Heritage Rx unlocked $1.4M in clean reimbursement — in their first year on MedMe.
A 9-store pharmacy chain across Tennessee and Kentucky moved off a generic EHR + spreadsheet billing in early 2025. Eleven days later, their first MedMe-billed claim was paid. Twelve months later, $1.4M of clean reimbursement was on the books.
9 stores. 87 employees. A generic EHR built for physicians.
Heritage Rx is a 9-store independent pharmacy group spread across Tennessee (5 stores) and southern Kentucky (4 stores). Founded in 1989 by the Holland family, it had grown organically — one store at a time, sometimes acquiring a closing competitor, sometimes opening fresh in an underserved community. By early 2025, the chain employed 87 people across the network — 14 pharmacists, 23 technicians, 8 billers/clerks, 3 district managers, and the rest split between front-store and pharmacy-bench roles.
Like most independent multi-store operators, Heritage Rx had pieced together a clinical-services workflow over the years. They had been doing CCM (chronic care management) since 2021 in two pilot stores. Vaccinations had always been part of the pharmacy. MTM (medication therapy management) was running in 6 of the 9 stores. RPM (remote patient monitoring) was a 2024 pilot. On paper, the clinical service portfolio looked impressive.
The reality on the back end was less impressive. The clinical encounters were documented in a generic ambulatory-care EHR designed for a primary-care physician's office — not for a pharmacist counselling a patient on medication adherence at a drop-off counter. The EHR did not understand pharmacy billing codes natively. CCM time-tracking required pharmacists to remember to start a stopwatch, then later type a number into a free-text note. The "Medicare billing" was, in practice, one of the billers exporting a spreadsheet from the EHR every Friday afternoon, manually pivoting the data, and submitting claims through a mid-tier clearinghouse that didn't natively support pharmacy CPT modifiers.
"We were doing the clinical work. We knew we were. The patients were getting the care. The pharmacists were following the protocols. We just couldn't see what was billable, and we couldn't trust what we were submitting."
Joshua Holland, Director of Clinical Services and the family member who took over the clinical side from his father in 2022, had been building the case internally for a pharmacy-specific EHR for close to a year before the team finally moved.
60–70% of the CCM work was happening — and not invoiced.
The number that finally moved the conversation was internal, not from a vendor pitch. In late 2024, Heritage's CFO ran a back-of-envelope analysis comparing pharmacist time logs to billed CCM minutes. The conclusion was uncomfortable.
Roughly 60–70% of documented CCM work was never making it into a claim. Either the time-tracking was incomplete (pharmacist forgot to log it), the patient was technically not enrolled in CCM that month (an enrolment-paperwork problem), the claim was bounced by the clearinghouse for a missing modifier, or — most often — the spreadsheet pivoting was simply wrong, and the biller didn't know it.
The CFO's analysis was not optimistic. Conservative estimate of "missed clean revenue" across the 9 stores: $1.1–1.6M annually. The conversation with ownership stopped being "should we change EHRs" and became "we cannot afford to keep doing this."
The team had three constraints they wanted any new platform to meet:
- 11-day go-live or less. Heritage was running a Q1 patient-enrolment push for CCM. They couldn't afford a 6-month implementation that broke patient enrolment momentum.
- Pharmacy-native billing. Not "generic EHR with a billing module" — actual support for CPT 99490, 99439, 99437, 99491, the MTM codes (99605–99607), and the RPM stack (99453, 99454, 99457, 99458).
- Multi-store roll-up. The CFO needed one dashboard to see all 9 stores. The clinical director needed protocol versioning across stores. The billing manager needed a single denial queue.
They evaluated three vendors. Two said "yes, we can do that, here's our 9-month implementation timeline." MedMe said "we can have you billing in 11 days, and here's the playbook" — and showed them the playbook.
CCM + MTM + Medical Billing rolled across all 9 stores in 11 calendar days.
Heritage signed the master agreement on a Monday in February 2025. By the following Friday — day 11 — the first MedMe-generated 837P claim was submitted, accepted, and paid four business days later. Here's what the rollout actually looked like:
Day 1–2: Kickoff + dispensing-system audit
MedMe's implementation engineer flew to Heritage's central office in Knoxville on day 2. The first task was a dispensing-system audit across all 9 stores: 6 stores were on PioneerRx, 2 on Liberty, 1 on Computer-Rx. Each store had to be confirmed on a supported dispensing-system version and given an integration profile.
Day 3–4: NPI confirmation + payer roster verification
Heritage already had Medicare Part B PECOS active for all 9 stores. MedMe verified the BCBS Tennessee, BCBS Kentucky, UnitedHealthcare, Humana, and Aetna enrollments — all active. Cigna had lapsed at one store; MedMe filed the recredentialing inside the same week.
