RXLens finds every claim paid below your acquisition cost, prepares the MAC appeal for each PBM's process and deadline, and follows the appeal until the payment arrives.
Reimbursement is compared with your own acquisition cost, not a national average, so the claims you see are the ones actually losing money.
| Item | Where | Status |
|---|---|---|
| Generic A 40 mg | PBM 1 | Appeal ready |
| Generic B 10 mg | PBM 2 | Appeal ready |
| Brand C inhaler | PBM 1 | Won, paid |
| Generic D 500 mg | PBM 3 | Won, not paid |
Claims paid short, paid late or not paid at all are listed, along with the fees and rates each PBM actually paid against your contract.
Prepared for each PBM, with a record of every outcome.
Won appeals and short payments tracked until paid.
What each PBM paid against what your contract says.
Items losing money, and the lowest-cost source you already use.
Claims paid below what you paid for the drug.
To that PBM's process and deadline.
Your team submits the appeal.
Until it arrives in your account.
A short screen share with our team. We will walk through the morning list, an underwater claim from appeal to payment, and audit preparation, using sample data.
