Suite 1300
Salt Lake City, UT 84111
Block-1 3rd Floor, Perungudi Bypass Rd, Perungudi,
Chennai - 600096
MGR Main Rd,
Perungudi, Chennai - 600096
Villupuram,
Tamil Nadu – 605602
LTC & closed-door pharmacy
Revenue Cycle Built for
Institutional Pharmacy Economics
Long-term care and closed-door pharmacies live or die on Medicaid economics, cycle-fill accuracy, and facility billing discipline. AnnexMed combines multi-state Medicaid expertise with LTC-trained billing professionals and proprietary AI — billing, AR, denial recovery, and facility collections handled as one integrated operation.
All 50 STATE
Medicaid Coverage
20–40%
Denial Reduction
< 45 DAYS
Facility AR
Explore LTC & Closed-door Solutions
LTC Pharmacy RCM
Hospice & Closed-Door Operations
The LTC pharmacy revenue cycle reality
The challenges keeping LTC pharmacy operators awake
Medicaid Complexity at Scale
Every state Medicaid program runs its own rules: covered drug lists, prior auth requirements, cycle fill regulations, MAC pricing, and appeal processes. A pharmacy serving facilities in 4–5 states is effectively managing 4–5 different billing operations.
MCO Denial Volume
Medicaid managed care organizations now cover the majority of LTC populations in most states. MCO denial rates exceed 25% in many markets, with state-specific appeal processes that demand local knowledge and dedicated follow-up infrastructure.
Cycle Fill Economics
Short-cycle, emergency-fill, and partial-fill rules vary by state, payer, and facility type. Mis-billing causes immediate reimbursement loss — often discovered weeks later when the cash never arrives.
Hospice Election Routing
Hospice election triggers Part A coverage that overrides standard Part D and Medicaid routing. Miss the election, and the pharmacy eats the cost of every fill until the routing is corrected — typically months of recovery work.
Facility AR Aging
Facility-billed claims sit untouched while the pharmacy carries the cash impact. Without active follow-up with facility business offices, 90+ day AR balloons and write-offs become routine.
Atypical Prior Authorization
Atypicals, behavioral health drugs, and high-cost specialty medications used in LTC settings require PA on nearly every fill. State Medicaid PA queues run 5–14 days; without active management, residents go without medication.
Who we are for LTC pharmacies
We become your LTC pharmacy operations engine
Recent Client Results
All 50
State Medicaid Programs Supported
< 18%
MCO Denial Rate (vs. 25–30% industry)
$800K–$3M+
Typical Annual Financial
Impact
How annexmed supports your LTC pharmacy
Full revenue cycle coverage — built for institutional pharmacy
By owning the full revenue cycle — pre-billing eligibility and PA, claims and cycle-fill billing, and downstream Medicaid and facility recovery — we deliver outcomes that narrow-scope LTC billing services cannot: lower denial rates, faster Medicaid reimbursement, and recovered cash from facility AR that other vendors write off.Â
Pre-Billing
Before the claim is filed
- Eligibility verification across Medicare, Medicaid, MCO, and commercial
- Prior authorization for atypicals and high-cost drugs
- Cycle fill logic by state and payer
- Emergency fill logic by state and payer
- Hospice election validation pre-fill
- Facility census updates
- Patient enrollment updates
- Coverage determination for Part A vs. Part D vs. Medicaid
Billing & Claims
Our core expertise
- NCPDP D.0 and 837 claim submission
- Cycle-fill billing based on state and payer requirements
- Accurate Part D, Part A, and Medicaid claim routing
- Facility billing and resident statement generation
- Claim reversals, rebilling, and adjustment processing
- First-pass clean claim rate exceeding 96%
Recovery & AR
After submission, through collections
- Medicaid and MCO denial appeals using state-specific playbooks
- Multi-state Medicaid follow-up coordination
- Facility AR follow-up and aged claim recovery
- Patient and family billing support
- Hospice retroactive election adjustments
- Underpayment identification and MAC appeal
Financial impact and performance
What these improvements mean in dollars?
For a mid-size LTC pharmacy serving 2,000–5,000 beds across multiple states, AnnexMed’s combined impact regularly delivers $800K–$3M+ in net annual financial benefit within the first 12 months. Most LTC pharmacies achieve full ROI within 6–9 months — often faster when significant aged Medicaid AR is recoverable.
Multi-State Medicaid Coverage
Built for LTC Workflows
We work natively with FrameworkLTC, DocuTrack, QS/1 NRx, Computer-Rx, PrimeCare, and SuiteRx. Onboarding typically completed in 2–3 weeks with no disruption to dispensing operations.Â
Improvement Area
Estimated Annual Impact
Medicaid Denial Reduction (28% → 9%)
$500K – $1.8M annually in recovered claims
MCO Appeal Recovery (first 6 months)
$300K – $1.2M in one-time aged denial recovery
Hospice Election Routing Accuracy
$200K – $700K annually in correctly billed Part A claims
Facility AR Acceleration (78 → 45 days)
$400K – $1.5M in freed working capital
Cycle Fill Billing Accuracy
$150K – $500K annually in prevented reimbursement loss
MAC Pricing Appeal Recovery
$100K – $400K annually in identified underpayments
Staffing Cost Reduction / Replacement
$300K – $800K annually
LTC pharmacy performance targets
KPIs we hold ourselves accountable to — tracked in real time through your operational dashboards:
Performance Metric
Industry Benchmark
AnnexMed Target
Clean Claims Rate
LTC industry avg: 82–88%
98%+ first-pass
Medicaid Denial Rate
LTC industry avg: 22–30%
< 9%
MCO Denial Rate
LTC industry avg: 25–32%
< 12%
Days in A/R
LTC industry avg: 65–85 days
< 45 days
Facility AR Over 90 Days
LTC industry avg: 28–38%
< 12%
Hospice Election Routing Accuracy
Industry varies widely
99%+
Net Collection Rate
LTC industry avg: 87–91%
96%+
State Medicaid Coverage
Most vendors cover 5–15 states
All 50 states
Why LTC pharmacies choose annexmed?
