Pharmacy Medical Insurance Billing Solutions

For Vaccines, Wellness Services and any other Medical Service

Use your existing pharmacy billing software or our web-based pharmacy vaccine billing software to submit claims and manage reimbursement for flu, pneumonia, shingles and all other adult and pediatric vaccines. Submit claims to Medicare Part B, Medicaid and Commercial Payers. Our systems work the same way you work now. Claims are submitted from your pharmacy billing system in standard NCPDP D.0 format through your current switch to our innovative Cross Benefit Clearinghouse that in real time checks the medical benefit eligibility of the patient and then converts the claim to an ANSI X12 837 professional medical claim that is forwarded to the patient's insurance plan through the appropriate medical claims clearinghouse.

TransactRx is your NCPDP S1 transaction set expert. We can assist your pharmacy or pharmacy software vendor in submitting NCPDP S1 claim transactions for services using CPT or HCPC codes rather than NDC codes. Our Cross Benefit Clearinghouse can receive S1 claims and convert them into X12 837 claims or receive X12 claims and convert them to NCPDP S1 claims.

Maximize Your Profits With Our Pharmacy Medical Billing Services

Using TransactRx to manage your vaccine and medical service billing will insure you are not missing any potential profits due to under billing, improper coding or missing information in your pharmacy insurance billing.

  • Claims submitted through TransactRx have a payment rate near 100%.
  • All claims are checked for patient eligibility in real time and claims are rejected with appropriate information such as different primary payer.
  • All claims are checked against payer specific edits in real time to minimize delayed payments or denied claims.

Hands Off Claims Management Services

Our pharmacy transaction services provide vaccine billing and medical service billing functionality not found in standard pharmacy software programs. Most software used in pharmacy billing of vaccines cannot submit claims to Medicare Part B and other medical benefit insurance plans. Add the functionality needed to your pharmacy system using our transaction services

  • No coding knowledge is required.
  • NDC codes are translated to appropriate CPT or HCPC codes.
  • Appropriate payer specific diagnosis codes are applied at the clearinghouse.
  • Proactive claims status management – We proactively work all payer rejected and zero pay claims
  • 835 ERA files referencing medical claim identifiers are converted to 835 files referencing your Rx Numbers for easy posting of 835 Electronic Remittance Advice in your pharmacy billing system