Medical Billing

CareCLAIM®

The industry-leading medical billing solution for pharmacies.

Pharmacies are becoming health hubs for the community, providing an ever-expanding range of medical services to patients. CareCLAIM is a medical billing solution that enables you to bill for items covered under the medical benefit and optimize reimbursement for the services, specialty drugs and supplies you provide to patients.

Medical claims made simple.

CareCLAIM allows you to submit claims for professional services, immunizations, durable medical equipment (DME), medical supplies and drugs covered under the medical benefit just as you would any other third-party prescription insurance. We manage the entire medical claims process for you, from claim submission to remittance to denial management and audit support.

Rev up your revenue cycle.

We are the industry leader in medical claims processing for pharmacies, with collection rates of up to 99 percent. With over 550 proprietary messaging edits, CareCLAIM ensures pricing accuracy and payer-compliant claims for optimized reimbursement. We provide daily reimbursement tracking and robust analytics reporting to improve your cash flow and enhance your revenue cycle. And, our dedicated account teams proactively resolve denials and audits to save you both time and money.

Don’t leave money on the table.

When it comes to providing certain services, supplies and drugs to patients, many pharmacies are leaving money on the table. CareCLAIM has the unique ability to translate pharmacy transactions into medical claims, ensuring proper reimbursement for services, supplies and drugs that are covered under the medical benefit. We support over 30 therapeutic classes and most pharmacy-provided medical services, including:

 

  • Birth control consulting
  • Biometric screening
  • Medical nutrition therapy (MNT)
  • Diabetes self-management training (DSMT)
  • Diagnostic testing (including influenza, strep and UTI)
  • Immunizations
  • Durable medical equipment (DME)
  • Oral anti-cancer, immunosuppressive and respiratory drugs

Connections that matter.

CareCLAIM is connected to Medicare, Medicaid and hundreds of commercial payers. CareCLAIM also integrates with your pharmacy management system to ensure seamless claims processing and streamlined workflow.

The CareClaim Difference

 

 

  • Proven, scalable solution
  • Real-time eligibility for all payers
  • Medical claim submission
  • 835 remittance and AR management
  • Denial recovery and audit services
  • Document collection, review and repository services
  • Pre-dispensing medical necessity document collection
  • Explanation of benefits (EOB) posting
  • Complete claim analytics and reporting
  • Exceptional customer service

Denials happen— but they don’t have to.

Join the ranks of our CareCLAIM customers and let us help you grow your business profitably.

 

pharmacies served

million transactions per year

million saved per year by reducing bad debt

%

collection rate

%

increase in profits with denial tracking

Learn How to Get Started with CareCLAIM