What’s included in MedRx™
Smart Messaging
Medicare, Medicaid and commercial immunizations
Smart Messaging alerts your staff at the point of engagement when a customer is eligible for an immunization (e.g. flu, pneumonia, shingles, etc.)
- Helps improve customer service and drive sales
Access real-time eligibility to check a customer’s Part B Medicare coverage and identify other existing coverage
File Medicare Part B vaccination claims as part of your standard pharmacy workflow
Automation for workflows
Administration-fee calculation
NDC (National Drug Code) to HCPCS (Healthcare Common Procedure Coding System) mapping
ICD-10 (International Classification of Diseases) submission
Pharmacy-to-Medicare billing-unit conversion
Customers frequently achieve more than 99% payment rates
Durable medical equipment (DME)
Easily bill for all major categories
Includes diabetic supplies, ostomy supplies, inhalation drugs and supplies, oncology agents, immunosuppressive drugs and hardware rentals
Help prevent denials by determining eligibility for medical supplies and subjecting claims to CMS policy, format and cardholder edits
Automatic edits help remove the burden for you to stay on top of CMS policy
Use Cross Check to integrate Medicare supplemental data on the front end to help ensure accurate patient collections and avoid customer refunds
Receive messaging at point of sale if your pricing is below the plan’s allowable amount
Simplify billing by submitting your DME claims in the standard NCPDP format using your pharmacy-management system
Recovery management
Recovery and denial management
SmartRelease helps ensure accurate pick-up dates captured and reflected on Medicare Part B/DME claims
Automated date corrections help eliminate disruptions to your workflow
Help recover substantial revenue using our MedRx Recovery Medicare specialists to initiate documentation requests, appeal denied claims and manage denials through the final determination
Gain insights from quarterly and annual reports on billing issues, documentation compliance and Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies challenges (DMEPOS)
Use this information to train staff to help ensure future Medicare compliance and to help reduce denials
Outsource labor-intensive physician outreach for audits
Our audit action specialists manage the entire audit process, including documentation from pharmacy and corporate staff and contacting physicians for medical records
Key benefits
Optimize pharmacy billing and boost revenue.
Connect directly to payers to help increase efficiency
Connect to a broad network of commercial and government payers directly from your pharmacy management system to bill medical claims. Advanced front-end editing capabilities help prevent denials and accelerate reimbursement.
Denial and appeal processes to help recover revenue faster
Improve denial and appeal processes for DME claims to recover revenue faster and help prevent future denials. Our MedRx specialists manage physician and pharmacy outreach to obtain compliance documentation.
Real-time eligibility information to help improve patient outcomes
Access real-time eligibility information for Medicare Part B, Medicaid and commercial plans to determine coverage for immunizations and DME supplies and rentals with MedRx.
Complementary solutions
Absolute AR
Converge Rx™
Rx Assist
Enterprise Pharmacy System™
Related healthcare insights
Thought leaders discuss the intentional vigilance needed to overcome obstacles impeding better access to healthcare for all.
Video
Learn about the in-depth security capabilities of cloud-native imaging.
Learn from Optum Rx thought leaders how access, affordability and transparency have become imperatives for pharmacy benefit management.