Advanced Claim Edit Solutions

Optimize Your Pharmacy’s Reimbursement Potential

Transform your claims data into revenue opportunities with RECLAIM | Rx, our enhanced pre and post edit service. This comprehensive solution automates the complexity of pharmacy claim management while proactively identifying reimbursement opportunities and preventing costly billing errors before they impact your bottom line. 

RECLAIM | Rx saved pharmacies over $7 million in reimbursement savings last year.

What's Included

DAW verification

Using the wrong DAW code can increase audit risk and reduce reimbursement. Our verification service ensures you’re using the most appropriate DAW code to reduce that risk and maximize reimbursement.

Standard Dispense Qty

Common errors of submitting incorrect quantities for inhalers, solutions, and other packaged medications can be costly to your pharmacy. We make sure your claims have the correct quantities to ensure accurate reimbursement.

NDC Validation

An outdated NDC can mean lower reimbursement from the pharmacy benefits manager. We analyze each claim to identify outdated NDCs and provide the updated NDC where available.

Proactive Claims Analysis

We identify underpaid claims using market intelligence and proactive staff outreach for timely reviews. This approach frees you from complex reports, leading to better business outcomes.



Weekly Reports

Our customized reports highlight savings opportunities and clear, actionable insights to help you make faster, better-informed decisions that improve revenue potential and productivity.

Guided by integrity, trust, and client-centricity, our values drive everything we do.

Interested in optimizing your claims process? Contact us today or call (800) 380-7435.

Key Benefits

Minimize errors

RECLAIM | Rx reviews your claims electronically, flags any errors that need intervention, and our team contacts you directly to help resolve them. This may include issues such as inaccurate quantities, brand name drug pricing errors, or outdated AWP pricing. If not resolved, these errors can result in lost profit.

Save time

We understand what it takes to run a busy independent pharmacy, and we’re here to make claims review and resolution easier for you. By removing that burden, we give you more time to serve your patients.

Maximizing reimbursement

RECLAIM | Rx is the solution to your reimbursement woes. By combining technology, data analysis, and market intelligence with outstanding customer service, we can help maximize your reimbursements and improve your bottom line. 

PRT (Payer Response Transparency)

Take control of your pharmacy’s reimbursements with our innovative Payer Response Transparency service. PRT actively monitors and identifies claims that PBMs redirect to cash discount cards, empowering you to make informed decisions about claim processing and protecting your bottom line from unexpected fee reductions. When insurance plans don’t cover NDCs or modify coverage terms, PBMs often automatically convert claims to their cash discount programs, resulting in administrative fees ranging from $6-$20 per transaction. Our PRT service brings transparency to these hidden conversions, alerting you when claims are redirected and providing clear explanations for claim denials.

Automated AWP Resubmissions

Transform your pharmacy’s reimbursement potential with our intelligent automated solution that identifies and captures overlooked revenue opportunities. Through continuous monitoring of Average Wholesale Price (AWP) changes, our advanced analytics platform automatically identifies eligible claims and manages resubmissions on your behalf, delivering an average yield of $17 – $18 per eligible claim. Our system processes claims weekly, ensuring no reimbursement opportunity goes unnoticed, while requiring zero additional work from your team. With real-time market intelligence and precision benchmarking, we handle the complexities of reimbursement optimization while keeping you informed through comprehensive reporting. Experience worry-free revenue enhancement with our performance-based service that works tirelessly to improve your bottom line.

Prescriber Schedule Authority

Safeguard your pharmacy operations with automated DEA compliance verification that works in real-time. Our Prescriber Schedule Authority service continuously validates prescriber DEA numbers and prescribing authorities, providing an essential layer of protection for controlled substance dispensing. Every time a prescription is processed, our system instantly verifies three critical components: the prescriber’s DEA registration status, ensuring it’s active and not expired or revoked; the prescriber’s authority to prescribe specific drug classes; and the validation of the NPI against authorized DEA registrations. This comprehensive verification process helps prevent dispensing errors and reduces audit risks associated with unauthorized prescriptions. By automating these essential compliance checks, we help protect your pharmacy from potential violations while streamlining your workflow. Let our technology handle the complexity of DEA compliance so you can focus on providing exceptional patient care with confidence.
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