UNIQUE CLAIMS
PROCESSING SERVICES
Ingenuity, Innovation, Integrity
Rebate Administration
ProCare Rx’s rebate application was created to support the entire rebate process, including contract management, market share calculations, NCPDP compliant submissions, and transparent reconciliation down to a claim level.
340B Administration
ProCare Rx powers our 340B clients to significantly improve financials for their health system by maximizing their 340B program, improving costs, and increasing patient’s ability to obtain access to medications.
Certify Hub Rebate Program
ProCare Rx’s Certify Hub Rebate Program accurately identifies and certifies 340B claims to submit to pharmaceutical manufacturers for rebates.
Concierges Pharmacy Services
ProCare Rx’s Concierge Pharmacy Services assist patients in obtaining select, high-cost brand medications at a lower cost to both the patient and plan sponsor through one or more of our savings programs.
Population Health Administration
ProCare Rx’s population health analytics engine leverages all data within your digital ecosystem to expertly analyze member health and provide actionable information for effective management.
Data Warehouse
ProCare Rx’s data warehouse is maintained so that all fields used for adjudication are either directly stored or accessible to any reporting or extracts coming from the warehouse. The data warehouse is updated nightly for clients that need immediate access to historical data for reporting, analytics, and comparative analysis; it is loaded immediately after the nightly disbursal and verification of claims on the adjudication system has completed.
SWITCHING
SERVICES
ProCare Rx is a pioneer in the switching of encrypted pharmacy claims across the internet. Our internally developed and maintained pharmacy transaction switching technology enables real-time and point-of-care connectivity for a variety of different transactions and data exchange along a broad array of critical communication messaging.
Not just for claims routing, switching can be for real-time actuarial notification, claim price auditing, debit card loading, health profile tracking, real-time evaluation of 340B claim eligibility, and many other unique transfers.
Online real-time switching services offer the following benefits:
- Pharmacy switching services with pre and post editing options
- Multiple mirrored systems for state-of-the-art reliability and stability
- Real-time routing of claims to approved external entities
- Real-time bank debit card processing for HSAS and pre-paid programs
- Real-time AWP validation
- Real-time payer contract rate validation
- Fast communication with payers