B-ClaimsRx
To help you get the most of your Medicare Part B claims processing, RelayHealth bridges the gap between pharmacy real-time claims processing and delayed batch processing. You will realize the cost savings by leveraging our reliable network, the power of real-time edits and the longstanding claims processing advantages of our clearinghouse services. For years, we have saved pharmacies millions of dollars and identified areas for opportunity by using our unique and actionable Pre & Post Editing Services.
What you might not know is that we already process over 150 million 837 claims per year via our ePREMIS® product. By combining elements of both our Pharmacy and Hospital division claims management solutions into B-ClaimsRx, we can deliver a highly effective Medicare Part B processing solution.
B-ClaimsRx will allow pharmacies to process Medicare Part B claims the same familiar way as regular thirdparty prescription claims. Using RelayHealth allows you to bring your Medicare Part B claims process more in-line with the current workflow of your regular prescriptions.
B-ClaimsRx offers:
- Real-time product and patient edits, and point of sale messages
- Access to knowledgeable support via our highly trained Help Desk
- The ability to perform and return calculations for reimbursement and co-pay amounts
- The ability to submit your claims to the appropriate Durable Medical Equipment Carrier (DMERC) in the ANSI X12 837P (HIPAA compliant format)
- The convenience of submitting claims just as you do today using the NCPDP v5.1 transaction — which means minimal training requirements
- Assured compliance via edits that will advise you when additional paperwork is required for reimbursements — such as Certificates of Medical Necessity (CMN) or DMERC Information Forms (DIF) — and when Written Orders need renewals
Point of Sale Messages include:
- Product coverage
- MAP price
- Minimum/maximum quantity verification
- Diagnosis code completeness validation
- HICN validation
- Dispensing limit checks
- OCNA validation
Additionally, B-ClaimsRx will:
- Process assigned and unassigned claims
- Create custom product listings
- Handle Coordination of Benefits
- Track Patient Deductibles
- Map DEA numbers to UPINs
