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Advanced pharmacy switch

PowerLine is the most modern claims infrastructure available to connect pharmacies, payers, and pharma manufacturers. It goes beyond routing claims to activate crucial connections between prescription data and patient behavior.

PowerLine’s complete tech stack includes automated affordability, targeted messaging, gap-in-care insights, and real-time edits.

Benefits Quick Links

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Leverage a Full Tech Stack

Add flexible tools like copay vouchers, eligibility checks, pre- and post-edits, and performance analytics to expand your capabilities

affordability

Activate Affordability

Inject copay assistance based on payer response and include your own patient messaging via SMS, receipt, app, etc.

point-of-care

Engage at the Point of Care

Target and retain in-process patients with fill-reminder logic, copay nudges, and gap-in-care insights

ADDITIONAL BENEFITS

advance pharmacy switch
Most Advanced technology
Cloud-native, API-first architecture means near-instantaneous responses and 99.99% uptime
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Designed for growth
Scales to any transaction volume automatically with no impact to response time, uptime, or security
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Independence and Transparency
Your alternative for claims management that’s unaffiliated with any distributor or PBM
rapid activation
Rapid Activation
State-of-the-art rules engine and modern connectivity framework allow rapid onboarding
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TOp-Tier Security
HITRUST and SOC 2 certified, deployed across 4+ geographic zones with 24-7 monitoring

View Integrated Partners

Services for pharmacy Claims Transactions

Claims Processing

Secure, centralized links certified by DirectTrust (formerly EHNAC) offer detailed adjudication, apply formulary rules, and calculate payments

Eligibility Checking

Real-time verification of commercial and government insurance coverage to minimize rejected claims and the hassle of resubmissions

BIN Hosting

BIN hosting can support custom formulary lists to include covered drugs and specific pricing based on NDC

Additional Claims Management  

Services to help submit speedy and accurate claims, to update prices, prescribers, and other clinical information, and more

Data Services

‍Paradigm-shifting data warehouse technology for smooth collection and transmission of vital healthcare data

Performance Metrics 

Comprehensive metrics – single pharmacy, BIN specific, or platform-wide

Technical CAPABILITIES AND PERFORMANCE

HITRUST + SOC 2 Type 2 Certified
Immutable component design allowing service recreation in minutes if needed
Multi-layered security, including 24/7 monitoring augmented by using machine learning
Extreme scale and performance exceeding traditional communications by more than 100x
Deployment and updates executed with zero disruption
Deployment across 4+ geographically distinct availability zones, ensuring geographic and resource diversity for total resilience
Advanced data warehousing techniques to empower customer support
Dynamic rules engine to enable custom edits
With decades of collective industry experience, the team provides round-the-clock monitoring and management, 24/7, 365 days a year

RXADVANTAGE COPAY Services for Patient Affordability

Explore Automated copay
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PowerLine & RedSail Advantage Solutions

RedSail Advantage offers solutions, enabled by PowerLine, that provide greater profitability for pharmacies and extend the reach of their pharma partners. To enhance your pharmacy transactions, learn more about these programs for patient education, medication adherence, cash pricing, copay assistance, and medical billing.

Pharmacy Claims Switch FAQs

What is a pharmacy claims switch?

A pharmacy claims switch is a telecommunications link that facilitates the electronic transmission of prescription claims from pharmacies to insurance payers, pharmacy benefit managers (PBMs), and other third-party payers. It acts as an intermediary to ensure that claims can be adjudicated.

What makes PowerLine different?

PowerLine is built using the industry’s most advanced technology, an important safeguard against downtime and security risks. Its design allows for service recreation in minutes, if needed, and PowerLine will scale to any transaction volume automatically. The modern connectivity framework means partners can be activated rapidly. And importantly, PowerLine is not affiliated with PBMs or distributors; its customer support is second to none.

Why should I consider another pharmacy switch?

Pharmacy services providers may consider changing switch providers because of security concerns, to leverage newer technology, access better uptime rates, enhance their support services, or benefit from more advanced reporting and analytics. They may also want the strategic advantage of an additional, secondary switch to ensure business continuity.

How do I choose the right claims switch provider?

When selecting a claims switch provider, consider factors such as:

Speed and Efficiency

  • Real-Time Processing: Look for a switch that can transmit claims – at any volume – in real time, ensuring quick approval or rejection.
  • High Throughput Capacity: The ability to handle a high volume of claims quickly, especially during peak times, is essential.

Reliability and Uptime

  • Consistent Performance: The switch should provide industry-leading uptime, ensuring continuous availability for claims processing.
  • Disaster Recovery: The presence of robust disaster recovery and backup systems to maintain operations during unforeseen events is crucial.

Compliance and Security

  • Regulatory Compliance: The switch must comply with relevant healthcare regulations such as HIPAA to protect patient data.
  • Data Security: Look for strong security certificates, such as HITRUST and DirectTrust, to safeguard sensitive information during transmission.

Integration Capabilities

  • System Compatibility: The switch should seamlessly integrate with your own systems without requiring extensive customization.
  • Scalability: The ability to scale up as your needs grow is important for long-term viability.

Responsive Support

  • Strong Support: Look for a switch with strong customer support, including 24/7 monitoring and technical assistance to resolve any issues promptly.

Customization and Flexibility

  • Tailored Workflows: Can the switch efficiently handle specific routing rules for different types of claims?
  • Adaptability: The ability to adapt to changing regulations, business needs, or new types of claims is a significant advantage.

Reputation and Track Record

  • Proven Performance: Look for a track record of reliability, accuracy, and customer satisfaction.

Innovation and Technology

  • Advanced Technology: Look for a switch that leverages the latest technology, such as artificial intelligence (AI) for fraud detection or machine learning for predictive analytics.
  • Continuous Improvement: Providers that regularly update their systems and offer new features to enhance claims processing are more attractive.