Claims & Adjudication
Third-party billing — submit, adjudicate and reverse pharmacy claims
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How claims flow
A claim routes to its payer by BIN / PCN / Group, returns paid (with copay + plan-paid) or rejected (with an NCPDP reason code). Rejects can be resubmitted; paid claims can be reversed.
Claims
6
1 pending
Paid
3
Rejected
2
Collected
$264.00
| Rx # | Patient | Drug | Payer | Billed | Copay | Plan paid | Status | Action |
|---|---|---|---|---|---|---|---|---|
| RX-100482 | Maria Alvarez | Progesterone 100mg Cap | OptumRxBIN 610502 · PCN 9999 | $84.00 | $15.00 | $69.00 | paid | |
| RX-100488 | James Tran | Testosterone Cyp 200mg/mL | Express ScriptsBIN 003858 · PCN A4 | $120.00 | — | — | rejected75 — Prior Authorization Required | |
| RX-100491 | Susan Patel | Diltiazem 2% Ointment | CaremarkBIN 004336 · PCN ADV | $96.50 | — | — | pending | |
| RX-100495 | Eli Navarro | Ketamine 10% Cream | OptumRxBIN 610502 · PCN 9999 | $142.00 | $35.00 | $107.00 | paid | |
| RX-100499 | Dana Cole | LDN 4.5mg Cap | HumanaBIN 015581 · PCN 03200000 | $60.00 | — | — | rejected79 — Refill Too Soon | |
| RX-100501 | Priya Shah | Magic Mouthwash | Cash / DiscountBIN — · PCN — | $38.00 | $38.00 | $0.00 | paid |
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