As insurers try new benefit designs to best optimize risk models and move drugs and services between medical benefits and pharmacy benefits it presents new transaction processing requirements and challenges.
Coral Gables, FL (PRWEB) October 23, 2013
TransactRx, the nation’s leading Medicare Part D Vaccine Physician Billing Service announced today the marketing launch of the first Cross Benefit Clearinghouse™.
The unique transaction platform seamlessly integrates the nation’s real-time pharmacy switching infrastructure with the nation’s batch medical claims clearinghouse infrastructure. It provides functionality to convert in real-time between NCPDP formatted and X12 formatted eligibility, claims and remittance transactions. In addition, the platform is one of the first to fully support the NCPDP S1 transaction set. The Cross Benefit Clearinghouse can be “plugged into” any current implementation of pharmacy switches and medical claims clearinghouse connections without any software modification requirements.
“I am extremely proud of Jack Guinan, TransactRx CEO and the entire team,” says Richard A. Wolpow, Founder and Chairman of TransactRx. “We have had our heads down developing this platform for the past 18 months and we are just starting to understand all the possible applications the platform can support; currently we have Implemented the following solutions based on the platform:”
- Medical providers using their current X12 standards based practice management, billing systems and clearinghouse can check a patient’s pharmacy benefit eligibility and submit claims for services covered by their pharmacy benefit. Examples of this include Medicare Part D covered vaccines or specialty pharmacy drugs covered by the patient’s pharmacy benefit.
- Pharmacies using their current NCPDP standards based pharmacy management systems and claims switch can check a patient’s medical eligibility and submit claims to medical payers for products and services covered by the patient’s medical benefit. Examples of this include pharmacies checking eligibility and submitting claims for flu shots covered by Medicare Part B or commercial payers. The Platform also provides an option for specialty pharmacies that are using two separate systems to bill for pharmacy and medical claims to now be able to use just their one primary management system for all claims.
As new healthcare delivery models arise, such as Retail Health Clinics proliferating in pharmacies, the lines between medical services and pharmacy services are blurring. This is creating a whole new set of systems requirements for the processing of claims and other data exchange. The TransactRx Cross Benefit Clearinghouse provides the services necessary to support these new healthcare reimbursement processes.
In addition to the ability to convert claims between the various standards, the Cross Benefit Clearinghouse also has robust payment processing functionality that facilitates translating claim status and remittance advice transactions into formats and with content that makes sense to the submitting platform. The platform provides all the tools necessary for providers to have all their financial claims data in their primary billing and/or fulfillment system. The Platform is also supported by the suit of TransactRx Applications, which include revenue cycle management and Provider Network Management applications.
“As insurers try new benefit designs to best optimize risk models and move drugs and services between medical benefits and pharmacy benefits, it presents new transaction processing requirements and challenges,” says Jack Guinan, CEO of TransactRx, “Our unique platform facilitates new types of business relationships between healthcare providers, insurers, PBMs and all types of healthcare entities that otherwise would have been impossible to create. We are excited about what this could mean to the marketplace and are already seeing a lot of interest from many of the larger stakeholders.”
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.