# Client Onboarding - Link: https://argosygroup.org/client-onboarding/ - Published: 2026-10-11T17:15:42+00:00 - Author: volage.abhishek@gmail.com Draft saved ## Getting Started This form collects the information needed to set up billing and revenue-cycle services for your pharmacy. Please keep a copy of the confirmation email you receive. You can leave at any time and resume from a link we email you. Email for form link & signed document * ## Section 1 — Pharmacy & Business Information Legal Business Name * DBA / Pharmacy Name * Tax ID / EINFormat: XX-XXXXXXX NPI (National Provider Identifier)Format: 10 digits NCPDP NumberFormat: 7 digits NABP NumberFormat: 7 digits Pharmacy License Number(s) State(s) Licensed Primary Pharmacy Address Website Main Telephone Fax General Email Pharmacy Type (check all that apply) Retail / Community Hospital-Owned Specialty Clinic / Physician-Owned Compounding Infusion Long-Term Care (LTC) DME / Medical Supplies Mail Order 340B Independent Other: Additional Location Information Add a row per additional location. Location Name Physical Address NCPDP Number State License Number Add a row per additional location. ## Section 2 — Ownership & Key Contacts Provide contact information for each of the core roles below. Passwords must NOT be provided on this form. Designated Contact Roles Role Full Name Title / License (e.g. PharmD, RPh, CFO) Direct Phone Email Address Role Full Name Title / License (e.g. PharmD, RPh, CFO) Direct Phone Email Address Role Full Name Title / License (e.g. PharmD, RPh, CFO) Direct Phone Email Address Role Full Name Title / License (e.g. PharmD, RPh, CFO) Direct Phone Email Address Role Full Name Title / License (e.g. PharmD, RPh, CFO) Direct Phone Email Address Role Full Name Title / License (e.g. PharmD, RPh, CFO) Direct Phone Email Address ## Section 3 — Services to Be Provided Pharmacy Claims & Billing (check all that apply) Prescription claim submission Secondary billing Third-party insurance billing Rebilling/ corrected claims Medicare Part claims Claim rejection management Medicaid claims Reversals Commercial payer claims Claim denial management PBM claims Prior authorization support Workers’ compensation Eligibility verification Auto insurance Coverage investigation Coordination of benefits (COB) Other: Accounts Receivable / Follow-Up Insurance A/R follow-up Denial follow-up Underpayment review Overpayment review Unpaid claim follow-up Reconciliation Other: Financial / Reporting Services Daily billing reports Weekly reports Monthly A/R reports Payer performance reporting Rejection reporting Denial reporting Payment reconciliation Revenue trend reporting Other: Additional Services Credentialing NCPDP enrollment support Payer enrollment Medicare enrollment Medicaid enrollment PBM enrollment DME billing CAQH management Medical billing Consulting 340B billing support Other: ## Section 4 — Pharmacy Operations Average prescriptions filled per day Average prescriptions filled per month Average paid claims per month Average rejected claims per month Average reversed claims per month Average cash-pay prescriptions per month Number of pharmacists on staff Number of pharmacy technicians Number of billing / administrative staff Hours of Operation (Monday through Sunday) ## Section 5 — PBM / Switch / Claim Submission Primary Claim Switch / Clearinghouse Secondary Switch / Clearinghouse Who currently submits pharmacy claims? Are claims submitted electronically? Yes No Are claims submitted in real time? Yes No Who currently manages rejected claims? Who currently manages unpaid claims? ## Section 6 — Payer Portals & Online Access SECURITY NOTICE: Do not write passwords on this form. Secure credentials should be transferred through the agreed secure method. Portal Access Details Portal Name / URL Username / User ID Access Contact Person MFA Required? Access Needed? ## Section 7 — Enrollment & Credentialing Medicare Part D Enrollment Status Medicaid State & Enrollment Status Commercial / PBM Enrollment Status Are copies of payer contracts available? Yes No Are reimbursement schedules available? Yes No Are Maximum Allowable Cost (MAC) pricing schedules available? Yes No ## Section 8 — 340B Information Does the pharmacy participate in a 340B program? Yes No 340B Covered Entity Name 340B ID Number 340B Administrator / Software Provider Current 340B Billing Process Description 340B Reporting Requirements 340B Primary Contact Person ## Section 