Support identification of pharmacy claim errors

Explore each edit — pick the one your pharmacy needs

• NDC Validation

  Stop reimbursement loss from discontinued or replaced NDCs

  Pharmacies often unknowingly submit claims using discontinued or replaced NDCs, creating reimbursement, inventory and audit challenges. NDC Validation identifies obsolete NDCs in real time and recommends valid NDCs before a claim is submitted. The result: cleaner claims, more accurate reimbursement, better inventory records and configurable support.

• NPI Validation

  Catch invalid prescriber NPIs before payers reject the claim

  Invalid or inappropriate prescriber NPIs can trigger claim rejects and increase audit risk. NPI Validation checks each NPI against the current registry in real time, alerting staff to mismatches before submission. The result: fewer manual lookups, fewer resubmissions, stronger compliance documentation and greater confidence that claims are billed correctly the first time.

• DAW Appropriateness

  Get DAW coding right the first time on multi-source brand claims

  Incorrect DAW codes are a common cause of preventable rejects and reimbursement issues. DAW Appropriateness reviews each claim's DAW value and provides confirmation or clear guidance when corrections are needed. Staff get actionable next steps, while centralized reporting helps identify DAW trends and coaching opportunities across stores.

• DEA Validation

  Protect controlled-substance dispensing with daily-refreshed DEA data

  Controlled-substance claims require accurate DEA credentials to avoid compliance and audit risk. DEA Validation checks each claim against a daily refreshed DEA registry, validating DEA presence, format and accuracy before submission. Staff receive clear, in-workflow guidance when issues are found, helping support compliant dispensing and keeping claims moving forward with reduced delays.

• Enhanced Min/Max

  Flag atypical doses and incorrect package multiples before they cost you

  Enhanced Min/Max helps prevent audit findings, rejects and reimbursement issues by validating daily doses and package multiples before claims are submitted. It compares claim data against MADD references and NDC package requirements, alerting staff to potential issues in real time while providing enterprise visibility into dose-related risk and trends.

• AWP

  Keep AWP current and resolve health plan-specific claim variations automatically

  PPE helps reduce reimbursement leakage and manual follow-up. AWP Comparison automatically updates AWP values and Gross Amount Due before adjudication to protect revenue.

• Cash Pricing

  Cash Pricing by CoverMyMeds enables clinical staff to view cash prices alongside insurance copays and deductibles in real-time, helping patients save money when standard insurance copays exceed the actual cost of the drug or apply to unmet deductibles.