Emdeon Commercial MedRx™

Emdeon Commercial MedRx enables pharmacies to submit claims electronically to major commercial medical insurance payers and plans in NCPDP format using existing pharmacy management systems. With this solution, commercial medical claims for items, such as crutches, syringes, immunizations and other items typically covered by a patient's medical insurance coverage rather than pharmacy benefits, are subjected to a variety of real-time edits that support more accurate payment collection at the point-of-sale. Once accepted into the Emdeon system, claims are forwarded to appropriate payers for adjudication and payments are delivered directly to the pharmacy.

Because Emdeon Commercial MedRx is designed to operate entirely within your standard pharmacy workflow, it provides an efficient alternative to submitting claims through traditional labor intensive paper billing processes and manual entry web-based services. Real-time eligibility, plan formulary based edits and patient co-pay and deductible information returned at the point-of-sale are among the features that can help simplify the claims filing process, streamline workflow and increase operating efficiency.

Features

• Electronic submission of claims in NCPDP format
• Integration with existing pharmacy management systems
• No additional hardware or software needed
• Easy implementation
• Real-time eligibility verification
• Patient co-pay/deductible information at point-of-sale, if applicable
• Plan formulary data included, when available
• Automatic translation from NCPDP to 837P
• Access to knowledgeable support personnel
• Assistance with enrollment and EDI paperwork
• Assistance with commercial medical insurance enrollment issues

Benefits

• Determines eligibility at point-of-sale
• Improves payment rates
• Provides electronic alternative to labor intensive paper billing and manual entry web-based services
• Creates a potential new revenue stream by providing access to medical payers
• Simplifies the billing process
• Increases pharmacy operating efficiency
• Reduces dispensing inefficiencies and accounts receivable interruptions
• Streamlines workflow processes
• Supports accurate point-of-sale payment collection
• Improves billing accuracy