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Adjudication that just works so I can focus on my business?

The way it's supposed to be.

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When your claims adjudication engine works, that's great.

When it also creates efficiencies while helping you manage your business, that's RxSense

Our adjudication engine is cloud-based and turnkey, and has all the flexibility and simplicity needed to manage your business now and as it grows. 

security

Certified Secure. Continuity Ensured.

We are committed to the security of our environment and the continuity of business. This is reflected in our un-breached, risk-based, multi-layered security approach, across multiple redundancies, with zero unscheduled down time since 2020.

ISO 27001 Certified
ISO 22301 Certified
HIPAA Compliant
Hitrust CSF Certified
AICPA SOC 1 Type 2
AICPA SOC 2 Type 2
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Complexity simplified. Savings optimized. Business maximized.

"We are proud to be partnering with an innovations-driven company like RxSense."

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What does advanced technology feel like?

Configuration Innovation

What formerly required IT and coding can be easily configured by business operations staff. Eligibility changes can be made by direct entry or drag-and-drop with intuitive validation interface for immediate processing and availability.

Single Source of Truth

Our API-driven platform provides a singular up to date view of your ecosystem. Whether it's member-pay pricing look-up, HDHP-support, or formulary changes – they are always current, in real-time, across the board.

Seamless Interoperability

APIs enable interoperability which in turn provides improved overall care delivery. Our APIs are JSON-based, RESTful-compliant, and meet the Fast Healthcare Interoperability Resources (FHIR) and NCPDP standards.

Branded Member Tools

Deliver the information members want in easy-to-use tools

Our member portal and apps are plug and play, brandable, and available to our private-label PBM clients. Since they are part of our adjudication, the information members need is real time and accessible once they log into their portal or mobile app (iOS and Android). Alternatively, if you have your own portal, virtually all of our member portal’s capabilities can be pulled in via APIs.

Pharmacy Locator

Limit display to those pharmacies available to the client's / plan's network selection

Robust Drug Search

Find drug information, interactions, along with real-time true member-pay price based on accumulator / benefit status

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Flexibility is inherent in all that we do

You bet we've changed the game.

From our transformative business and service models to pick and choose accelerators, our scalable adjudication platform to customizable reporting and alerts (with everything available in your brand), we believe in providing you with options. It’s your business our solution simply makes it easier to do it faster and more efficiently. You’re welcome!

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What else would you like to learn about today? 

 

Transformative Model

Transparency, control, flexibility are all long over due. We got here as fast as we could.

 

Interoperability

This is table stakes for us. Find out just how well we do this.

 

Service Model

We're here for you. In the way we wished our PBM was there for us and wasn't.

 

Adjudication

Dig into more details about the claims adjudication engine that could.

 

Business Accelerators

Whether you're new or been there, we've got an accelerator for you.

 

Security & Continuity

We're rather proud of all the badges we've earned and the downtime we haven't had.

 

Analytics

Beyond reports, data, and analysis, find out how to optimize your business.

 

Strategies

Our recommendations leverage automation and machine learning.

 

Who We Are

Learn more about our leadership and why we decided to build these platforms.

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