If you are a vendor that needs to invoice the TPA to be paid, we use a “Plan Claim” approach which takes dollars directly from the claims fund. However, by plan claim type, there is a difference of whether the dollars spent are stop loss eligible. Below is the following process used broken down by vendor type:
DPCs
We ask you to email your accounting contact a consolidated invoice of all ancillary spend from the group for that month.
We pay these at the group level so they must be broken down by group.
The plan will cover all/any ancillary services you offer (e.g. labs, imaging, medications, additional services, etc).
If your accounting contact is directly with Yuzu, email accounting@yuzu.health.
Once you have sent the invoice, we will process and send payment to you within two weeks.
PBMs
We ask you to email accounting@yuzu.health an invoice of all pharmacy spend (and admin costs, per-script fees if not auto-remitted) from the group bi-monthly (1st and 16th).
We pay these at the group level so they must be broken down by group.
We strongly prefer bi-monthly (twice a month) invoicing cycles if possible to reduce administrative costs of processing invoices especially when working to make high-quality benefits scaled for small businesses. We typically pay these within one week.
The PBM invoice MUST reconcile against a daily pharmacy claims report sent via file feed to Yuzu. Yuzu does not support Pharmacy only accumulator files. This file must include:
Date of Service
Drug Name
Plan Paid Amount
Member Paid Amount
Retainage Fees
Typically, Network fees associated with percent of savings programs invoiced at a monthly basis. Examples:
% of savings model used over a PEPM fee
Claims editing fee
Case management hourly fee
Stop Loss coverage for these fees varies by Stop Loss. We recommend discussing them with the program, the stop loss carrier, and Yuzu before go-live