As we look forward at the activities in the healthcare marketplace there is an increasing blurring of lines between the types of services offered by medical and pharmacy providers and the products and services covered by medical and pharmacy benefits
Coral Gables FL (PRWEB) November 26, 2013
TransactRx, the nation’s leading Medicare Part D Vaccine Physician Billing Service, announced today the filing of the first of what is expected to be a series of patent applications for technology components of its Cross Benefit Clearinghouse™. The patent application titled a ‘SYSTEM AND METHOD FOR MEDICAL BILLING SYSTEMS TO SUBMIT TRANSACTIONS FOR SERVICES COVERED UNDER PHARMACY BENEFITS’ covers one subset of functionality included in the overall set of technology and functionality in the Cross Benefit Clearinghouse™.
The patent covers a set of functionality related to medical billing and other systems based on X12 transaction standards that provides the capability to exchange transactions with pharmacy benefit managers and other entities whose systems are based on the NCPDP transaction standard. The functionality included in the patent application includes:
- Cross Benefit Eligibility – The ability for medical billing systems using their standard medical benefit eligibility module to determine a patient’s pharmacy benefit eligibility.
- Cross Benefit Coverage Predetermination – The ability for a medical provider to determine a patient’s financial responsibility for a particular drug product under their pharmacy benefit using their standard medical benefit eligibility module.
- Cross Benefit Real-time Claims Processing – The ability for a medical billing system to submit an X12 based claim transaction in real time which will be processed by the patient’s pharmacy benefit manager and in real time provide a claim response to the medical provider.
- Cross Benefit Batch Claims Submission – The ability for a medical billing system to submit batches of X12 based claims in their normal workflow which are then submitted as NCPDP real-time pharmacy claims to the appropriate pharmacy benefit manager.
- Cross Benefit Electronic Remittance Advice Processing – The ability to receive electronic remittance advice transactions from pharmacy benefit managers and convert them to be able to be applied against claims submitted from medical claims systems.
“As we look forward at the activities in the healthcare marketplace there is an increasing blurring of lines between the types of services offered by medical and pharmacy providers and the products and services covered by medical and pharmacy benefits,” says Jack Guinan, CEO of TransactRx. “We see our Cross Benefit Clearinghouse™ technology playing a key role in deploying new models of service distribution and benefit design.”
POC Network Technologies, Inc. d.b.a. TransactRx is a leading national provider of reimbursement solutions for vaccines and specialty pharmaceutical products administered at the point-of-care. The TransactRx proprietary technology platform seamlessly connects the nation’s pharmacy and medical transaction infrastructures to enable physicians, public health departments and pharmacies to check coverage information and submit claims for both medical and pharmacy benefits. The Company’s unique national provider networks significantly reduce the cost and effort associated with contracting a large numbers of providers to administer a particular vaccine or group of pharmaceutical products. The combination of technology and provider networks assists payers of all types including Medicare, Medicaid, Commercial and Self-Funded Employer plans.
To learn more, please visit http://www.transactrx.com/cross-benefit-clearinghouse.