Pharmacy claims adjudication is complex due to the intricate interplay of drug formularies, patient eligibility, and varying insurance plans. Reimbursement is constantly changing due to evolving healthcare regulations and drug pricing structures.
Veridikal’s pre- and post-edit (PPE) solution, DetectRx, stands as the premier choice for optimizing reimbursement, enhancing productivity, expediting collections, minimizing resubmissions, and boosting profits.
In contrast to legacy PPE systems with 5-10 basic rules, Veridikal’s next-generation platform features hundreds of advanced, customizable business rules and edits tailored to meet the unique needs of each customer.
DetectRx changes the way that both individual pharmacy locations and national chains use their data to drive margin improvement, mitigate audit risk, and provide actionable insights.
Leveraging event processing technology, DetectRx operates through a sophisticated business analytic platform, complete with an integrated dashboard. This live analytical technology captures 100% of claims and fields during the adjudication process, identifying errors and pinpointing opportunities for improvement.
