How to Streamline Claims Processing

How to Streamline Claims Processing

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While patient care is at the heart of every pharmacy, running a successful business also requires tackling tricky behind-the-scenes tasks, like claims processing.

Each time you fill a script and submit a claim, you’re under pressure to ensure each submission is accurate, compliant, and processed quickly.

For many pharmacists, this process can feel like a tangled web of paperwork, deadlines, and hurdles.

Add in the challenge of managing third-party payers and potential issues that can delay the process, and it’s easy to see how claims management can become something you have to do rather than something you want to do.

Luckily, PowerLine can ease some of the pressure. PowerLine, RedSail Technologies’ advanced pharmacy switch, makes claims management easier and processing more efficient for BestRx customers.

As a part of the RedSail network, BestRx users can integrate PowerLine into their system to streamline claims, ensure compliance, and free up time to focus on what matters most: patient care.

What is a Pharmacy Switch?

A pharmacy switch acts as a central hub, helping pharmacies connect with pharmacy benefit managers (PBMs) and processors to send and receive claims data.

In simple terms, it routes claims from your pharmacy to the right PBM based on BIN/PCN numbers. Think of it like an air traffic controller guiding planes to their destinations.

The switch ensures that claims are processed quickly and accurately, providing real-time eligibility checks, formulary information, and co-pay calculations back to your pharmacy along the way.

It also helps minimize errors by verifying prescription data and ensuring compliance with regulations like HIPAA.

In the past, clearinghouses were used to convert non-standard transactions into standard ones, but today, the switch ensures that pharmacies can submit claims electronically in compliance with standards set by the HHS and CMS.

In short, PowerLine offers pharmacies an efficient way to manage claims without needing direct connections with payers.

What is PowerLine Switch? + 7 Key Benefits

PowerLine has been serving independent pharmacies since 1991. With over thirty years of industry experience, it offers BestRx customers a tried-and-true solution for streamlining their claims.

Here’s what sets PowerLine apart:

  • Centralized connectivity: PowerLine links your pharmacy to multiple industry partners, like PBMs and processors, to eliminate the need for managing multiple systems.
  • Real-time processing: PowerLine transmits claims in real-time, allowing for quick approval or rejection and ultimately speeding up your reimbursement cycle.
  • Modern cloud architecture: Built on cloud-native infrastructure, PowerLine offers scalability that can grow with your pharmacy's needs. PowerLine can handle 10x the current transaction volume and offers 99.99% availability, so your claims are always processed without interruption.
  • Seamless integration: PowerLine is fully integrated into your existing BestRx system, creating a unified platform for all your pharmacy operations. Everything works together in one place, which eliminates the need for other solutions or lengthy learning curves.
  • Top-tier security: With HITRUST and SOC 2 Certifications, PowerLine uses the latest security protocols to ensure HIPAA-compliant data transmission and keeping your pharmacy’s sensitive information safe.
  • Transparency: Unlike other switches, PowerLine is unaffiliated with distributors or PBMs. This means that you get unbiased support focused solely on your pharmacy's needs.
  • Unmatched value: Independent pharmacists know every dollar counts. PowerLine helps reduce operational costs by speeding up claims submission, minimizing rejections, and ensuring accurate transactions so you spend less and earn more on reimbursements.

How to Get Started with PowerLine Switch

Getting started with PowerLine is easy. As a BestRx customer, you can integrate PowerLine directly into your existing system.

Our dedicated PowerLine team will work with you throughout the setup process to ensure everything is customized to fit your pharmacy’s needs and goals.

Once integrated, you’ll immediately benefit from faster claims processing, greater reliability, and streamlined workflows. And, with 24/7 support, we’re here to help you with any hiccups that come up along the way.

As a BestRx customer, you can integrate PowerLine directly into your existing system.

Reach out today to get started and see how PowerLine can optimize your pharmacy’s operations and boost your bottom line.