Road Test: RJ Health Medical Drug Edits – Micro Webinar – Improve payment accuracy, compliance, efficiency via API

Below is the transcript and demo from our on-demand MicroWebinar:

 Road Testing the RJ Health Medical Drug Edits and API Platform


RJ Health’s MDEs intake customer claim data and apply our best in class medically covered drug data and algorithms in order to improve reimbursement timeliness, drug coding, and payment accuracy, drug formulary adherence, and operational efficiency. Fee schedule, drug formulary, and policy data can be utilized to further enhance automation opportunities.

RJ Health's Medical drug edits employ industry's must trusted and used medically covered drug data, logic applied using best in class algorithms, select customer claim, fee schedule, and policy data

RJ Health has developed a library of Medical Drug Edit configurations that are accessed using our API platform prior to claim submission or claim adjudication. The medical drug edits are comprised of best in class algorithms which provide or verify pricing, coding, crosswalk, and unit conversion data. The logic within the edits interrogates customer-submitted claim data and generates returns which include data validation, corrected values, and reason codes for incorrect data submissions.


API Demonstration Utility (ADU):


In addition to real-time responses to your claim data, the RJ Health Medical Drug Edit platform captures data to provide insight to improve your management of medically covered drugs. Our outcome reporting and analyses help to identify global and discreet trends related to drug classes, specific drugs, disease states, and conditions. Network analyses allow you to support providers where specific educational opportunities exist. Additionally, claim analyses can help you identify the types of claims that were submitted in accordance with the payors policy and types where payments were challenged or adjusted.

RJ Health’s outcome reporting and analyses can identify improvement opportunities in operations, contracting, and systems.

rj health api services medical drug edits

The RJ Health Medical Drug Edit Claim Analysis

RJ Health ingests a sample file of your de-identified medically covered drug claim data.

The sample claim data is analyzed to identify and quantify the opportunity for the RJ Health Medical Drug Edits to:

Correct Coding (J Codes, NDC, HCPCS)

Assess Diagnosis/Dosing

Convert Units and/or Units of Measure

Validate and/or Provide Pricing

Results are shared with the focus of the analysis on specific cost and efficiency opportunities are discussed.

Questions? Contact us at, and ask us about signing up for a free trial.


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