9 — DME / Medical Billing Does the pharmacy bill medical insurance for any products or services? Yes No Select categories billed Durable Medical Equipment (DME) Diabetic supplies Continuous Glucose Monitors ( CGM) Infusion supplies Wound care supplies Compression garments Ostomy supplies Incontinence supplies Medical supplies Pharmacy-administered drugs Other: Medical Billing Software Medical Billing Clearinghouse Current CPT / HCPCS Billing Process Current DME Enrollment Status ## Section 10 — Current Billing Performance Average Monthly Gross Billed Amount Average Monthly Insurance Payments Received Average Monthly Patient Payments Received Average Monthly Claim Reversals Amount Average Monthly Rejected Claims Value Average Monthly Denied / Unpaid Claims Value Average Monthly Billing Adjustments Current Total Accounts Receivable (A/R) Balance Estimated Current Clean Claim Rate Aged Accounts Receivable Breakdown A/R Balance 0 – 30 Days A/R Balance 31 – 60 Days A/R Balance 61 – 90 Days A/R Balance 91 – 120+ Days ## Section 11 — Common Claim Rejections & Denials Common Rejection Reasons (check all that apply) Prior authorization required Patient eligibility expired / invalid Refill too soon Quantity limitation exceeded Non-covered drug Drug not on formulary Invalid member ID Invalid BIN / PCN Coordination of benefits required Pharmacy not contracted Prescriber not enrolled / invalid NPI NDC issue / obsolete drug DAW code issue Drug Utilization Review (DUR) rejection Pricing / cost issue MAC price dispute Duplicate claim Compound claim issue Timely filing limit exceeded Other: Top Rejection / Denial Problems Ranking Rejection / Denial Problem Ranking Rejection / Denial Problem Ranking Rejection / Denial Problem Ranking Rejection / Denial Problem Ranking Rejection / Denial Problem ## Section 12 — Prior Authorization & Coverage Support Does the pharmacy currently assist with prior authorizations? Yes No Who handles the prior authorization workflow? Does the pharmacy perform benefits investigations? Yes No Does the pharmacy assist with manufacturer copay assistance? Yes No Does the pharmacy work with specialty medication manufacturers? Yes No ## Section 13 — Software & Technology Pharmacy Management System (PMS) Billing System Accounting System Electronic Payment / ERA System Clearinghouse / Switch Provider Other Operational Software Operational Integrations (check all that apply) Pharmacy software → Switch Pharmacy software → Clearinghouse Pharmacy software → Accounting ERA → Billing system Switch → PBM Other: ## Section 14 — Reporting Requirements Desired Reports (check all that apply) Daily claim report Rejection report Denial report A/R aging report Payment report Revenue report Payer performance report Prescription volume report Specialty revenue report 340B report DME report Other: Report Frequency Daily Weekly Monthly Custom Additional Reporting Requirements ## Section 15 — Compliance & Security Regulatory & Security Compliance (check all that apply) HIPAA Compliance PCI DSS Compliance Medicare Compliance 340B Compliance Medicaid Requirements PBM Contractual Requirements State-Specific Pharmacy Board Requirements Other: Does the pharmacy have a HIPAA Business Associate Agreement (BAA) process? Yes No ## Section 16 — Access & Authorization SECURITY NOTICE: Do not provide passwords on this form. Use client-created individual users, portal invitations, or another secure access method. ## Section 17 — Client Expectations & Goals Strategic Goals (check all that apply) Increase revenue collections Reduce claim rejections Reduce claim denials Reduce outstanding A/R Improve cash flow cycle Improve payment posting accuracy Improve payer follow-up frequency Improve reporting visibility Reduce administrative workload Improve reimbursement rates Identify underpayments Improve claim turnaround time Other: ## Section 18 — Implementation & Communication Preferred Go-Live Date Preferred Billing Cutover Date Preferred Meeting Frequency Preferred Communication Method Primary Client Decision Maker Backup Operational Contact ## Section 19 — Client Attestation I certify that the information provided in this onboarding form is accurate and complete to the best of my knowledge. I understand that incomplete or inaccurate information may delay implementation or affect billing and revenue cycle performance. Authorized Representative Name * Official Title * Signature * Sign with mouse or finger above