Business Intelligence for Maximum Reimbursements on Pharmacy Prescription Claims

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Although it only takes seconds to submit a pharmacy claim, the amount of information required for each claim creates dozens of potential roadblocks to receiving maximum reimbursement. Processing thousands of prescriptions each month, pharmacies are challenged to review each claim for inaccuracies or missing data. Pharmacies need to make corrections in the post-adjudication deadline window and reconcile claims after processing to reclaim missing reimbursement and ensure proper payment. Miss a detail in any of these steps and significant revenue can be lost.

Scriptmax is Innovatix’s new Web-based tool with the industry’s most complete support for pharmacy data analytics and adjudication services. Scriptmax offers a comprehensive suite of pre-edit, post-edit, and reconciliation services. The goal: enable pharmacies to receive maximum reimbursement by minimizing errors on prescription claims.

A Health Affairs study found that approximately 27% of Medicare Part D claims are rejected due to inadequate or incomplete data or invalid information. Another 39% of claims were rejected for a variety of administrative reasons.

Benefits to the max

With its three-phase suite of services, Scriptmax empowers pharmacies with actionable claims review data during every step of adjudication:



Real-time claim validation that maximizes reimbursement and minimizes rejected claims.

Sample pre-edit features include:

  • AWP Verification
  • NDC Updating
  • DAW Code Validation
  • Drug Recall
  • Standard Dispense Quantities



Timely feedback on submitted claims enables corrections within the post-adjudication window.

Samples post-edit features include:

  • Actionable reports to reduce future claims errors
  • Acceleration of retrospective claims action
  • Margin analysis
  • Contract rate verification



Automates third-party payment reconciliation and contract rate compliance.

Sample reconciliation features include:

  • Claim-by-claim reconciliation of third-party payments and adjudicated amounts
  • Flag unpaid/underpaid claims and open receivables
  • Track reimbursement rate discrepancies and transaction fees

Prescription claims made easy

Scriptmax is a powerful tool that any pharmacy can use to streamline and optimize prescription claims. Its features include:

  • Simple, straightforward integration with any pharmacy software system and switch.
  • Convenient Web-portal with exportable reports that make claims information accessible anytime, anywhere.
  • Customization — pharmacies can use all three functions (pre-edit, post-edit, and reconciliation) or any combination thereof.
  • Support – complete pharmacy staff training and ongoing support provided by a dedicated Scriptmax team at Innovatix.

Scriptmax is a fee-based service and is open to any pharmacy. Users are charged per adjudicated claim, so you pay based on the number of claims reviewed. You do not have to be an Innovatix GPO member to use Scriptmax.

Stop leaving money on the pharmacy claims table. Start using Scriptmax today!

Get started with Scriptmax