Day 5–7: EHR + scheduler setup, formulary import
The MedMe Pharmacy EHR was provisioned for all 9 stores on day 5. The team imported Heritage's existing CCM patient list (1,162 patients) and MTM patient list (487 patients). Care plans were migrated where possible; remaining gaps were flagged for pharmacist review during the first encounter. Scheduler went live on day 6 across all stores with a unified booking page on heritagerx.com.
Day 8–9: Pharmacist training
14 pharmacists, 4 sessions each — 30 minutes per session. MedMe ran them in groups of 4-5 pharmacists at a time, by store cluster. Two of Heritage's senior pharmacists were trained as internal champions on day 8 so they could backstop questions across the network during go-live week.
Day 10: Shadow billing
The first day of clinical encounters in MedMe production. Encounters went into MedMe; billing was generated but held in shadow mode for a 24-hour audit by Heritage's billing manager and MedMe's billing lead. Three coding edges were caught (a 99439 add-on that needed parent context, a CPT modifier on a Tennessee Medicaid claim, an HCPCS code for a Part B vaccine that needed a place-of-service correction). All three were fixed in the templates that night.
Day 11: First claim out, first claim paid
The first batch of MedMe-generated 837P claims went to Availity — Heritage's preferred clearinghouse — at 09:14 Eastern on day 11. First Medicare CCM claim (CPT 99490) for a Knoxville-3 patient cleared 277CA acknowledgement at 09:47. Pay-out via 835 remit landed four business days later. By the end of day 11, the team had submitted 84 claims. By the end of week 2, 312. By end of month 1, over 1,400.
Then came the harder part — actually expanding clinical work, not just cleaning up what was already happening. CCM enrolment, which had been stuck at around 1,150 patients across 9 stores for the better part of a year, started moving. By month 6 it crossed 2,400. By month 12 it sat at 3,720 — a 3.2× increase. This was not because Heritage's pharmacists got better; they had always been good. It was because the friction of enrolment and time-tracking had collapsed.
Four numbers that mattered to the Heritage P&L.
The full quote.
"Before MedMe we had 9 stores all doing CCM and MTM, and absolutely no idea what was actually being billed vs documented. Our CFO was guessing. Eleven days after we signed, we sent our first claim through MedMe Medical Billing. Year one, we unlocked $1.4M of reimbursement that was already happening — we just had no system to capture it. The thing I tell other multi-store operators when they ask me about MedMe is this: it's not a productivity tool, it's a revenue tool. It found money we were leaving on the floor. The next-most-important thing it did was give us one dashboard for all 9 stores. Our district managers used to call each store every Friday to ask about the week. Now they look at the dashboard. The Friday calls are about coaching, not data collection."
— Joshua Holland, PharmD, Director of Clinical Services, Heritage Rx
Five things Joshua tells other multi-store operators.
1. The clinical work is already happening. Find out what's not being billed.
The single biggest insight from Heritage's first quarter on MedMe was just how much CCM time was already being delivered but not billed. If you're a multi-store operator and you've been doing clinical services for more than a year, run the analysis: pharmacist documented time vs billed time. The gap is the opportunity, and it's larger than you think.
2. Don't try to roll out everyone on the same Monday.
Heritage rolled all 9 stores in 11 days because the implementation team did a wave plan: 2 pilot stores in days 5-7, 4 stores in days 7-9, last 3 stores in days 9-11. Trying to flip 9 stores at once would have been chaos. Trying to flip them one at a time over 9 weeks would have been an indefinite project. Waves are the right answer.
3. Train two internal champions per region. Not "all pharmacists at once."
The most useful thing Heritage did was train 2 senior pharmacists — one in TN, one in KY — as internal champions on day 8, before general training started on day 9. When questions came up across the network during go-live week, the answer wasn't "ask MedMe support" — it was "ask Marcus or Renée first, then escalate." The escalation rate to MedMe support was less than 5% of inbound questions.
4. Audit the first 24 hours of claims in shadow mode.
Heritage caught three coding edges in their first 24 hours of shadow billing. None of them were MedMe bugs — they were Tennessee Medicaid quirks, Heritage-specific protocol details, and one Part B place-of-service edge. The shadow audit caught all three before any claim went out. Had they skipped shadow mode, those three edges would have been three first denials and a week of cleanup.
5. Move fast on Q1. The CCM enrolment window is real.
Heritage chose February for go-live deliberately. Q1 is when most Medicare beneficiaries are willing to discuss new clinical-service enrolments — they've just refilled prescriptions, they've just had a wellness visit, they're attentive. Going live in Q1 meant Heritage could ride the enrolment wave into the rest of the year. If they had waited to Q3, they would have hit the lull. Don't underestimate timing.
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