Insurance & Billing

At Park Shore Pharmacon, we know that managing insurance and reimbursement can be overwhelming for group homes, intermediate care facilities, and waiver support programs. Our Insurance & Billing services are designed to simplify every step—helping you stay compliant, reduce administrative stress, and ensure timely reimbursement for essential medications and consumable medical supplies. With more than six decades of experience serving Florida’s long-term care community, we bring clarity, precision, and peace of mind to your financial operations. That’s why our Insurance & Billing services are built to simplify the process from start to finish. With over six decades of experience serving Florida’s long-term care community, we offer transparent, compliant, and efficient billing systems that take the stress out of managing healthcare expenses.

Whether you’re dealing with state Medicaid, Medicare, waiver programs, or private insurance, Park Shore Pharmacon ensures that your facility or group home receives the support needed to streamline claims, track approvals, and get the most out of every benefit plan.

Let us manage the paperwork—so you can focus on delivering care.

Medicaid Coverage: Traditional, Managed Care Plans, and HMOs

Medicaid plays a critical role in supporting long-term care residents, and navigating its requirements can be complex. At Park Shore Pharmacon, we have extensive experience working with Florida’s Traditional Medicaid program, Medicaid Managed Care (Managed Care Plans), and Medicaid HMOs to ensure that eligible residents receive the pharmacy services and medical supplies they need—without unnecessary delays or disruptions in care.

Our pharmacy team is well-versed in the administrative and billing procedures associated with Medicaid coverage. We provide electronic eligibility verification to confirm resident benefits in real-time, helping your staff avoid guesswork or potential gaps in service. When medications require additional approvals, we offer full assistance with prior authorizations, working directly with prescribers and insurance providers to speed up the approval process.

To help facilities stay within Medicaid coverage limits, we also manage medication refills with precision and care. Our refill tracking system monitors each resident’s usage and prevents overfills, ensuring compliance with payer guidelines and reducing waste. In the event of an audit or regulatory review, we supply complete, organized documentation that supports accurate recordkeeping and program compliance.

Whether you oversee an assisted living facility, intermediate care program, or APD group home, our team understands the nuances of Medicaid policies and how to align your pharmacy needs accordingly. By partnering with Park Shore Pharmacon, you gain a reliable pharmacy provider who takes the administrative burden off your team—so you can focus on delivering compassionate, high-quality care to every resident.

Medicare Providers (A, B, C, D) with Medicare Accredited Billing Systems

At Park Shore Pharmacon, we specialize in pharmacy and billing support for facilities serving individuals with intellectual and developmental disabilities, including I/DD waiver group homes, intermediate care facilities, and behavioral health programs. We also serve assisted living and other long-term care settings.

Park Shore Pharmacon is proud to be Medicare accredited, offering comprehensive billing support for Parts A, B, C, and D. We help facilities determine what’s covered under each plan and manage complex Medicare requirements efficiently.

Our Medicare services include:

• Coordination of Part D drug plans
  We work directly with Medicare Part D prescription drug plans to ensure residents receive covered medications without interruption. Our team helps facilities choose the most appropriate plan options, manage enrollment, verify drug coverage, and resolve any issues related to plan changes, co-pays, or formulary limitations.

• Understanding Medicare Advantage (Part C) formularies
  Navigating Medicare Advantage plans can be challenging due to their varying formularies and coverage rules. We help facilities interpret these plans, identify preferred medications, and ensure formulary compliance. Our staff also works with physicians to recommend appropriate alternatives when a prescribed drug isn’t covered, minimizing delays in resident care.

• Claim submissions and appeals
  Our billing team handles all aspects of Medicare claim submissions, from initial entry to final resolution. If a claim is denied, we take immediate action to file appeals with the appropriate documentation. This proactive approach helps facilities avoid unnecessary out-of-pocket costs and ensures timely reimbursement for eligible pharmacy services.

