Pre & Post Editing Services
Pre & Post Editing (PPE) Services uses our claims processing network to perform real-time validation and data processing of pharmacy claim submission data to optimize claim reimbursement and minimize reimbursement errors. PPE provides a high performance, flexible claim editing solution to help optimize reimbursement. You can maximize appropriate reimbursement for third-party claims and cash transactions are also supported, increasing profitability through prescription claim management.
Real-time edits perform financial and administrative reviews on each transaction running across our claims processing network. Examples include checking the submitted claim pricing for appropriateness, generic drug dispensing opportunity reminders and confirming that the claim detail is valid prior to submission to the third-party payer such as AWP validation, appropriate DAW codes, prescriber validation and coding compliance edits. These alerts can help you optimize your bottom line and:
- Manage reimbursement from third-party plans
- Compare U&C pricing to area competitors
- Help ensure appropriate DAW code assignment
By reducing potential claim submission errors at the point of dispensing, you receive maximum reimbursement value and add efficiency to the claim reimbursement process without allocating unnecessary time and resources retrospectively. With PPE, the entire process adds less than one half-second to your claim submission time.
PPE performs real-time claim validations that optimize claim submission through increased accuracy and data processing capabilities while identifying opportunities that could offer additional value.
