AdjudicateAdjudicate — Batch 340B-2026-0224
RECOVERED: $12,840
CLAIM IDNDCBINMEMBERERRAMOUNTSTATUS
RX-0044100093-7274-01610415Patricia M.B1$142.80
REJECTED
RX-0044216714-0682-01004336James T.70$89.40
REJECTED
RX-0044357237-0015-05610415Sandra K.76$210.15
REJECTED
RX-0044400378-3248-01015995Robert H.79$67.20
REJECTED
RX-0044565862-0093-10610502Linda C.88$315.60
REJECTED
RX-0044600093-0058-01004336Michael D.M/I$178.90
REJECTED
6 CLAIMS IN BATCH0 RESOLVED6 PENDING
NCPDP TELECOM D.0 · 340B ELIGIBLEClaims Adjudication Engine
Rejected claims
flip to paid.
Catch overbilled NDC codes and rejected BIN numbers before they hemorrhage revenue from your pharmacy desk. NCPDP D.0 compliant. No PMS replacement needed.
98.3%
Clean Claim Rate
$38K
DIR Saved/Qtr
4.2m
Avg Resolution
Live Claim Lookup
NCPDP D.0 COMPLIANT NCPDP D.0 COMPLIANT · 340B ELIGIBLE · HIPAA SECURE · NO PMS REPLACEMENT · 50 CLAIMS FREE · LIVE ADJUDICATION · DIR FEE FORECASTING · AUDIT TRAIL GENERATION · NCPDP D.0 COMPLIANT · 340B ELIGIBLE · HIPAA SECURE · NO PMS REPLACEMENT · 50 CLAIMS FREE · LIVE ADJUDICATION · DIR FEE FORECASTING · AUDIT TRAIL GENERATION · NCPDP D.0 COMPLIANT · 340B ELIGIBLE · HIPAA SECURE · NO PMS REPLACEMENT · 50 CLAIMS FREE · LIVE ADJUDICATION · DIR FEE FORECASTING · AUDIT TRAIL GENERATION · NCPDP D.0 COMPLIANT · 340B ELIGIBLE · HIPAA SECURE · NO PMS REPLACEMENT · 50 CLAIMS FREE · LIVE ADJUDICATION · DIR FEE FORECASTING · AUDIT TRAIL GENERATION ·
01Rejection Engine
Every rejection code,
resolved in real time.
Adjudicate maps 340+ NCPDP rejection codes to payer-specific override paths. No manual lookup. No guessing. The engine knows your PBM contracts.
NCPDP Rejection Queue — 2,131 Claims
Resolution Summary
Clean Claim Rate98.3%
Industry avg: 91.2%+7.1pp above benchmark
Avg Recovery Time
4.2 min
vs 3–5 days manual
DIR Fee Savings
$38,400
per quarter avg
Rejection Codes
340+
NCPDP D.0 covered
PBM Contracts
47
payer overrides loaded
Payer Override Suggestions
CVS Caremark
B1NDC swap → preferred tier
ESI / Express Scripts
70Plan year correction flag
OptumRx
76Maintenance split protocol
02Revenue Recovery
Watch the savings
ticker climb.
DIR fee forecasting. Batch recovery tracking. Audit trail generation. Every dollar recovered is logged, timestamped, and exportable for PBM contract review.
Batch Revenue Recovery — Live
$0
recovered this batch · 340B-2026-0224
FEB 12TODAY
Claims Processed
0
this month · 0 manual touches
DIR Fee Forecast
$0K
avoided this quarter · Q1 2026
3 DIR windows closing Feb 28
Clean Claim Rate
0.0%
+7.1pp above industry avg
TPA contract threshold met
Audit Trail — Last 6 Events
HIPAA COMPLIANT18:09:42
Batch 340B-2026-0224 initiated
18:09:58
NDC 00093-7274-01 override applied → PAID
18:10:14
BIN 004336 plan year corrected → PAID
18:10:31
DUR override 1B submitted for RX-00445
18:10:47
DIR fee flag: 3 claims near window close
18:11:02
Batch complete — 6/6 resolved, $14,280 recovered
03Integrations & Proof
Works with your stack.
Live in 20 minutes.
Native connectors for Pioneer Rx, QS/1, Liberty, and McKesson. Override logic pre-loaded for CVS Caremark, Express Scripts, OptumRx, and 44 more PBM networks.
Pharmacy Management Systems — Native Integration
Pioneer Rx
QS/1
Liberty Software
McKesson EnterpriseRx
PioneerRx
BestRx
RxDispense
Computer-Rx
PBM Payer Networks — Override Logic Loaded
CVS Caremark
Express Scripts
OptumRx
Humana Pharmacy
MedImpact
Navitus
Pharmacy Directors & Benefits Managers
$22K/mo recovered
"We were losing $22K a month to DIR clawbacks we couldn't see coming. Adjudicate caught 3 DIR windows in the first week. That alone paid for a year of the platform."
Marcus Oyelaran, PharmD
Pharmacy Director
Riverside Independent Pharmacy · Cincinnati, OH
98.7% clean rate
"Our TPA contract required 98% clean claim rate or we'd lose the account. We were at 91.4%. Three months on Adjudicate, we're at 98.7%. Contract renewed without negotiation."
Deborah Krishnamurthy
VP Benefits Operations
Meridian Health Partners · Nashville, TN
847 B1 rejections resolved
"The B1 rejection rate on our 340B claims was killing our margins. Adjudicate identified a formulary mismatch across 847 claims in the first batch. QS/1 integration was live in 20 minutes."
Sandra Kowalczyk
Director of Pharmacy Operations
Lakewood Community Pharmacy · Milwaukee, WI
04PBM Contract Comparison
Know which PBM
is costing you most.
Adjudicate ingests your remittance data and surfaces which PBM contracts are generating the highest rejection rates, the largest DIR clawbacks, and the lowest net reimbursement per claim. Renegotiate from a position of data.
DIR fee transparency
See clawback exposure before the reconciliation window closes
Rejection rate by PBM
Rank your payers by clean claim rate across 12 months
Net reimbursement delta
Compare contracted rate vs. actual paid per NDC
PBM Contract Analysis — FY 2026
CVS Caremark
Rej Rate
8.2%
DIR Exp.
$12,400
Net Δ
-3.1%
Express Scripts
Rej Rate
4.7%
DIR Exp.
$8,200
Net Δ
-1.8%
OptumRx
Rej Rate
3.1%
DIR Exp.
$5,600
Net Δ
-0.9%
Humana Pharmacy
Rej Rate
2.4%
DIR Exp.
$3,100
Net Δ
-0.4%
MedImpact
Rej Rate
1.8%
DIR Exp.
$1,900
Net Δ
+0.2%
Based on 2,131 claims · 5 active PBM contracts · Q1 2026
05Get Started
50 claims.
No credit card.
Full adjudication logic. Live rejection resolution. DIR fee forecasting. Enough to prove the clean claim rate lift before you ever talk to sales.
NCPDP D.0 compliant
HIPAA secure
340B eligible
No PMS replacement
Live in 20 minutes
50 claims/month free
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Work Email
No credit card. 50 claims free. Cancel anytime.