PowerLine is a cloud-native pharmacy claims switch and adjudication platform designed to manage and process prescription claims between pharmacies, pharmacy benefit managers (PBMs), and payers. It receives NCPDP transactions, orchestrates their processing, and routes claims to the appropriate PBM or processor based on BIN/PCN numbers. PowerLine operates independently of PBMs and distributors, providing direct connectivity and control for pharmacies. Its serverless microservices architecture ensures automatic scaling, millisecond response times, and 99.99% uptime across multiple geographic zones. The platform includes a state-of-the-art rules engine, customizable cash claim adjudication, BIN hosting, and advanced data warehousing for healthcare data. PowerLine supports real-time eligibility verification, pre- and post-editing, copay assistance, patient messaging, and seamless integration with pharmacy management systems. Security is maintained through multi-layered protection, 24/7 monitoring, and machine learning.

Key Features

Cloud-Native Claims Processing Automates and orchestrates pharmacy claims transactions with high speed and reliability.

• Millisecond response times for claim submissions
• Serverless microservices architecture for infinite scalability

Intelligent Routing & Adjudication Routes claims to the correct PBM or processor and supports customizable adjudication.

• BIN hosting for custom formulary and pricing
• Dynamic rules engine for NCPDP field actions

Real-Time Eligibility & Verification Minimizes rejected claims and resubmissions through instant insurance checks.

• Commercial and government coverage verification
• Pre- and post-editing of claims

Patient Engagement & Messaging Supports targeted patient communication during pharmacy workflow.

• Fill-reminder logic and copay nudges
• SMS, email, and app-based messaging

Advanced Data Management Collects and transmits vital healthcare data for reporting and compliance.

• Data lake and warehouse for 340B, reconciliation, and inventory
• Comprehensive performance metrics and instant transaction queries

Security & Reliability Ensures secure, compliant, and highly available operations.

• 99.99% uptime with multi-zone deployment
• 24/7 monitoring and machine learning-based security

Benefits

Operational Efficiency Streamlines claims management and reduces manual workload.

• Fast, automated claim routing and adjudication
• Scalable infrastructure with no impact on speed or uptime

Improved Financial Outcomes Maximizes reimbursements and supports custom pricing strategies.

• Dynamic copay assistance and cash claim management
• BIN hosting for accurate pricing and coverage

Enhanced Patient Care Enables pharmacies to focus on patient engagement and adherence.

• Integrated messaging and fill reminders
• Seamless connection to patient education and adherence programs

Compliance & Security Maintains regulatory compliance and protects sensitive data.

• HIPAA-compliant infrastructure
• Multi-layered security and monitoring