PBM reimbursements that don't match expectations
What a claim adjudicated for, what was actually paid, and what fees were taken later can all differ.
Pharmacy Accounting & Financial Consulting
Know what every prescription actually earned your pharmacy.
We reconcile prescription claims, PBM reimbursements, payer fees, wholesaler purchases, and dispensing activity against your books, with CPA-overseen accounting and financial reporting.
- CPA-overseen
- Completely remote
- Works with the systems you already use
The challenge
Pharmacy margins disappear in the details
Volume can look strong while cash stays tight, because reimbursement, fees, and inventory rarely line up on their own.
Rejected and reversed claims slipping through
Rejections and reversals that aren't followed up mean dispensed product that was never paid for.
Inventory that doesn't agree with purchasing
Wholesaler invoices, dispensing records, and the books drift apart, hiding shrink and margin loss.
Audit requests that become a scramble
When documentation lives in different places, every PBM or payer audit takes days to pull together.
What we do
Accounting and reconciliation for independent pharmacies
Prescription claim reconciliation
Claims and adjudication status reconciled against what was dispensed and what was paid.
PBM reimbursement analysis
Reimbursements, DIR and other payer fees reviewed so you can see the true earnings on each claim.
Rejected & reversed claims monitoring
Rejections and reversals tracked to resolution so dispensed product gets paid.
Inventory & purchasing reconciliation
Wholesaler purchases and dispensing activity compared against inventory and the books.
Accounts payable & receivable
Payables, receivables, and third-party payments managed and reconciled each month.
Financial reporting & profitability
Monthly statements and profitability analysis by payer and category, plus fractional CFO planning.
Technology & reconciliationHow our technology works
Your pharmacy data, finally in agreement
We connect to your pharmacy management system, point-of-sale platform, drug wholesalers, PSAO, third-party payers, payroll provider, and general ledger software, then reconcile claims, reimbursements, purchases, and dispensing in one place.
YCA Healthcare is led by Gia Ros-LaNeve, a Certified Pharmacy Technician (CPhT) with pharmacy compliance and operations experience.
Systems we connect
- Pharmacy management systems
- Point of sale
- Drug wholesalers
- PSAOs
- Third-party payers
- Payroll providers
- General ledger software
- Claims adjudicatedPayments received
- Expected reimbursementFees taken
- Wholesaler purchasesDispensing activity
- Point of saleBank deposits
- Third-party paymentsGeneral ledger
We confirm which connections are available for your systems before you commit.
Business outcomes
What pharmacy owners gain
- A clear picture of earnings by claim, payer, and category.
- Fewer unpaid claims from rejections and reversals left unresolved.
- Inventory, purchasing, and the books that agree.
- Documentation organized before an audit request arrives.
- Monthly financial statements you can use to plan.
Example scenario
From claim to cash: a typical pharmacy review
Pull the data
Claims, remittances, wholesaler invoices, and point-of-sale records are gathered through connections you authorize.
Match it up
Each claim is matched to its payment and fees, and purchases are matched to dispensing.
Flag the exceptions
Underpayments, unresolved rejections, and inventory variances are listed for follow-up.
Report and plan
You receive clear monthly reporting and a CPA-overseen plan for what to fix first.
An illustration of how an engagement typically works, not a specific client's results.
FAQ
Frequently asked questions
What is PBM reconciliation?
It's the process of comparing what each prescription claim adjudicated for with what the pharmacy benefit manager actually paid, and accounting for fees taken at the time of payment or later. It shows the true earnings on each claim.
Do you replace our pharmacy management system?
No. We connect to the pharmacy management, point-of-sale, wholesaler, and accounting systems you already use and reconcile the data between them.
Can you help us prepare for PBM or payer audits?
Yes. We support audit preparation and documentation management, so the records an auditor asks for are organized and easy to find.
Do you handle the pharmacy's regular accounting too?
Yes. We provide CPA-overseen bookkeeping, accounts payable and receivable, and monthly financial reporting, alongside the reconciliation work.
See what your pharmacy is really earning
Talk with YCA Healthcare about reconciling your claims, reimbursements, and inventory, and getting financial reporting you can plan with.