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Claims Processing - RxAmerica requires all network pharmacies, including the mail service pharmacy, to process claims electronically through our on-line AmeRx claims processing system. This system requires that all claims pass through eligibility verification, are checked against plan design parameters, and are subjected to DUR edits prior to dispensing.

Electronic submission allows a higher degree of plan management and the opportunity for better member healthcare.

RxAmerica’s claims processing system is based upon a Sun computer system. The Sun platform is fully-redundant which ensures that our claims processing system runs at optimal levels 24 hours a day, 7 days per week.

On-line Concurrent DUR - RxAmerica’s on-line claims processing system provides sophisticated concurrent drug utilization review (DUR) to ensure safe drug usage. The system evaluates the appropriateness of the medication at the point-of-sale by checking for:

• drug-drug interactions
• incompatibilities
• appropriate dosage
• therapeutic duplications
• refill frequency

RxAmerica offers a fully integrated program that allows concurrent DUR edits to track any prescription from any participating pharmacy, including the mail service.

The concurrent DUR system alerts the practitioner to areas of concern, and can help them avoid possible drug therapy problems that could cause harm to patients, complicate care unnecessarily or needlessly, and increase the cost to the client. Therefore, the patient’s prescription drug care is enhanced and the costs of treatment are decreased.