A solution for pharmacies that want to improve their medical-claims billing efficiency, revenue, and customer satisfaction.


OptimizePharmacy Billing and Boost Revenue

  • Connect to a broad network of commercial and government payers directly from your pharmacy-management system to bill medical claims.
  • Use advanced, front-end editing capabilities to help prevent denials and accelerate reimbursement.
  • Improve denial and appeal processes for DME claims to recover revenue faster and to help prevent future DME denials; specialists manage physician and pharmacy outreach to obtain compliant documentation.
  • Access real-time eligibility information, including for Medicare Part B, Medicaid, and commercial plans, to determine coverage for immunizations and DME supplies and rentals.
  • Receive messaging prompts at the point of service when a customer is eligible for immunizations, driving sales and satisfaction; receive prompts when your DME pricing is below a plan’s allowable amount.
  • Optimize compliance and audits by engaging our specialists to obtain physician records and completed documentation and to manage claims to final determination.


Drive Engagement, Sales, and Claim-Management Efficiency

  • 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.) to 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.
    • Automate administration-fee calculation, NDC (National Drug Code) to HCPCS (Healthcare Common Procedure Coding System) mapping, ICD-10 (International Classification of Diseases) submission, and pharmacy-to-Medicare billing-unit conversion. Customers frequently achieve 99%+ payment rates.
  • Durable Medical Equipment (DME)

    • Easily bill for all major product categories, including 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 (Centers for Medicare and Medicaid Services) policy, format, and cardholder edits. Automatic edits remove the burden for you to stay abreast 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 the point of sale if your pricing is below the plan’s allowable amount. Then, simplify billing by submitting your Durable Medical Equipment (DME) claims in the standard National Council for Prescription Drug Programs (NCPDP) format using your pharmacy-management system.
  • Recovery and Denial Management

    • Use Smart Release to help ensure accurate pick-up dates are 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 to final determination.
    • Gain insights from quarterly and annual reports on billing issues, documentation compliance, and Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) challenges. 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 obtaining documentation from pharmacy and corporate staff and contacting physicians for medical records.

Providing Measurable Value

Card Background
30k +

Pharmacies enrolled

89 %

Average audit success rate

99 %

Overall Medicare payment rate

Our outcomes

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Resources and brochures


Medicare Audit & Documentation Compliance Pharmacists and pharmacy staff: learn how to be better prepared for an audit while earning Medicare Audit Compliance continuing education credit (CEC).


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