• Hospice care coordination under Part A
  When a resident enters hospice care, medication coverage and billing requirements change under Medicare Part A. We collaborate with hospice providers to ensure proper medication authorization, accurate billing, and regulatory compliance. Our team ensures that residents receive compassionate, uninterrupted care without confusion over benefit transitions or eligibility.

• Audit-Ready Documentation
  We maintain complete, organized records to ensure your facility is fully prepared for Medicaid, Medicare, or waiver program audits. Our proactive compliance approach helps minimize risk and protect your organization during reviews.

We provide clarity and control over Medicare pharmacy benefits, ensuring that each resident receives the medications and supplies they need without unnecessary delays.

Handling Third Party Liability (TPL) and Cross-Over Billing

In many cases, residents have both public and private coverage. Our Insurance & Billing system is designed to handle Third Party Liability (TPL), where a private insurer is the primary payer, and Medicaid or Medicare serves as the secondary.

We offer:

• Coordination of benefits (COB)
  We manage the coordination of benefits process to ensure that claims are billed in the correct order—starting with the primary insurer and followed by the secondary payer, such as Medicaid or Medicare. This prevents payment conflicts, reduces denials, and helps your facility receive proper and timely reimbursement.

• Cross-over billing automation
  Our system automatically routes claims from the primary to the secondary payer, streamlining the cross-over billing process. This reduces manual intervention, eliminates duplicate data entry, and speeds up payment cycles. By automating this step, we improve billing efficiency and ensure that every eligible claim receives full consideration.

• Balance billing compliance
  We help facilities stay compliant with balance billing regulations by ensuring that no resident is incorrectly billed for amounts that should be covered by insurance. Our billing team carefully monitors claim outcomes and secondary payments to make sure all charges align with state and federal guidelines, protecting both residents and your facility.

• Denial tracking and resubmissions
  When claims are denied or underpaid, our billing team actively tracks the issue, identifies the cause, and quickly resubmits the claim with corrected or additional information. This ongoing monitoring reduces lost revenue, shortens reimbursement delays, and keeps your facility’s financial performance on track without requiring extra administrative effort from your staff.

This ensures your facility maximizes reimbursement without getting lost in red tape.

Seamless Billing through Availity

Efficient billing and insurance coordination are essential to the smooth operation of any long-term care facility. At Park Shore Pharmacon, we understand the importance of timely reimbursements and accurate claims processing. That’s why we utilize the Availity platform—one of the nation’s most trusted healthcare portals for managing insurance workflows and payer communication.

By integrating our pharmacy services with Availity, we provide our facility partners with reliable, real-time access to essential billing tools and insurance verification. Through this platform, we can instantly confirm resident coverage, reducing delays and allowing your staff to make informed decisions faster. Claims are submitted and monitored electronically, with full visibility into their status, minimizing guesswork and cutting down on processing time.

Availity also supports a range of functions beyond simple submissions. Facilities can track claims, manage denials, and utilize built-in tools to file appeals—all within a secure, centralized system. This level of accessibility promotes smoother coordination with insurance providers and allows for quicker resolution of any billing discrepancies.

Our use of Availity supports a digital-first approach, significantly reducing paper-based processes and manual entry errors. This not only speeds up reimbursement timelines but also enhances accuracy and transparency for all parties involved.

With Park Shore Pharmacon and Availity working together, facilities gain access to a smarter, more streamlined billing experience. We take the administrative burden off your team, so you can stay focused on resident care, knowing that your pharmacy claims are handled with precision, security, and speed.

State Plan Medicaid and Institutional Contract Services

Long-term care organizations operating under Florida’s State Plan Medicaid require a pharmacy partner that understands the complexities of institutional billing and regulatory compliance. At Park Shore Pharmacon, we offer specialized services designed to support the financial and administrative needs of Medicaid-funded facilities across the state.

