Prescription claim adjudication refers to the process by which a pharmacy claim is reviewed, processed, and validated by an insurance company, Pharmacy Benefit Manager (PBM), or other payer to determine whether the prescribed medication is covered, and if so, how much the pharmacy will be reimbursed. The adjudication process involves evaluating the submitted prescription claim for accuracy, eligibility, formulary compliance, and any applicable co-pays or deductibles before the claim is approved or denied for payment.
Prescription claim adjudication is a critical process in ensuring that pharmacy claims are processed correctly, payments are made efficiently, and patients are only responsible for the appropriate portion of their medication costs. It ensures that the financial aspects of pharmacy services are managed effectively while adhering to insurance and payer regulations.
The Pharmacy500 is awarded to 500 pharmacy supply chain businesses and associations that significantly impacted dispensing pharmacies in the U.S. over the past year.
The following are complimentary benefits extended to Pharmacy500 companies and associations (coming this spring!)
Agadia
American HealthCare Capital
American Pharmacy Cooperative, Inc. (APCI)
Americorp Financial, LLC
AssistRx
AssureCare, LLC
Atlas Health
Buy-Sellapharmacy.com
Byline Bank
Cardinal Health
CarepathRx
Cervey
Clearway Health
CoverMyMeds (McKesson Corporation)
CPESN USA, LLC
CuraScriptSD
D2 Solutions
EnlivenHealth
EPIC Rx
First Financial Bank, Inc.
GeriMed, Inc.
Hayslip Rx Brokers Inc.
HealthTrust
Inmar Inc.
Innovatix, LLC
Inovalon
Integrity Pharmacy Consultants
Lincoln Savings Bank
Live Oak Bank
Managed Health Care Associates, Inc. (MHA)
McKesson Corporation
Net-Rx (an MHA Solution)
Mobile MediClaim, Inc.
OmniSYS (XiFin Pharmacy Solutions)
Optum, Inc.
Outcomes
Paragon Ventures
Pharmacists Mutual Insurance Company
Pharmacy Brokers
Pharmacy Consulting Broker Services
Pharmacy First
PharmaPoint, LLC
PPOk
PRS Pharmacy Services
QRx Solutions
R.J. Hedges & Associates
RedSail Technologies, LLC
Revelation Pharma
RxOwnership (McKesson Corporation)
RxPreferred
ScriptPro LLC
ServRx, Inc.
Shields Health Solutions
STACK, LLC
Surescripts
Sykes & Company, P.A.
The Craneware Group
The Medicine Shoppe Pharmacy
Value Drug Company
Veridikal
Visante
Workflow Services
Stay informed on pharmacy supply chain news, market trends, and product releases by subscribing to RXinsider’s emails, newsletters, and publications. If building awareness with pharmacy management is part of your marketing strategy, consider advertising with RXinsider.
