# Transaction Processing Services for Pharmacy Claims

PowerLine claims switch provides tools for managing pharmacy claims. It receives NCPDP transactions and orchestrates their processing, including calling add-on services, sending the transactions to processors, performing post-adjudication processing, and returning responses to submitters. These tools enable pharmacy service providers to streamline claim editing, submission, and adjudication. They also enhance claim accuracy and verify patient coverage.

PowerLine stands out as a remarkably customer-friendly alternative for claims management that’s unaffiliated with any distributor or PBM. In an industry focused on security and reliability, PowerLine’s ultra-modern technology is second to none, and it touches virtually every U.S. pharmacy through in-flight or post-transaction processing.

## Services for Pharmacy Claims Transactions

**Claims Processing**

Secure, centralized links certified by DirectTrust (formerly EHNAC) offer detailed adjudication including checking eligibility, applying formulary rules, and calculating payments.

**Eligibility Checking** Instantly verify commercial and government insurance coverage in real-time. Minimize rejected claims and the hassle of resubmissions, making prescription fills easier for you and your patients.

**BIN Hosting** BIN hosting can support custom formulary lists to include covered drugs and specific pricing based on NDC.

**Additional Claims Management** Services to help submit speedy and accurate claims, to update prices, prescribers, and other clinical information, and more.

**Data Services**

**‍** Paradigm-shifting data warehouse technology for smooth collection and transmission of vital healthcare data.

**Performance Metrics**

**‍** Any transaction can be queried instantly by PowerLine’s support application for comprehensive metrics – single pharmacy, BIN specific, or platform-wide.

## RxAdvantage Services for Patient Affordability

**Automated Voucher Solution**

**‍** Automatically applies manufacturer discounts/coupons at the time of claim adjudication on a brand’s patient copay. It’s effortless for the pharmacy, with an instant alert in the claim response about the copay reduction.

**Automated Conversion Solution**

**‍** If a commercial payer blocks or limits coverage on a patient’s prescription claim, this program steps in with real-time copay assistance provided by the drug sponsor.

**Discount Copay Card Solution** Traditional manufacturer savings programs using BIN and PCN that provide discounts to eligible patients on a medication’s copay.

## PowerLine & RedSail Advantage Solutions

RedSail Advantage offers solutions, enabled by PowerLine, that provide greater profitability for pharmacies and extend the reach of their pharma partners. To enhance your pharmacy transactions, learn more about these programs for patient education, medication adherence, cash pricing, copay assistance, and medical billing.

## PowerLine Benefits

Most Technologically Advanced Pharmacy Switch

With its cloud-native structure developed using leading-edge tools and techniques, PowerLine consistently delivers near-instantaneous millisecond response times, ensuring seamless, ultra-responsive operations.

Unmatched Performance

Deployed across four+ geographic zones and with multi-layered security, including 24-7 monitoring and machine learning, PowerLine delivers industry-leading 99.99% uptime.

Designed for Growth

PowerLine’s serverless microservices design allows it to scale to any required transaction volume automatically, with no impact to response time, uptime, or security.

Rapid Activation

With a state-of-the-art rules engine and modern connectivity framework, RedSail can activate pharmacies and partners rapidly on the platform.