Pre-Adjudication Editing
Pre-Adjudication Editing is a real-time solution designed to enhance efficiencies, protect margins and improve third-party reimbursements.
Pre-Adjudication Editing consists of a series of edits that evaluates prescription claims and provides financial, administrative and legal compliance reviews prior to being sent to the processor. Reports are provided via email in a weekly summary.
Pre-Adjudication Editing receives the claim from the pharmacy's switch vendor
(eRx or QS1 Network) and performs a set of pre-edits. If there is an issue requiring pharmacist intervention, the claim is rejected with a clear message outlining the problem and suggestions.
Featured edits include AWP pricing updates, Enhanced DAW code validation, Standard Dispense Quantity checks, and Discontinued NDC alerts.
On average per customer, Pre-Adjudication Editing identifies an AWP incremental profit of more than $4,000 monthly.