pharmacy claims processing
Our Claims Processing Model Offers:
  • Shorter reimbursement period as compared to traditional mailing of HFCA forms
  • No additional billing staff requirements
  • Real time claim payment and status information – at the time of dispense.

First Coast works with clients to develop customized electronic solutions that are designed to accelerate the revenue cycle. Our executive team has experience to work specifically with several variations of non-pharmacy dispensing sites.

Non-pharmacy dispensing sites
  • Realtime adjudication
  • Complete dispensing and inventory management
  • SureScripts™ certified E-prescribing
  • Complete software and database tools
  • Flexible revenue cycle management
pharmacy claims processing

NCPDP Claims Adjudication:


Your organization can now utilize NCPDP 5.1 to adjudicate claims immediately after dispensing.

Within seconds, the claims are factored and the reimbursement amount is known. (Factoring means the claim is purchased and cannot be returned, even if reimbursement is not received from the payer.)

Claim adjudication experts resolve any missing data or problems with claims from a central location. This usually involves obtaining missing information from the practice through the software’s help desk system.

In most states reimbursement amounts are based on AWP and vary from state to state depending on several factors, including the prevailing reimbursement rate for any specific state workers compensation program.