TransactRx Enables PBM Adjudication of Retail Clinic Medical Claims

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Cross Benefit Clearinghouse enables PBMs to adjudicate Medical Service Claims from Retail Clinics and Urgent Care Centers

The TransactRx Retail Clinic Claims Service is another example of the unique and forward looking solutions made possible through our Cross Benefit Clearinghouse, said Jack Guinan, CEO of TransactRx.

TransactRx announces the release of enhanced functionality in its Cross Benefit Clearinghouse supporting the real time adjudication of medical service claims by Pharmacy Benefit Managers that were submitted by Retail Clinics and other Urgent Care providers using their current medical claims management software. The TransactRx Cross Benefit Clearinghouse receives standard professional medical claims submitted from the retail clinic’s medical billing system and converts those claims to real-time pharmacy claims for submission to the PBM. The Cross Benefit Clearinghouse also receives X12 835 ERA files from the PBM that reference the pharmacy claims information and converts them to 835 ERA files that can be directly imported into the medical billing system to programmatically post against the outstanding claims.

The Cross Benefit Clearinghouse Retail Clinic services have been in use by national Pharmacy Benefit Managers and Retail Clinics for over two years. The unique service allows Pharmacy Benefit Managers to offer new products to their plan sponsors which create new access for members to receive services covered under their pharmacy benefit at Retail Clinics and other walk-in type providers that use medical billing systems rather than pharmacy billing systems. Newly released features include enhanced pre-adjudication edits, hosted eligibility support and improved reporting.

“The TransactRx Retail Clinic Claims Service is another example of the unique and forward looking solutions made possible through our Cross Benefit Clearinghouse,” said Jack Guinan, CEO of TransactRx. “We are excited about the potential of our technology platform to assist Payers and Benefit Managers of all types in offering programs that blur the line between pharmacy and medical benefits.”

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 (PBMs, 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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Jack Guinan
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