Image of computer keyboard in pharmacy using a pharmacy claims reconciliation solution by Net-Rx

RecRx – Pharmacy Claims Reconciliation Solution – Net-Rx

Did you get the “promise to pay” amount from the third-party payer whether it’s a PBM or a manufacturer?

RecRx simplifies the tracking and verification of “promise to pay” amounts from third-party payers for your pharmacy claims. Our software automates the matching process between the adjudicated claims data (based on the “promise to pay” amounts) and actual payment amounts received, even with multiple payers involved, saving you time and enhancing cash flow. If any discrepancies arise, RecRx identifies such claims enabling you to take prompt action.

RecRx helps pharmacies:

Compare promised paid amounts and actual amounts received from the payer
Identify missing and short paid claims
Quantify expected incoming funds

RecRx achieves 100% Third-party reconciliation including PBMs, manufacturers, and manual payments

99% of claims are reconciled through our automated electronic remittance advice collection process.

1% of claims are reconciled through our unique process of converting paper remittances into electronic 835 files.

Here’s How RecRx Works

RecRx simplifies and automates the reconciliation process for third-party claims. Here’s how it works:

Prescription claims data loads to RecRx
Payment data (835 files) loads to RecRx
Pharmacy confirms funds are received
Automated data analysis runs nightly
Payments are checked, reconciled, and verified
Actionable tools and reports help the user in identifying and correcting issues during third-party reconciliation

RecRx Claims Reconciliation Services

Automatic Claims-to-Payment Matching

Automatically matches payments to the right claims, cutting down on manual work and reducing errors. This saves time and ensures accuracy, improving your pharmacy’s financial management.

Offers peace of mind knowing that 100% of third-party pharmacy claims are checked, reconciled, and verified with payments received.

Easy-to-Understand Reports

Provides detailed reports that give you a clear picture of your pharmacy’s financial health. These reports help you:

Carve out revenue into categories
Quantify fees and adjustments
Track payment trends including aging and average days to pay
Make informed decisions to improve cash flow.

Maintain Payment History

RecRx ensures that your payment history is retained even when you switch dispense software, PSAOs, or wholesalers. This continuity eliminates the risk of losing critical financial records and provides uninterrupted tracking of your pharmacy’s claims and payments.

RecRx Benefits

RecRx Features

– Offers peace of mind knowing that 100% of third-party pharmacy claims are checked, reconciled, and verified with payments received
– Provides flexibility to view sales and receivables by corporation or at an individual location level
– Improves efficiency by automating the comparison process
– Supports spending decisions by predicting cashflow
– Reduces paper with electronic processing
– Keeps your downloadable financial data history for as long as 4 years even if you change wholesaler, PSAO, or dispense software

– 24/7 secure portal access to review data in real-time
– Simplified payment views from third-party payers including payer type
– Enables prescription claim level payments to be imported back into your dispensing software
– Identifies missing checks, transaction fees, and payer takebacks
– Insight into fees and adjustments
– Personalized aging date range buckets available to align with your business needs
– Robust reporting package includes missing remit reporting and average DSO (days sales outstanding) per PBM and manufacturer

IRA Mitigation Solutions

Net-Rx is a CMS-certified Third-Party Support Entity (TPSE) within the Medicare Transaction Facilitator Data Module (MTF DM), with the ability to receive and automatically reconcile manufacturer Maximum Fair Price refunds to your claims data.

Medicare Prescription Payment Plan (M3P)
The Inflation Reduction Act has brought new challenges for pharmacies, particularly with M3P requirements. Net-Rx is here to help your pharmacy navigate these complexities with the M3P copay smoothing report on the RecRx portal.

Get more value from RecRx with these optional add-on services:

Third-party Accounts Receivable

This service helps you manage and track payments from third-party payers. It ensures all outstanding payments are pursued. This reduces the risk of unpaid claims and improves your pharmacy’s overall financial health.

Provides month-end numbers enabling accounting teams to “close the books” for adjudicated claims during each period
Summarizes third-party claim-level detail, payments, fees, sales, adjustments, receivables and outstanding values
Includes Financial and Total Sales Report tools
Quantifies dollars by payment source (i.e., Medicaid, Medicare, manufacturer, and others)

Archive Assistance

Archive Assistance is a process designed to help pharmacies manage their deposit information efficiently. The automated check receipt validation process matches bank deposits to electronic remittance files, ensuring that payments are accurate and up-to-date.

Aging Assist

Aging Assist is a product designed to save your team time and effort in categorizing aged claims for research. It is an add-on service to the reconciliation solution that helps pharmacies manage their aging and payer follow-up needs efficiently. This service includes a review of aging by analysts with industry expertise, anomaly clean-up caused by data discrepancies and timing challenges, and active pursuit of missing 835 files, missing deposits, and unpaid claims. In addition, analysts can provide follow-up activities to help capture outstanding payments.

See what Net-Rx customers had to say about RecRx

“Choosing Net-Rx for your reconciliation services is a decision that is sure to enhance your business.” Read more.

Why Choose Net-Rx for your Pharmacy Reconciliation Services

As a market leader in pharmacy claims processing solutions, Net-Rx is a trusted partner to thousands of pharmacies. These pharmacies have come to rely on Net-Rx for superior support, actionable insights, and proven results.

Here’s why pharmacies choose Net-Rx:

Innovative Technology: Our advanced technology solutions in pharmacy claims reconciliation help pharmacies stay ahead in a rapidly evolving healthcare environment. With the recent IRA manufacturer refund process to pay pharmacies for MFP medications, Net-Rx developed a unique 360-degree view into your PBM reimbursements and manufacturer refunds all in one place.
Customized Solutions: We recognize that every pharmacy is different. Our personalized approach ensures our services align with your specific needs and goals.
Dedicated Support: We provide ongoing support and consulting services to help your pharmacy grow.

By simplifying the reconciliation of pharmacy claims, RecRx helps your pharmacy maintain financial accuracy and efficiency, ultimately improving your bottom line.

For more information about RecRx or any of these add-on services, fill out the contact form or call 1-866-336-3879.