Administrative Tools

Through the PHA program, AmerisourceBergen provides the full scope of services required to replace the third-party administrator. By removing the middleman, the pharmacy and hospice can work directly to improve patient outcomes. Additionally, all parties are enabled to manage the overall cost for the hospice to achieve greater savings with reasonable reimbursement for the pharmacy.  Through our knowledge, reach and partnership, AmerisourceBergen is able to offer the following administrative services:

                             (must have special permission to log in to site)     

  • Claims Administration
    Claims are submitted electronically by participating pharmacies to a centralized common claims processing BIN to support centralized billing, invoicing and reporting and other requirements of the program. 

  • Eligibility Management
    Hospice patients can be added and removed from the claims system through a dedicated web portal.  This is an important administrative function for coverage availability and accurate reporting under the program based upon new and terminated patient eligibility management.

  • Reimbursement Coding
    The administrative system is programmed to insure reimbursement accuracy according to the contracted pricing arrangement negotiated between the pharmacy and the hospice agency. 

  • Utilization Edits
    Safeguards are built into the system so that the hospice agency can set prior review authorization guidelines on drug approvals.  These edits provide assurance to the hospice agency that medication exceptions based on cost and other criteria do not go through without professional review and authorization.

  • Reporting
    An online reporting system allows for user authorized access to reports on a 24/7 basis to support routine and strategic information needs.  These reports can be customized to the hospice agency’s needs. Log on:
  •  (must have special permission to log in to site)                          
  • Cash management
    Invoices with claims level detail are generated twice a month to support timely review and payment by hospice agencies.  Upon remittance of these invoices to the administrator, dispensing pharmacies are paid within 3 days.

  • Network development
    The administrative system is coded to recognize the primary and secondary pharmacy providers for each hospice agency.  The PHA program offers access to a national network of almost 60,000 retail pharmacies. 

  • General Oversight and Support
    AmerisourceBergen administrative subject matter experts will work directly with the PHA pharmacy and hospice agency to support the ongoing success and expansion of each individual program.

A fixed administrative fee is paid to AmerisourceBergen for these administrative services.  This fee is used to cover the costs of the PHA program.