Our team provides structured billing solutions tailored specifically to institutional care settings. We assist facilities in accurately tracking pharmacy-related costs within established daily rate structures, ensuring clarity and consistency in financial reporting. This level of detail helps administrators manage budgets more effectively while remaining compliant with Medicaid requirements.

In addition to routine billing, we offer full coordination with audits conducted by the Agency for Health Care Administration (AHCA). Our system is built to support audit readiness by maintaining organized, transparent documentation that meets state and federal guidelines. We help facilities navigate audit processes confidently and efficiently.

We also provide facility-based billing models that are compatible with various long-term care settings, from skilled nursing homes to group residences. Our approach is flexible enough to adapt to your internal workflows while maintaining accuracy and compliance in every transaction.

To further support compliance, our reporting tools are aligned with current Medicaid regulations. These reports simplify administrative oversight and help facilities demonstrate accountability and accuracy in their pharmaceutical expenditures.

At Park Shore Pharmacon, our Insurance & Billing system is more than a service—it’s a seamless extension of your facility’s operations. With tailored solutions, regulatory insight, and reliable support, we help you stay focused on care while we handle the complexities of institutional billing.

Billing Support for iBudget and DD Waiver Programs

Park Shore Pharmacon specializes in billing for Florida’s Agency for Persons with Disabilities (APD) iBudget and Developmental Disability (DD) waiver programs. We ensure that medications and consumable medical supplies are billed accurately under approved services, eliminating errors and avoiding delays in care. Our team collaborates directly with support coordinators to align pharmacy services with each resident’s support plan, manage Service Authorizations (SAs), and maintain compliance with APD guidelines. We ensure Medical Supplies and pharmacy services align with support plans and allowable expenditures.

Services include:

• Item eligibility verification
  We review and confirm which medications and medical supplies qualify under iBudget and DD Waiver guidelines, ensuring only approved items are billed for reimbursement.

• Direct communication with waiver support coordinators
  Our team works closely with waiver support coordinators to ensure services match each client’s support plan, streamlining approvals and eliminating delays in care delivery.

• SA (Service Authorization) support
  We assist in generating and managing Service Authorizations (SAs), helping facilities and coordinators navigate requirements and avoid gaps in pharmacy coverage or documentation.

• Custom billing statements for each client
  Each client receives detailed, individualized billing statements that align with their specific waiver plan, making it easy to track services and verify allowable charges.

We understand the nuances of the iBudget and help maximize value for every approved service.

Supporting Waiver, Med Waiver, and Developmental Disability Waiver Billing

Florida’s Medicaid Waiver programs are essential in helping individuals with disabilities receive care in home- and community-based settings rather than institutional environments. At Park Shore Pharmacon, we understand the complex requirements that come with managing these programs, which is why we offer specialized Insurance & Billing services tailored specifically for waiver providers.

Our billing process is structured to accommodate the detailed nature of programs such as the Developmental Disability (DD) Waiver, Med Waiver, and other support tracks. We provide secure, timely monthly invoicing to waiver support coordinators and authorized providers, ensuring transparency and easy recordkeeping. Each invoice includes a comprehensive, itemized breakdown of all billable products and services, clearly outlining what was dispensed, to whom, and under which authorization.

We also monitor allowable medication quantities and expenditure limits to help your facility stay within program guidelines. This helps avoid overspending, billing errors, or reimbursement delays. Our team tracks these variables closely to ensure your program remains compliant and efficient.

Coordination with state agencies, including the Agency for Persons with Disabilities (APD) and the Centers for Medicare & Medicaid Services (CMS), is built into our billing workflow. We stay up to date on policy changes and adjust our systems accordingly, so your organization doesn’t miss important updates or regulatory deadlines.

Whether you’re managing a group home, supported living environment, or adult day training program, Park Shore Pharmacon delivers reliable billing support that aligns with your administrative processes, making compliance simpler and more manageable.

