Real-Time Processing,
Reliable Outcomes
Our claims adjudication platform, which is developed and owned internally by ProCare Rx, processes every prescription in real time — accurately, consistently, and in alignment with each plan’s benefit design. Eligibility, coverage, and formulary rules are verified instantly to reduce errors and prevent pharmacy delays. With integrated clinical checks to flag drug interactions and prior authorization needs, we help ensure members receive the right medication at the right time — without interruption. Owning our own intellectual property allows us to oversee every aspect of its design, performance, and evolution, guiding each claim with focus, accuracy, and accountability.
Real-Time Processing,
Reliable Outcomes
Our claims adjudication platform, which is developed and owned internally by ProCare Rx, processes every prescription in real time — accurately, consistently, and in alignment with each plan’s benefit design. Eligibility, coverage, and formulary rules are verified instantly to reduce errors and prevent pharmacy delays. With integrated clinical checks to flag drug interactions and prior authorization needs, we help ensure members receive the right medication at the right time — without interruption. Owning our own intellectual property allows us to oversee every aspect of its design, performance, and evolution, guiding each claim with focus, accuracy, and accountability.
Pharmacy Networks
ProCare Rx manages hundreds of networks for our clients. We process claims online and in real-time for the entire network and reimburse pharmacies on regular payment cycles. Our networks are fully credentialed to ensure all insurance, licensure, and quality measures are compliant with ProCare Rx standards. Our Pharmacy Audit and FWA team also monitors pharmacy activity and performs both desktop and on-site audits, which result in a sentinel effect for pharmacy behavior.
Pharmacy Networks
ProCare Rx manages hundreds of networks for our clients. We process claims online and in real-time for the entire network and reimburse pharmacies on regular payment cycles. Our networks are fully credentialed to ensure all insurance, licensure, and quality measures are compliant with ProCare Rx standards. Our Pharmacy Audit and FWA team also monitors pharmacy activity and performs both desktop and on-site audits, which result in a sentinel effect for pharmacy behavior.
Real-Time, Accurate Processing
Every prescription claim is verified and adjudicated instantly, reducing errors and preventing delays at the pharmacy.
Automated Eligibility & Coverage Checks
Eligibility, plan rules, and formulary requirements are applied automatically to ensure each claim is processed correctly the first time.
Built-In Clinical Oversight
Our system flags potential issues—such as drug interactions or prior authorization needs—before they impact patient care.
Compliance You Can Trust
Claims are processed in full alignment with plan policies and regulatory requirements, supporting both operational integrity and patient safety.
Real-Time, Accurate Processing
Every prescription claim is verified and adjudicated instantly, reducing errors and preventing delays at the pharmacy.
Automated Eligibility & Coverage Checks
Eligibility, plan rules, and formulary requirements are applied automatically to ensure each claim is processed correctly the first time.
Built-In Clinical Oversight
Our system flags potential issues—such as drug interactions or prior authorization needs—before they impact patient care.
Compliance You Can Trust
Claims are processed in full alignment with plan policies and regulatory requirements, supporting both operational integrity and patient safety.