Software

Rx Edit

A comprehensive pharmacy claim solution designed to increase third-party reimbursements and improve in-store productivity.

 

Get Support
Contact Sales

BoostIncome, Efficiency


  • Provide proven, real-time pre- and post-edits as prescription claims are routed to and received from the third-party processor. 
  • Override a suggested edit to allow a claim to process without an update. 
  • Identify outdated ingredient costs prior to submitting the claim to the processor.
  • Perform a series of post-edits with specific messages added to the claim response for review.

Real time pre- and post-claim edits.

  • Financial savings and revenue enhancement

    • Verifies current ingredient cost is submitted on each claim by comparing the price in the third-party file, updated daily. If the price in file is higher, the price is automatically updated before submission.
    • Identifies inappropriate quantities for products dispensed as milliliters, grams, or total packs and messages with suggested proper pack sizes.
    • Identifies claims submitted with a discontinued NDC based on customer-defined thresholds––giving the pharmacy time to work through its inventory following discontinuation. 

  • Audit and Regulatory Compliance

    • Validate prescriber identifiers and check for conditions such as DEA or NPI identifiers that have been expired for greater than 30 days or that are invalid.
    • Evaluate commonly audited products for specific fields such as day supply, new prescription requirement, and date written.
    • Detect suspect combinations of products and DAW fields likely to lead to under-reimbursement or audit risks. These edits also help monitor many state-specific regulations around acceptable DAW usage.

  • Operational Assistance

    • Help ensure compliancy for third-party negative formulary and narrow therapeutic programs in which certain drugs should not be interchanged by pharmacists. 
    • Provide assistance with specific payer requirements, support pharmacy operations, reduce audit risks, and maximize reimbursement. 
    • Third-party edits include audit alerts regarding payer day supply and refill requirements, as well as hard copy documentation guidelines.

Our outcomes

View all insights

White Paper

Improving the Dental Eligibility and Benefit Verification Process

White Paper

Improving the Dental Eligibility and Benefit Verification Process

Discover why the dental industry has been slow to adopt EDI for eligibility and benefit verification and how Dental Benefits Advisor will help it catch up.

Learn More

Fact Sheet

Rx Cost Savings Advocate

Fact Sheet

Rx Cost Savings Advocate

Rx Cost Savings Advocate is a custom claims routing system that reduces costs for patients, health plans, and PBMs.

Learn More

White Paper

Prioritizing Investment in the RCM Patient Experience

White Paper

Prioritizing Investment in the RCM Patient Experience

Discover how enhancements to your patient experience across the revenue cycle can significantly improve your top- and bottom-line financial performance.

Learn More

PRODUCT SUPPORT

Need support for
this solution?

Get support
Explore related solutions

Join Community discussions

Find and share knowledge, exchange ideas, and collaborate with peers and Change Healthcare experts to drive your solutions to success.

Let’s start a conversation

We’re here to help you find out how pharmacy solution could benefit your organization. Complete the quick form to the right, and someone will reach out to you soon.

Our experts will:

  • Discuss your individual use case and business needs
  • Explain our features, benefits, and services
  • Show how pharmacy solutions can help achieve your goals

Want more information? Start here.

Contact Information

Store Information

Thank You

We appreciate your interest in Change Healthcare. A member of our team will contact you to better understand your needs and discuss potential solutions.

Together, we are accelerating the journey toward improved lives and healthier communities.