Cross Benefit Clearinghouse

The Nation’s Only Cross Benefit Clearinghouse

The TransactRx Cross Benefit Clearinghouse was developed to solve the new technology challenges created as medical benefit and pharmacy benefit covered services start to overlap with Medical Providers needing to be reimbursed under Pharmacy Benefits and Pharmacy Providers needing to be reimbursed under Medical Benefits. The Cross Benefit Clearinghouse provides a transaction platform that seamlessly integrates the X12 batch and real time medical claims infrastructure, the NCPDP real time pharmacy claims infrastructure and the HL7 batch and real time clinical data interconnectivity infrastructure.

Cloud Based Technology

The Cross Benefit Clearinghouse was developed from the ground up as a cloud based platform using all of the very latest technologies on the Amazon AWS environment. The micro-service based architecture is deployed as redundant clusters across multiple data centers ensuring 100% uptime. The use of dynamically provisioned server instances allows for extreme scalability. The platform has been tested at sustained processing speeds of over 1,000 transactions per second.

Built for Partnering

The Cross Benefit Clearinghouse services are made available to any Healthcare Provider through a set of web based application services or to any Software Developer or Healthcare System Provider through a broad set of standards based transaction interfaces or REST API’s. Any system can be enabled and extended to use the Cross Benefit Clearinghouse services with very little development effort.

Transaction Services

The Cross Benefit Clearinghouse transactions include:

  • NCPDP D.0 B1 Pharmacy Claims converted to X12 837 Professional Claims
  • NCPDP D.0 E1 Eligibility converted to X12 270 Eligibility
  • NCPDP D.0 S1 Service Claims converted to X12 837 Professional Claims
  • X12 837 Professional Claims converted to NCPDP D.0 B1 Pharmacy Claims
  • X12 270 Eligibility converted to NCPDP D.0 E1 Eligibility
  • X12 837 Professional Claims converted to NCPDP D.0 S1 Service Claims
  • X12 835 with Professional Claim ID’s converted to Pharmacy Rx Numbers and NDC’s
  • X12 835 with Pharmacy Rx Numbers and NDC converted to Professional PCN and CPT
  • Proprietary API and Web Service calls converted to NCPDP D.0 Pharmacy Claims

The platform also supports Population Health Management initiatives offering:

  • Identify Gaps in Care from X12 837, NCPDP D.0 Claims, HL7 Clinical Records
  • Deliver Care Opportunities based on Gaps in Care to Pharmacies

Additionally the platform supports Payers in their Medical Drug Rebate processing:

  • Convert Pre and Post Adjudication Claim and Remittance Data to NCPDP Rebate Files