MedRx Medicare & Medicaid DME

A solution for pharmacies that want to determine eligibility for Medicare and Medicaid DME, reduce denials, maximize reimbursement, and submit claims electronically through existing pharmacy management systems.

Maximize Reimbursement

Determine eligibility for medical supplies at the point-of-sale to reduce DME denials and maximize reimbursement.

Receive a messaging alert at the point-of-sale if your usual and customary pricing is below the plan’s allowable amount. 

Facilitate fast, clean claim submissions for Medicare Part B and Medicaid DME by obtaining real-time eligibility information and front-end edits.

Simplify billing by submitting your DME claims in the standard NCPDP format using your existing pharmacy management system.

Have your claims subjected to CMS policy, format and cardholder eligibility edits to help ensure compliance, and ultimately reduce denials.

Easily bill for all major product categories, including diabetic supplies, ostomy supplies, inhalation drugs and supplies, oncology agents, immunosuppressive drugs, and hardware rentals.

Streamline Eligibility and Simplify Billing

Real-time eligibility and clean claim submissions

  • Facilitates fast, clean claims submissions for Medicare Part B and Medicaid DME by leveraging real-time eligibility information and front-end edits. Additional features help you maximize reimbursement.
  • Helps ensure compliance by subjecting claims to CMS policy, format and cardholder eligibility edits. Automatic edits alleviate the pharmacy’s burden of manually staying abreast of CMS policy changes.
  • Allows you to submit your DME claims in the standard NCPDP format using your existing pharmacy management system. MedRx Network lets you bill for all major product categories.

Patient payment capture

  • Alerts you at the point-of-sale if your pharmacy’s usual and customary pricing is below the plan’s allowable amount to adjust the claim prior to submission.
  • Enables pharmacies to track patient deductibles and receive a real-time response with payment responsibility if a patient’s deductible is unmet.
  • Supports a more accurate estimation of patient responsibility amounts and enables the pharmacy to request patient payment on the front-end versus spending time and money on collection efforts.

Support network

  • Gives you access to our secure HIPAA-compliant website and online web tools, allowing you to view/download the Medicare/Medicaid billing manual, analyze your EOBs directly, and download other CMNs and documentation.
  • Provides support from our enrollment team to complete necessary documentation, meet enrollment requirements, and ensure your provider identification numbers remain active.
  • Lets you partner with our experienced pharmacy customer support team to navigate complex protocols and policies.

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