Payer Reconciliation

Share this article

We support our clients by facilitating the development and maintenance of relevant data, employing modern analytic applications, and building scalable, automated processes.


Client Situation

Pharmacies face pressure from PBMs, health plans, and other third-party payers within an ever-changing industry landscape directly impacting their financials and strategic initiatives.

Many pharmacies lack transparency to the detail of reimbursement by payer affecting their ability to appropriately manage payer relationships, accurately reconcile their contracts, and drive value for their organizations.


Opportunities/Actionable Items

Proper collaborates with the pharmacy to conduct an in-depth review of its data views and business tools to pinpoint gaps within its reporting activities.

Reconciliation of payer reimbursement necessitates the use of a complex hierarchy to trace payment on individual transactions to a specific contract and rate. Following a detailed inventory of the pharmacy’s payer contracts, Proper applies their proprietary mapping and logic to generate a consolidated dataset of all transactions.

Deploying the pharmacy’s preferred business application, Proper produces near real-time reporting designed to monitor contract compliance, direct recoupment strategies, and provide expanded insight into key performance metrics.

Utilizing the enhanced reporting functionalities, Proper assists the pharmacy in coordinating the appeal process directly with its payers. All the required facts are gathered through the automation of data extracts, accessibility to an organized contract repository, and estimation and tracking of the financial impact.



The Proper team’s efforts to strengthen the pharmacy’s reporting capabilities prove to be invaluable and deliver between 1 – 5% savings on total annual drug spend. With clear, actionable information from readily available dashboards, easily consumable evidence can quickly be produced for escalation to payers and ongoing dispute resolution. This enhanced oversight improves the pharmacy’s operational efficiency while capturing value through payer accountability.

Cover image by zinkevych on Freepik

  • Comment (2)
  • my life says:

    I simply could not leave your website without saying how much I appreciated the quality information you provide to your users. I will definitely be returning often to see what new updates you have made.

  • Tree Email says:

    I loved even more than you will get done right here. The picture is nice, and your writing is stylish, but you seem to be rushing through it, and I think you should give it again soon. I’ll probably do that again and again if you protect this walk.

Leave Your Comment

Connect With Us

We look forward to engaging with you about our services, product accelerators, or about joining our growing team.

185 N Franklin St, 3rd Floor Chicago, IL 60606

185 N Franklin St, 3rd Floor Chicago, IL 60606

Fill in the form to contact us