A PPOk company · Pharmacy claims switch since 1997
Pre and post edits
RECLAIM | Rx is Rx Linc’s pre and post edit service for pharmacy claims. It checks claims in real time for errors such as the wrong DAW code, incorrect package quantities and outdated NDCs, flags underpaid claims, and has our team contact you to resolve them. RECLAIM | Rx saved pharmacies over $7 million in reimbursement last year.
RECLAIM | RxAdvanced Claim Edit Solutions
Pre and post edits
RECLAIM | Rx turns your claims data into revenue opportunities. It automates the complexity of pharmacy claim management, identifies reimbursement opportunities and prevents costly billing errors before they reach your bottom line.
Pre edits run before a claim reaches the payer, so mistakes are corrected while there is still time. Post edits review the response, so underpayments and missed opportunities are found and followed up instead of written off.
What’s included
The wrong DAW code can increase audit risk and reduce reimbursement. We verify you are using the most appropriate code.
Incorrect quantities for inhalers, solutions and other packaged medications are costly. We make sure claims carry the correct quantity.
An outdated NDC can mean lower reimbursement from the PBM. We find outdated NDCs and provide the updated NDC where available.
We identify underpaid claims using market intelligence, and our staff reaches out for timely review, so you do not have to dig through complex reports.
Customized reports highlight savings opportunities with clear, actionable insight for faster, better-informed decisions.
Beyond the edit
When plans do not cover an NDC or change coverage terms, PBMs often convert claims to their own cash discount programs, which can carry administrative fees of $6 to $20 per transaction. PRT monitors and identifies claims redirected to cash discount cards, alerts you when it happens and explains the denial, so you can decide how to process the claim.
We monitor Average Wholesale Price (AWP) changes continuously, identify eligible claims and manage resubmissions on your behalf every week. It is a performance-based service that requires no additional work from your team, with comprehensive reporting to keep you informed.
Every time a prescription is processed, we verify that the prescriber’s DEA registration is active and not expired or revoked, that the prescriber is authorized for the drug schedule, and that the NPI matches the authorized DEA registration. It adds a layer of protection for controlled substance dispensing and reduces audit risk.
Key benefits
RECLAIM | Rx reviews claims electronically and flags errors such as inaccurate quantities, brand pricing errors or outdated AWP pricing. Our team contacts you directly to help resolve them.
We know what it takes to run a busy independent pharmacy. We take on claims review and resolution so you have more time for patients.
Technology, data analysis and market intelligence combined with outstanding customer service to improve your bottom line.
Interested in optimizing your claims process? Contact us today or call (800) 380-7435.
“We are very thankful for Rx Linc catching the underpaid claim! We saw an increase in thousands of dollars after reprocessing these claims. Thank you for everything you do.”
Digital brochure
Ask for the RECLAIM | Rx brochure and our team will send you a link to download it.
Pre edits check a claim before it reaches the payer and correct issues such as DAW codes, package quantities or outdated NDCs. Post edits review the payer response to find underpayments, pricing errors and redirected claims. Rx Linc delivers both through RECLAIM | Rx.
RECLAIM | Rx is Rx Linc’s real-time pre and post edit service. It flags claims that need intervention, our team contacts the pharmacy to resolve them, and weekly reports show the savings. Rx Linc reports that it saved pharmacies over $7 million in reimbursement last year.
PRT identifies claims that PBMs redirect to cash discount programs, which can carry administrative fees of $6 to $20 per transaction. It alerts the pharmacy and explains the denial so staff can make an informed decision.
Rx Linc monitors AWP changes, finds claims eligible for resubmission at the updated price and resubmits them weekly on the pharmacy’s behalf. The average yield is $17 to $18 per eligible claim, and the pharmacy team does no extra work.
Get started
Let us show you how Rx Linc can drive your pharmacy’s success. Our team will contact you promptly to discuss your specific needs.
Answers come only from rxlinc.com. Please do not share patient information.
Hi! Ask me about our pharmacy switch, pre and post edits, SCRIPTWI$E or how to reach our 24/7 team.