Health plans and pharmacy benefit programs run on strict message formats and tight SLAs. We build and modernize the systems that move claims, eligibility, and NCPDP pharmacy transactions without breaking on the next payer update.
NCPDP D.0 claims adjudication, rejection handling, and clearinghouse integration.
FHIR R4 and X12 EDI connectivity across eligibility, claims, and prior authorization.
Automated prior authorization and claims exception workflows.
Safeguards appropriate to plan and PBM data handling requirements.
Yes - both are core to our interoperability service line, including rejection handling and clearinghouse integration.
Yes - this typically runs through our modernization solution, phased to avoid disrupting live claims processing.
Payers and pharmacy programs are a secondary focus area for us, so most engagements start with a scoping workshop before any build commitment.
Book a workshop to walk through your current transaction flows and where they're breaking.