In-house Billing vs. AnnexMed Partnership
In-House / Traditional
AnnexMed Partnership
Medicaid Coverage
Strong in 2–3 home states; weak in expansion or new contract states
All 50 state Medicaid programs supported with state-specific appeal playbooks
Hospice Election Routing
Frequent mis-routing; write-offs absorbed as cost of doing business
Election validation pre-fill with Part A routing logic; 99%+ accuracy
Cycle Fill Logic
State-by-state rules learned through denials over months
Pre-loaded state cycle fill matrix; correctly billed on first claim
MCO Appeal Capacity
Limited; many MCO denials written off after first rejection
Dedicated MCO appeals team with state and payer-specific playbooks
Facility AR
Aged 90+ days routinely; collection lapses on smaller facilities
Active follow-up cadence with facility business offices and family billing support
Atypical Prior Authorization
Reactive; residents go without medication waiting for PA
24/7 PA team with pre-fill submission to prevent therapy interruption
Multi-State Scaling
Adding a new state requires hiring, training, and 6–9 month ramp
New state contracts onboarded within 30 days with existing team capacity
Cost per Script
Rising with wage inflation, turnover, and software costs
30–40% lower with stable offshore delivery scale and no recruiting overhead
Technology
Powered by proprietary AI & analytics
AnnexMed’s technology stack was built for payer-specific operational demands, not adapted from provider-side billing tools. Risk adjustment accuracy, payment integrity, and credentialing compliance each require different data models, workflow logic, and reporting architectures than provider RCM. Our platform reflects that.
AI Agents & Automation
AI Agents & Intelligent Automation deploys autonomous AI agents across the full revenue cycle, automating eligibility verification, prior authorization, claims processing, payment posting, and denial management at hospital scale and speed.
Data & Analytics Platform
Data & Analytics Platform delivers real-time Power BI dashboards built for hospital executive visibility, including system-wide KPIs, service line performance, payer analysis, productivity, financial forecasting, and national benchmarking insights.
Intelligent AR Management
Intelligent AR Management handles A/R follow-up at hospital scale with intelligent worklists prioritized by dollar value and aging, payer-specific follow-up rules, automated escalation for high-value accounts, and full accountability for every claim.
Computer Assisted Coding
Computer Assisted Coding orchestrates hospital coding operation, intelligent chart assignment by service line, TAT tracking with SLA monitoring, quality audits with accuracy scoring, and coder performance management at enterprise scale.
Together, these platforms create a fully instrumented RCM operation where nothing falls through the cracks. You don’t interact with these systems directly, but the results they enable show up directly in your financial performance.
LTC & closed-door settings we serve
Built for every institutional pharmacy setting
AnnexMed supports the full range of LTC and closed-door pharmacy operations — each with billing teams trained on the specific facility type, payer mix, and regulatory environment:Â
Skilled Nursing Facility (SNF) Pharmacy
High-volume cycle fill operations serving Medicare Part A, Medicare Part D, and Medicaid populations. Includes consultant pharmacist services billing and MDS-tied medication management.
Correctional Pharmacy
Closed-door pharmacy serving state and federal correctional facilities with capitated and per-script reimbursement models. Specialized chargeback and contract billing workflows.
Assisted Living & Memory Care
Lower-acuity LTC pharmacy serving Medicare Part D, Medicaid, and private pay populations. Family billing coordination and patient pay support included.
PACE Program Pharmacy
Pharmacy operations serving Programs of All-Inclusive Care for the Elderly with full-risk capitated payment models and integrated care coordination billing.
Hospice Pharmacy
Part A election routing with retroactive adjustment capability, hospice formulary management, and end-of-life medication billing. Cap calculation and reconciliation support.
Long-Term Acute Care (LTACH) & Behavioral Health
Specialty institutional pharmacy serving LTACH, inpatient psychiatric, and substance use treatment facilities with mixed Medicare, Medicaid, and commercial billing.
Ready to bring multi-state medicaid muscle to your LTC pharmacy?
Payer client outcomes
$15M–$40M
Risk
Adjustment
$18M–$50M
Payment
Integrity
6 Weeks
Credentialing Clearance
$15M–$50M+
Revenue
Impact
Case Studies
See the impact we deliver
Discover how AnnexMed reduces denials, accelerates reimbursements, and strengthens financial performance. Backed by measurable outcomes and proven RCM expertise, we deliver operational excellence, revenue stability, and sustainable growth you can trust.
Client Voices
See how our clients succeed
Proven RCM expertise. Delivered at scale.
For over 20 years, AnnexMed has delivered RCM solutions nationwide, combining expert billing, coding, and AR support to drive measurable results and growth.
- 20+ years of proven healthcare RCM experience
- 2,000+ professionals supporting billing, coding & AR
- 500+ certified coders across multiple specialties
- 99%+ compliance with HIPAA and security standards
- All 50 states served with consistent, scalable operations
