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Software

MedRx™

Use this flexible platform for billing commercial Medicare and Medicaid claims such as DME, immunizations and more.

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.

Let’s start a conversation

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