Government & Institutional Contract Pharmacy Services

Park Shore Pharmacon proudly serves government agencies and institutional care providers across Florida by offering specialized contract pharmacy services tailored to large-scale operations. Our team is experienced in navigating the unique needs of public-sector facilities, and we maintain full compliance with both state and federal contract standards to ensure smooth, accountable service delivery.

We work closely with a range of institutions, including correctional facilities, veterans programs, municipal and county group homes, and community-based health centers. Each partnership is built on trust, transparency, and a shared commitment to delivering consistent pharmaceutical care to vulnerable or underserved populations.

Our insurance and billing services are designed to relieve administrative burden while improving financial oversight. We manage everything from eligibility verification and claims processing to detailed billing reports and price reconciliation. All documentation is maintained to support audit-readiness and long-term recordkeeping, so your team remains prepared for regulatory reviews at any time.

With Park Shore Pharmacon, institutions can count on accurate, timely support that ensures residents and clients receive the medications they need—without delays or discrepancies. We understand the operational challenges faced by government programs and community health services, and our scalable systems are built to adapt to facilities of any size or scope.

By taking a proactive approach to compliance, insurance coordination, and fiscal accountability, Park Shore Pharmacon allows public institutions to focus more on care delivery and less on administrative complications. Our goal is to be a dependable partner that strengthens both clinical efficiency and financial accuracy within your organization.

What We Handle for You

Park Shore Pharmacon takes the guesswork out of reimbursement. Here’s what our Insurance & Billing team manages:

• Medicaid & Medicare plan management
  We handle all aspects of Medicaid and Medicare pharmacy benefits, ensuring that residents are correctly enrolled and medications are billed to the appropriate plans. Our team monitors policy updates and billing codes to maintain compliance and reduce denials, making reimbursement more reliable and hassle-free for your facility.
• iBudget & waiver billing
  Our billing experts manage claims under the Florida iBudget system and other Medicaid waiver programs, ensuring timely and accurate submissions. We understand the specific requirements of these programs and help facilities navigate billing cycles, limits, and authorization processes, so you receive the appropriate reimbursement without administrative confusion.
• Private insurance coordination
  We coordinate directly with private insurance providers to verify coverage, submit claims, and resolve issues such as denials or out-of-network concerns. This ensures that each prescription is processed correctly, and your facility receives timely payment without the burden of long phone calls, follow-ups, or appeals.
• Cross-over claims processing
  We manage the processing of cross-over claims where both Medicare and Medicaid are involved. Our system ensures accurate coordination of benefits, reducing delays and minimizing payment errors. This service streamlines multi-payer claims and helps your team avoid the complications often associated with dual-eligible resident billing.
• Prescription benefit verification
  Before any medication is dispensed, our team verifies the resident’s pharmacy benefits to confirm coverage, copays, and restrictions. This prevents claim rejections and ensures cost transparency for both facilities and residents. We proactively address benefit limitations, so you’re not caught off guard after medications are delivered.
• Refill & authorization tracking
  We monitor upcoming refills and manage prior authorizations for medications that require provider approval. By tracking expiration dates and renewal needs, we ensure continuity of care and avoid gaps in medication delivery. Our system notifies your team of required actions, helping prevent treatment interruptions.
• Electronic invoice generation
  Invoices are generated electronically with full transparency, including itemized charges, claim status, and payment application. These detailed digital records simplify financial tracking and support easy integration with your facility’s accounting systems. This approach reduces paperwork, improves accuracy, and supports a more organized billing workflow.
• upport for government audits
  We maintain thorough documentation and billing records to ensure your facility is always prepared for audits by Medicaid, Medicare, or other regulatory bodies. Our team responds to audit requests, compiles necessary documentation, and ensures your records reflect compliant billing practices, protecting your reputation and financial standing.
• Resident, guardian, or rep payee account setup
  We facilitate account setup for residents whose medications are billed through third parties, such as legal guardians or representative payees. This includes verifying payer information, linking accounts to billing profiles, and maintaining up-to-date records—ensuring accuracy in charges, payment application, and ongoing communication.

