Every service you deliver, billed correctly — every time
aheadRx handles the full spectrum of health plan billing for pharmacies, from clinical services to immunizations to medication therapy management. If you're delivering care, we make sure you get paid for it.
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Pharmacy billing is complex. We've mastered it.
Health plan billing for pharmacies spans dozens of service categories, each with its own codes, documentation requirements, and payer rules. Most pharmacies leave significant revenue on the table — not because they aren't doing the work, but because the billing infrastructure hasn't kept up. aheadRx brings decades of pharmacy billing expertise to close that gap.
12+ billing service categories supported
From immunizations to complex medication therapy management, aheadRx covers the full range of billable pharmacy services.
Immunizations & Vaccines
Accurate billing for all administered vaccines including flu, COVID-19, shingles, pneumonia, and travel vaccines across Medicare, Medicaid, and commercial plans.
Medication Therapy Management (MTM)
Full MTM billing support including Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs) for eligible patients.
Point-of-Care Testing
Billing for CLIA-waived and moderate-complexity tests including strep, flu, COVID-19, and other rapid diagnostics performed at the pharmacy.
Chronic Disease Management
Reimbursement for pharmacist-led chronic disease management services including diabetes, hypertension, asthma, and COPD monitoring.
Collaborative Practice Agreements
Billing support for services delivered under CPAs with physicians, including prescribing authority services and patient monitoring protocols.
Transitional Care Management
Capture reimbursement for pharmacist involvement in post-discharge medication reconciliation and care transitions.
Smoking Cessation Counseling
Billing for structured smoking cessation counseling sessions covered by Medicare Part B and many commercial health plans.
Contraceptive Services
Billing for pharmacist-prescribed contraceptives in states with expanded pharmacist prescribing authority.
Opioid Treatment Programs
Specialized billing for pharmacies participating in opioid treatment and medication-assisted treatment (MAT) programs.
Durable Medical Equipment
DME billing for pharmacies supplying eligible equipment and supplies to Medicare and Medicaid beneficiaries.
Specialty Pharmacy Services
Complex billing for specialty medications including prior authorization support, patient assistance programs, and hub services.
Medicare Annual Wellness Visits
Billing for pharmacist-delivered components of Medicare Annual Wellness Visits where state law and payer contracts permit.
How our billing workflow works
A streamlined process designed to maximize your reimbursements with minimal administrative burden.
Service documentation
We integrate with your pharmacy management system to capture service documentation at the point of care, ensuring every billable encounter is recorded with the right codes and supporting data.
Claim preparation & scrubbing
Our billing engine validates every claim against current payer rules before submission, catching errors and missing information that would cause denials — before they happen.
Payer submission
Claims are submitted electronically to the appropriate health plans, Medicare, Medicaid, and commercial payers through our established clearinghouse connections.
Denial management
When claims are denied, our team investigates the reason, corrects the issue, and resubmits — recovering revenue that most pharmacies simply write off.
Payment posting & reporting
Payments are posted and reconciled against expected reimbursements. You get clear reporting on what was billed, what was paid, and what's still outstanding.
Health plans we work with
aheadRx has established billing relationships and deep knowledge of reimbursement rules across the major health plan categories pharmacies encounter.
Medicare Part B
Medical benefit billing for vaccines, DME, and clinical services
Medicare Part D
Prescription drug plan billing including MTM and adherence programs
Medicaid
State Medicaid fee-for-service and managed care organization billing
Commercial Health Plans
Major commercial payers including BCBS, Aetna, Cigna, UnitedHealth, and regional plans
Workers' Compensation
Billing for pharmacy services delivered to workers' compensation patients
340B Programs
Billing support for pharmacies participating in the 340B drug pricing program
Find out how much revenue you're leaving on the table
Book a demo and our team will walk through your current billing setup and identify where aheadRx can recover revenue for your pharmacy.
Book a Demo