Contract language becomes usable only when its terms, definitions, periods, and exceptions are represented in a model somebody can review.
Knowledge collection
PBMs & reimbursement
The contract terms, pricing benchmarks, and post-adjudication adjustments that set what a pharmacy is actually paid.
GERBERAWPNADAC
Articles
Fees, retrospective adjustments, reversals, and reconciliations change realized economics after adjudication, so each one needs its own event record.
A reversal is an event that changes the state and economics of an earlier transaction, and that earlier transaction still has to be readable afterwards.
A pharmacy benefit manager administers parts of a prescription-drug benefit on behalf of health plans and employers.
Reimbursement terms each describe a different part of how a pharmacy claim is priced and paid.
Related collections
How to
Step by step guides for the work people actually do in Attergo, written from journeys that were run rather than from what the screens appear to offer.
Revenue integrity
How to measure the gap between what a claim should have paid and what it did, explain the gap, and recover it.
Pharmacy economics
What a pharmacy pays for medication, what it collects for dispensing it, and how long the money sits in between.