We act as your facility’s personal billing department, eliminating friction and saving your team hours of admin time each month.

Easy-to-Understand Billing for Families and Guardians

At Park Shore Pharmacon, we understand that families, guardians, and representative payees play a vital role in managing a resident’s healthcare. That’s why we prioritize billing clarity and transparency, making it easier for caregivers to stay informed and in control. In addition to working directly with long-term care facilities and state agencies, we offer tailored billing support for those overseeing individual accounts.

Our team provides straightforward, easy-to-read monthly billing summaries that clearly outline charges for medications, supplies, and services. These summaries are designed to remove confusion and help caregivers quickly understand what is being billed and why.

Each account is supported by a dedicated representative who can answer questions, explain coverage details, and help resolve any concerns. We also assist with setting up manageable payment plans when needed, ensuring that families are not overwhelmed by unexpected costs.

To further support clarity and convenience, we offer online wallet access for real-time account management. Families can view balances, track payments, and access documents from any device. For those managing residents with limited income, we provide guidance on low-income subsidy programs and help navigate the necessary paperwork.

Our benefit clarification support helps families understand what’s covered, what requires approval, and how to make the most of available insurance or government assistance.

By offering personalized billing services with a focus on clarity, access, and responsiveness, Park Shore Pharmacon strengthens trust and communication between care teams, residents, and their loved ones—ensuring that everyone involved feels informed, supported, and confident in the care being provided.

Why Park Shore Pharmacon is the Right Partner for Insurance & Billing

At Park Shore Pharmacon, we understand that managing insurance and billing in long-term care is often as complex as the clinical care itself. That’s why facilities across Florida trust us—not just for medication services, but for reliable, efficient, and facility-focused billing support. Our Insurance & Billing program is designed specifically for the needs of long-term care providers, group homes, and disability support organizations.

With decades of hands-on experience in Florida’s healthcare system, we bring in-depth knowledge of Medicaid, Medicare, and various waiver programs. Our team stays current with evolving state and federal billing guidelines, so your facility remains compliant without the administrative burden falling on your shoulders. We also provide tailored support, assigning billing specialists based on facility type to ensure you’re working with someone who understands the unique structure of your organization.

What makes our approach truly stand out is our proactive communication and seamless system integration. We coordinate closely with our pharmacy and supply services, which helps prevent billing delays and eliminates disconnects between medication orders and insurance claims. Our responsive team is available to answer questions, troubleshoot issues, and advocate on your behalf when complexities arise.

From day-to-day claims processing to long-term reimbursement strategy, we focus on accuracy, speed, and accountability. At Park Shore Pharmacon, we don’t just manage your billing—we help optimize it, allowing your team to focus more on resident care and less on paperwork. Partnering with us means gaining a trusted ally in both clinical and financial operations.

Frequently Asked Questions (FAQs) About Insurance & Billing

1. What types of insurance do you accept?
   We accept Traditional Medicaid, Medicare Parts A–D, Managed Care (Managed Care Plans), DD Waiver programs, and many private insurance plans. We also work with institutions using government funding or TPL.

2. Can Park Shore Pharmacon bill Medicaid and Medicare at the same time?
   Yes. We provide full cross-over billing support for clients who are dual eligible for Medicare and Medicaid, ensuring both payers are coordinated correctly.

3. Do you help with iBudget or DD Waiver documentation?
   Absolutely. We work directly with waiver support coordinators and APD to ensure all Medical Supplies and pharmacy services align with iBudget and waiver rules.

4. Can you help families or guardians understand pharmacy bills?
   Yes. We offer family-facing billing support, simple statements, and digital access to payment options for guardians, rep payees, and caregivers.

5. What’s the benefit of using a pharmacy that handles Insurance & Billing in-house?
   It saves time, prevents billing errors, and ensures faster reimbursement—plus your staff won’t have to juggle multiple vendors or portals. Everything is handled through one trusted partner.