By usr@qconsult

May 2, 2022

Manufacturer Copay Card Process

The step-by-step method Q Consulting Support Services (QCSS) uses to process manufacturer copay cards to help alleviate our patients and their families from the financial burden resulting from the cost of expensive medications.

What is a Manufacturer Copay Card ?

Manufacturer copay cards are used in combination with commercial or private insurance plans. The copay cards are offered through the drug manufacturer and are intended to help reduce the patient’s total out-of-pocket expense.

At Q Consulting Support Services (QCSS), our job is to alleviate our patients and their family from the financial burden resulting from the cost of medications required to treat their condition. Our clients at Hospital Infusion Centers and Oncology Practices utilize our services to manage the entire copay card process.

Copay Card Application Process:

QCSS determines which patients are eligible for a copay card and requests the patient’s consent to enroll them into the program.

  • The application is completed and submitted by QCSS.
  • Depending on the manufacturer, the approval process can be immediate or take up to a week.
  • Upon approval, the program provides the member information, including the copay card number, via fax, email, or mail.
  • QCSS then monitors patient explanation of benefits (EOBs) that have patient out-of-pocket responsibility to submit a claim on their behalf.

Copay Card Claim Submission:

Each copay card program is different; however, the process for claim submission is generally the same. The copay card program requires that EOBs be submitted within a certain amount of time after approval (90 days) to secure the copay card benefit.

Step 1: Complete the Reimbursement Claim Form

  • Patient Demographics
  • Name of the insurance provider & Member ID
  • Facility Name, Provider Name, and NPI number
  • The allowed amount, the amount paid to the provider, and the patient’s responsibility.

Step 2: Gather the Medical Claim Form

  • UB4
  • CMS 1500 HCFA

Gather the Explanation of Benefits (EOB)

The EOB will explain what the insurance carrier paid, and what the patient’s responsibility is for the specific treatment and date of service.

Once QCSS gathers the claim information listed above, we submit the claim by fax or online portal to the copay card program. Upon submission, the program verifies the claim. The copay card payment is processed – processing time can vary between hours, days, and weeks – regular phone calls to the copay card company are required to ensure the claim is processing correctly, and no further action is necessary.

Receiving Reimbursement:

  • After the payment is approved, the program releases the funds via check or credit card payment. The patient pays a small portion of their copay or nothing at all – generally around $5.00.
  • Suppose the copay card company loads the payment to a credit card. In that case, QCSS works directly with the accounting department and provides them with the date of service, the amount due, and the credit card information to process the payment. At this time, the accounting department applies the payment to the patient’s account – reducing their balance immediately.
  • If the program issues a check payment, QCSS coordinates with the copay card company to have the check sent directly to the provider. We update our client with the check number, check amount, and service date to ensure the check is received and applied to the patient’s account.

If the copay card company denies the claim, QCSS works tirelessly to rectify the situation to obtain payment approval.

Avoiding Financial Toxicity

Healthcare expenses related to medication costs are financially burdensome to patients and their families. QCSS assists our clients in removing this financial toxicity associated with chronic or life-altering diagnoses. We take pride in knowing that we can reduce some of our patients’ burdens during such a difficult time in their lives.