services (MTM) provided to patients enrolled in Medicare Part D?
Payment for professional pharmacy services will be determined by the individual health plans. We encourage you to contact the plan before providing services to determine if they will recognize claims for these services. If a health plan were to deny payment for services, this does not mean that you should not submit invoices. The next year is one of change as the concept of billing for professional pharmacy services develops. By having the invoices ‘on the books ‘ will allow payers the opportunity to see the volume of professional pharmacy services that they can anticipate.
