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OCTOBER 6, 2022

Millions Recouped Via Flipped Infusion Claims

A prior authorization win for health system

By Karen Blum

PHOENIX—Pharmacists at UNC Medical Center, in Chapel Hill, N.C., are showing their worth when navigating the intricacies of denied insurance claims and other managed care challenges.

Their effort, which began in 2009 to ensure prior authorizations (PAs) for chemotherapy infusions were completed at UNC, has evolved into a full-fledged pharmacy revenue integrity (PRI) team that has captured millions of dollars by overturning denied claims and significantly lowering the amount of