API

Rx Edit

Enhance income and efficiency with real-time pharmacy claim edits.

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

Boost Income, 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  • Identify outdated ingredient costs prior to submitting the claim to the processor.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.
Related resources
Brochure

Optimize reimbursement and regulatory compliance with Rx Edit

Pre and post editing helps avert common payment glitches and drives efficiency, compliance, and revenue.

Frequently Asked Questions

Q: How does this pharmacy claim solution help increase third-party reimbursements?

 

A: This solution provides real-time pre- and post-edits as prescription claims are routed to and received from the third-party processor. By identifying outdated ingredient costs and performing a series of post-edits with specific messages, it helps ensure that claims are accurate and optimized for maximum reimbursement.

Q: How does this solution improve in-store productivity?

A: By providing proven, real-time edits and identifying outdated ingredient costs prior to submitting claims, this solution streamlines the claims process. It reduces the time and effort required to manage claims, allowing your pharmacy staff to focus on other important tasks and enhance overall productivity.

Q: Is there flexibility if I need to make edits?

A: Yes, you can override a suggested edit to allow a claim to process without an update. This flexibility ensures that you have control over the claims process and can adjust as necessary to meet your pharmacy's specific needs.

Marketplace updates

Subscribe to The Spark

We're adding new products and services to rapidly expand our marketplace and the potential is huge. Be an early adopter and stay ahead of the trend with our bi-weekly e-updates.

Request Sandbox Access
That's right. FREE. Zip. Nada.
As in, no money.

Begin your free trial today!

Sandbox Request

Application Programming Interface

To request for a sandbox access, please select product by category.

Personal information
Please fill out the form to request access to a sandbox.
 
 

By submitting my information I consent to receiving more information about Optum products.