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TransactRx Enables Pharmacy Benefit Managers to Adjudicate Medical Claims

TransactRx announces, since its Retail Clinic Service was released in late 2015, it has now been implemented with three national scale PBM’s and has processed claims for over 250,000 patient encounters. The TransactRx Retail Clinic Service is a set of transaction processing services offered on the TransactRx Cross Benefit Clearinghouse.

The TransactRx Retail Clinic Service allows Retail Clinics to submit standard medical claims for professional services from their existing billing systems through the TransactRx Cross Benefit Clearinghouse to Pharmacy Benefit Manager adjudication systems as real time NCPDP D.0 claims with complete financial reconciliation back into their medical billing systems.

The TransactRx Retail Clinical Service enables PBM’s to create new hybrid benefits for plan sponsors so that their members can use the easy to access and lower cost services of Retail Clinics and the claims for the services can be managed by the sophisticated real time utilization management tools of the PBM.

“The adoption of our unique medical to pharmacy transaction service demonstrates the value our Cross Benefit Clearinghouse brings to the overall healthcare marketplace," says Jack Guinan, CEO TransactRx. “We are taking the industry one step closer to the realization of real time medical claims adjudication by enabling Pharmacy Benefit Managers to extend their services and use their sophisticated real time processing platforms to adjudicate medical professional service claims. This is just the start. We are currently working on other major implementations addressing specialty and infused drugs administered by physicians and covered under medical benefits that would perform pre-adjudication edits, training and enforcement of Medical Drug Policies and allow the medical claims to be adjudicated on the PBM platform.”

About TransactRx

POC Network Technologies, Inc. d.b.a. TransactRx provides cloud based transaction services that enable a seamless real-time interface between the medical and pharmacy claims processing infrastructures for Benefit Managers (PBM), Health Plans, Billing and Technology Providers. Using existing systems, the TransactRx proprietary Cross Benefit Clearing House and Population Health Management Platforms provide unique and flexible solutions to help manage any type of benefit no matter if it is on the Medical or Pharmacy spend.

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Source: PRWeb
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