HIPAA Insurance Claims and Security for Pharmacies

Make Insurance Claims Easy

Start with a HIPAA-Compliant Website

Pharmacy security should be your first concern when you’re looking for a new HIPAA-compliant website. Failing to follow HIPAA compliance guidelines can bring about steep fines — sometimes in the millions of dollars — from law enforcement. HIPAA breaches must also be announced in a public venue, including the front page of your website and local news outlets. This negative press will certainly drive once-loyal customers away. 

This same security must apply to HIPAA-compliant mobile apps as well. More than half of web searches are done on phones and other mobile devices, so having a secure HIPAA-compliant app is just as important as one for your website. Fortunately, the website and the app can be brought together under one eCommerce portal to provide PHI data security and improve customer interactivity at the same time. Digital protection for your pharmacy is vital to your business, so seek out the best HIPAA-compliant CRM software you can find.  

Identify the Laws in Your Sales Area

HIPAA pharmacy rules can vary from state to state. It’s very important to customize a site so that it follows the laws in whatever area you’re selling. This most often applies to state laws that won’t allow you to sell a particular medication to someone, or even show it to them if they don’t produce a prescription for it. 

While this customization might sound daunting, it’s relatively easy if you pick a HIPAA website developer that can offer you a custom eCommerce solution. Some EHR integration services can delineate laws by state so that you stay in compliance with local laws, all the while keeping PHI data security intact. 

Gather Information Before Checkout

Most B2CeCommerce businesses don’t need to collect information about the customer before they start shopping. Customers often approach an online store with the intention to browse the items and compare prices before they hand over any information. 

The process is very different for an e-pharmacy.  Let’s look at a few ways that a user’s path within your pharmacy’s website will be unique. 

Determine insurance coverage 

Customers aren’t just looking for a site that works with their insurance company; They’re looking for one that takes their exact insurance plan. Both of these affect what they will see on your site, which is why it’s so important to gather insurance information before they start looking for a particular product.  

Verify the plan will pay 

A customer’s health insurance plan might cover their medication...or it might not. Gathering insurance information, and verifying the plan will pay, can make a customer confident that their purchases will be covered. Once payment reimbursement has been verified, insurance information determines how their entire experience will unfold during their visit. 

Find out where they are 

Finding out where a customer is located will help you follow the rules of a particular state. This might change if they have a legal residence in one state but are asking for the prescription to be shipped to another. Verifying their location with a GEO IP lookup can also determine if they are allowed to see certain products. 

What Changes from User to User?

User experience will customize based on the customer’s information mentioned above. But what is changing once they navigate the site? Here are some of the most common differences that occur based on the customer’s information. 

What they’re allowed to see 

Laws vary from state to state regarding what medications can be sold. A person shopping in that state should not be given the option to put it in a cart — or even see it — if it is not legally available to them.  

Insurance plan prices 

Prices change from healthcare plan to healthcare plan. Medication prices will change based on the insurance tiers, while some medications won’t be covered at all. Each online pharmacy must have the ability to change prices based on specific plans. 

Alternate medications 

Customer prescriptions may request a name-brand medication, but will their doctor allow generics? If their prescription isn’t covered by their plan, is there one that works just as well that a customer could request from their doctor? Showing customers options could keep them on your site instead of abandoning it. 

Special offers 

A customer’s special offers might be different depending on their health insurance plan. Medicare might offer a coupon for a particular medical supply, while Medicaid might not.  

Special SKUs 

Having a customer’s insurance information could determine which SKU you offer them. Having multiple SKUs for the same product could help you consolidate orders and make requests easier from organizations such as Medicare and Medicaid. 

• HIPAA-compliant apps – PHI security isn’t just limited to laptop and desktop computers. HIPAA apps must be just as secure, and the best time to launch a new pharmacy app is when you are getting a new eCommerce site.
• Chat support – Customers want to be able to get their questions answered quickly, especially when it concerns two of the things they care about most: their health and their money. Offering an easy-to-use—and HIPAA compliant—chat system will help them know that your business respects them.
• Data security – Customers don’t want to input insurance information again and again, and that data must follow HIPAA compliance encryption requirements. Your new website must follow industry best practices for security to make customers feel secure.
• Insurance updates – Whether they’re changing jobs or upgrading Medicare supplements, customers always need to update their information. Welcome screens can remind customers to update their insurance information so that their claims can process without incident.
• Pharmacist/Employee Training – eCommerce sales portals can offer so much more than just the ability to sell product. ERP integration can bring together multiple applications — such as HR information and employee training—via a single login portal.

Clarity Pharmacy Portals Increase Efficiency

Clarity has worked on hundreds of HIPAA-compliant websites over the past 15 years, and we bring the compliance knowledge we’ve accumulated during that time. We know what works and what doesn’t when it comes to HIPAA websites and are ready to listen to your needs. We’ll help you navigate the world of eCommerce pharmacies and PHI data security.