TransactRx Payers

Increase Member Vaccination Rates

TransactRx’s unique combination of provider contracting networks and its cross-benefit clearinghouse platform provides a winning combination to assist payers of all types in increasing vaccination rates. TransactRx expands access to your members and increases your member’s choices for where to receive vaccines. Increased access and convenience turns into higher vaccination compliance rates, higher quality scores and higher satisfaction of members and providers.

Medicare Part D Covered Vaccines Administered by Physicians

The TransactRx Part D Vaccine Manager web application and the TransactRx Part D Provider Network form the nation’s leading solution for overcoming reimbursement issues related to medical providers administering Medicare Part D covered vaccines. The solution enables over 20,000 medical providers to submit real-time pharmacy claims and receive payments all within their normal medical office workflow.

The TransactRx Part D Vaccine Manager is a web-based application that allows medical providers to determine patient Part D eligibility and financial responsibility prior to administering a vaccine and then after administering the vaccine to quickly and easily submit real-time claims to the appropriate pharmacy benefit manager.

The TransactRx Part D Provider Network is the only provider network of its kind that enables physicians and other medical providers to check patient Medicare Part D eligibility and submit claims for all Medicare Part D covered vaccines in real time to Medicare Advantage Plans and Medicare PDP’s that cover over 80% of all Medicare Part D subscribers. The Network allows Medicare Part D plans to include medical providers in their Part D networks without the expense and hassle of contracting with tens of thousands of providers that would normally not be included in their pharmacy network. TransactRx performs all provider credentialing and the expense of payment processing to the providers is also delegated to TransactRx.

Adult Vaccines Administered in Pharmacies and non-Medical Settings

Payers are not reaching otherwise achievable adult influenza and other immunization rate targets because of member access issues created by current provider contracting restrictions related to vaccines covered by medical benefits administered by non-medical setting providers.

Adult members of insurance plans have increasingly begun to use these non-medical setting providers for their seasonal immunizations such as retail pharmacies, retail stores or their employer site. The convenience of using these locations have made them the fastest growing segments of immunization providers. In 2011 adults age 18-64 used these non-medical settings more than they used physicians to receive their flu shots. However, these non-medical setting providers have not been able to contract with the majority of health plans to be in-network providers of these services and to be able to accept a patient’s insurance as payment for the services.

TransactRx has established the TransactRx National Immunization Network, a national provider network made up of pharmacies, public/community health centers, shot clinics, visiting nurse associations and other non-medical office healthcare providers that administer immunizations to members of contracted payers. In addition the TransactRx cross-benefit clearinghouse allows pharmacies to submit claims from their existing software systems using real-time pharmacy claims standards that are then converted and sent to insurance plans as standard medical claims through their current clearinghouse partners.