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Saas Workflow

Since 2000, ReimbursementCodes has been the industry’s go-to partner when it comes to reimbursing for Specialty Drugs against medical claims. Providers, payers and affiliated healthcare organizations rely on our platform with its the coding and clinical data sets; to power workflow, drive accuracy into reimbursements and create a clear understanding for injectable drugs.

ReimbursementCodes is a software-as-a-service application and data platform that delivers a comprehensive crosswalk and conversion of HCPCS/CPT® codes to NDC codes. It includes unit conversions, calculators and workflow features to drive payment integrity for specialty drugs against the medical claim.

The data set accounts for validated pricing using AWP, WAC, ASP (Medicare Allowable), APC and CMAC for each HCPCS/CPT® code. It also includes ICD-10, Min and Max dosing (FDA and Compendia), as well as Age, Gender, Part B or D designation and the applicable Administrative codes. Our data is designed for direct integration with various healthcare systems, such as financial and analytic platforms, pharmacy operations, network contracting, and claims management.

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RC Claim Assist

RC Claim Assist is an easy to use website application that converts HCPCS/CPT® level pricing units to NDC level pricing units. RC Claim Assist allows for transparency into medical benefit claims processing between Payer organizations and their Provider network. RC Claim Assist is available as a self-service application for Providers required to bill by NDC unit, as well as from Payer’s via the Payer’s Provider network portal.

Benefits of RC Claim Assist

  • Supports education and enforcement of NDC billing policy and guidelines
  • Reduces number of claims requiring reprocessing and aids in appeals management
  • Provides a comprehensive crosswalk of HCPCS/CPT® drug codes, product names and NDCs
  • Backed by the trusted data of ReimbursementCodes from RJ Health

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