Your rebate is priced on the units you report. Once our team confirms them, the quarter locks, and those counts are what your share is paid on. A careful hour before the lock is worth more than any correction after it.
What counts
Report the biologics your practice bought and administered during the quarter, for the medications enrolled in the network’s contracts. Count only what the practice bought. Doses a specialty pharmacy shipped in for a named patient, and samples, were purchased by someone else and don’t belong in your report.
Use the calendar quarter and the date each dose was given: January through March is the first quarter, April through June the second, and so on.
If you start stocking a biologic you haven’t reported before, tell our team, so it can be enrolled in the network’s contracts before you count it.
Units, not billing units
The portal asks for units by presentation: the syringes, pens or vials of each strength that you administered. These are not the HCPCS billing units on your claims.
One syringe, pen or vial is one unit, whatever its strength; the strength decides which line it goes on. A drug that comes in two strengths has two presentations, and the portal lists them separately.
Where to report
In your practice portal. Type the units in for each medication, or upload the utilization report from your practice management or EHR system. Either way, the numbers land in the same place, and you can see what you submitted.
Build the report once
Most practice management and EHR systems can save a report. Build one that lists administrations of the enrolled biologics by drug, strength and date, and run the same report every quarter. Name one person who owns the submission and one who can cover, and put the reporting window on both calendars.
Check before you submit
- Count administrations, not orders
- Use the administration record. Scheduled, cancelled or rescheduled doses don’t count.
- Reconcile with purchases
- Compare with what you bought from your distributor in the quarter. A large gap usually means a missed strength, a sample counted, or a dose recorded under the wrong product.
- Look for zeros
- A medication you stock with no units reported is more often a report filter than a quiet quarter.
- Keep the source
- Save the report you used, so a question months later is easy to answer.
What happens after
- Your team reports the units it administered.
- Our team confirms them, and the quarter locks.
- Your share is paid, with a one-page statement.
Our team reviews what you submitted and asks when something doesn’t line up. Once the numbers are confirmed, the quarter locks and your counts price your rebate. The statement that comes with your share shows each medication, the units, the rebate on each and the check date. If a manufacturer later revises a quarter, the correction appears on its own line.
