AdvancedRx Leverages NCPDP D.0 Standards and Automation to Process Pharmacy Claims Faster
THE CHALLENGE
Time-consuming, error-prone pharmacy claims processing
AdvancedRx was processing pharmacy claims manually as flat files—an outdated process that was
time-consuming, prone to errors, and not scalable. It was time to adopt the more widely used NCPDP
D.0 industry standard for pharmacy claims processing. This standard, developed by the National
Council on Prescription Drug Programs (NCPDP), would allow for direct integration between pharmacy
dispensing software and third-party claims systems.
THE SOLUTION
Adopting the NCPDP D.0 Standard to Reduce claims processing time
AdvancedRx decided to implement the NCPDP D.0 standard, which would directly integrate with
pharmacies, reduce claims processing time, and improve accuracy
- Replacing manual interventions with automated workflows.
- Ensuring accurate, real-time data exchange.
- Integrating seamlessly with multiple pharmacies.
- Reducing operational overheads and claims processing time
- Incorporating the solution into their existing EHR system without disruption, while ensuring interoperability with external stakeholders such as pharmacies and regulatory bodies.
- Ensuring full compliance with Drug Enforcement Administration (DEA) regulations for electronically prescribing controlled substances.
- Protecting sensitive patient and prescription data from unauthorized access and fraud.
To implement this solution, AdvancedRx partnered with OZ Digital Consulting and selected Microsoft BizTalk Server as the integration platform. BizTalk’s capabilities in Electronic Data Interchange (EDI), message transformations, and business rules engine execution were crucial for seamless communication between AdvancedRx and pharmacies.
Key Solution Components:
- NCPDP D.0 Standard: Enabled structured, secure, and real-time claims data exchange.
- BizTalk Server: Managed the EDI message processing, transformations, and routing between AdvancedRx and pharmacies.
- Direct Integration: Banished manual flat file exchanges by directly integrating with multiple pharmacy systems.
- Exception Handling and Monitoring: BizTalk’s built-in monitoring tools allowed for real-time tracking and automated error handling, reducing manual intervention.
IMPACT
Pharmacy Claims Wait Times Drop, Patient Care Advances
The adoption of the NCPDP D.0 standard, combined with BizTalk’s integration capabilities, transformed AdvancedRx’s pharmacy claims processing. The solution significantly improved operational efficiency, data accuracy, and scalability while reducing manual effort. As a result, AdvancedRx is now well-positioned to scale and meet future industry demands.
The adoption of the NCPDP D.0 standard, combined with BizTalk integration capabilities made AdvancedRx’s pharmacy claims processing more efficient. By automating workflows and ensuring real-time, standardized communication, the solution improved efficiency, data quality, and the ability to scale, all while reducing manual effort.
Key Results:
- Automated Workflow: Manual flat file processing was fully eliminated, leading to significant time savings and reduced errors.
- Faster Claims Processing: Real-time data exchange enabled quicker adjudication and fewer delays.
- Better Data Quality: Standardized messaging ensured higher claims accuracy and fewer rejections.
- Enhanced Scalability: New pharmacies were seamlessly integrated without manual interventions.
- Cost-savings: Operational costs were reduced by automating processes and decreasing reliance on manual labor.
FEATURED SERVICES:
TECHNOLOGY:
- Microsoft BizTalk Server
- Microsoft BizTalk Adapters
- NCPDP D.0 Standard
- Business Rules Engine (BRE)
