PHARMACY CLAIMS
Claims Submitted With Precision
We prepare and submit pharmacy claims accurately to reduce rejections and improve reimbursement turnaround times. Our team ensures claims meet payer requirements while maintaining efficient processing across multiple billing systems.
PHARMACY CLAIMS
Every Claim Submitted Clean. Paid Fast.
We process pharmacy claims through all major PBMs in NCPDP D.0 format with pre-submission validation for NDC mismatch, days supply errors, quantity limits, PA requirements, and refill-too-soon flags before each claim reaches the payer.
CoreMedX pharmacy clients average a 96.2% first-submission acceptance rate and resolve all remaining rejections the same business day.
ALL MAJOR PBMs
Express Scripts. CVS Caremark. OptumRx.
We maintain direct connections to all three major national PBMs plus 200+ regional pharmacy benefit plans, state Medicaid programs, and Medicare Part D payers with continuously monitored formulary and coverage change tracking.
For prior authorization requirements discovered at point of sale, we initiate the PA request immediately and work with the prescribing physician to complete documentation same day.
SAME-DAY REJECTION RESOLUTION
Rejected at 10 AM. Resolved by Noon.
Every rejection triggers a resolution workflow within 30 minutes. Patient-present rejections are escalated to immediate priority prescriber contacted and PBM engaged simultaneously so the patient gets their medication without leaving and coming back.
We document every rejection and resolution in monthly reports that identify recurring patterns for upstream prevention.
