RxClaimPro™

The unique regulatory process of prescribing cannabis has created a market gap in electronic processing of these prescriptions from a medical document to an insurance claim for submission to an adjudicator under the jurisdictional standard, for Canada, the CPhA Pharmacy Claim Standard.

TCE Group’s solution addresses this gap by taking the discrete data elements of a Medical Document and filtering the Licensed Producer’s product catalogue to meet the criteria of that prescription. The product identification number (PIN) can be selected and pushed to an enterprise resource management system or other systems as required, and create an electronic claim consumable by adjudication networks in which DINs are submitted.

RxClaimPro™ Features

Speed up the fulfillment of cannabis prescriptions, from entry of patient and insurance data to finalizing the order. The features of RxClaimPro™ will save valuable time allowing the fulfiller to better focus on the patient and increase volume.

Patient Management

Search and maintain patient data and health insurance/benefit plan data for the patient. View their demographics, prescription history and order history for effective decision-making
and quick processing.

Order Creation

View patient demographic, clinical and prescription data for effective decision-making. Filter products that meet the parameters of the prescription, adjust those prescription parameters or sort products based on their attributes. Place one or more products in the order basket for further processing.

Prescriber Management

Import or record a repository of prescribers including their demographics, credentials and locations of practice.

Clinic Management

Maintain a repository of prescriber clinic locations.

Claims Adjudication

Submit products for public or private plan electronic claims adjudication and view the response. Also coordinate benefits with secondary plans such as spousal plans.

Catalogue Management

Maintain the catalogues of multiple licenced producers with product attributes including name, licensed producer, strain, CBD and THC, format, as well as inventory and pricing information.

Order Posting

Save the order to the patient’s history for speedy renewals.