Convert every encounter into a clean Medicare Part B claim.
Eligibility, CPT/HCPCS coding, time tracking, claim submission, and denial management — wired into the same workflow your pharmacists already use. Built for CCM, MTM, RHC, and the services pharmacy is paid to deliver.
A real Q1 2025 snapshot from a 6-store partner before MedMe.
60–80% of billable pharmacy services never get invoiced.
Your pharmacists are already counseling MTM patients, building care plans, and following up with chronic-disease patients. The encounter happens. The work gets done. But somewhere between the SOAP note and the claim form, the revenue evaporates — and the average pharmacy never sees it.
- Eligibility wasn't verified, so the encounter wasn't billable to begin with
- The right CPT/HCPCS code wasn't selected — or worse, was downcoded
- Time-based services (CCM, MTM) had no defensible time log
- Claims sat in a denied/pending bucket nobody owned
- No one had a dashboard tying clinical work to revenue
MedMe closes every leak in that chain — inside the same screen the pharmacist already lives in.
From appointment scheduled to claim paid — automated end to end.
No spreadsheets. No re-keying. No outsourced biller you've never met. Every step is captured in MedMe and surfaced in one billing console.
Eligibility check
Real-time Medicare Part B and commercial-payer eligibility runs the moment a patient books — or before the encounter starts. Pharmacists never deliver a service the payer won't cover.
Smart coding
As the SOAP note is written, MedMe suggests the correct CPT/HCPCS code, the right modifier, and the diagnosis pointer — referencing the encounter type, time spent, and patient conditions.
Time tracking
Time-based services like 99490 (CCM 20+ min) and 99607 (MTM additional 15 min) are tracked automatically in the background — start, pause, resume — producing a defensible audit trail.
Claim submission
Clean 837P claims pushed to your clearinghouse of choice — Change Healthcare, Availity, or Office Ally — with diagnosis, NPI, place-of-service, and modifier pre-validated against payer-specific rules.
Denial management
Denials are routed by reason code into a working queue. MedMe pre-fills the corrected claim, drafts the appeal letter, and tracks the resubmission cycle until the dollar lands.
Money in the bank
14-day median pay cycle from encounter to ERA across the customer cohort. Every dollar reconciled to a service, a pharmacist, and a patient.
Every code your pharmacy is paid to use — built in.
MedMe ships with a maintained CPT/HCPCS library covering the services US pharmacy actually delivers. Codes update with CMS quarterly releases. Custom payer rules layer on top.
| Code | Service | Time / requirement | Typical reimbursement |
|---|---|---|---|
| 99490 | Chronic Care Management — staff, first 20 min | 20+ min/month, 2+ chronic conditions | $62–$83 |
| 99491 | Chronic Care Management — provider, 30+ min | Provider-delivered, 30+ min/month | $82–$110 |
| G0511 | RHC general care management visit | 20+ min/month, RHC-eligible site | $77 (RHC AIR) |
| G0512 | RHC psychiatric collaborative care | 60+ min/month, certified BHM | $148 (RHC AIR) |
| 99605 | MTM — initial face-to-face, first 15 min | New patient, in person | $54–$72 |
| 99606 | MTM — established patient, first 15 min | Established patient | $42–$58 |
| 99607 | MTM — additional 15 min (add-on) | Used with 99605/99606 | $22–$30 |
| 99211 | E/M — incident-to (collaborative practice) | State-dependent, supervising MD | $23–$28 |
| 90471/90472 | Immunization administration | First/each additional vaccine | $25–$40 |
| 99401–99404 | Preventive counseling (smoking, weight, etc.) | 15/30/45/60 min tiers | $28–$110 |
Reimbursement ranges reflect 2025 CMS national average locality rates. Actual rates vary by MAC, locality, and payer contract. Full code reference in the CPT/HCPCS guide.
Three places generic billing tools fall apart.
If you've tried to bolt a billing add-on onto a generic EHR, this is the part that broke. We rebuilt each of these from scratch, for pharmacy.
Eligibility verification
Live 270/271 transactions through Change Healthcare and Availity. Patient eligibility, copay, deductible-met, plan type, and CCM-already-billed-this-month — all surfaced before the encounter starts. No more delivering a service to a patient who already had it billed elsewhere.
Smart coding engine
Encounter type plus time plus diagnosis plus pharmacist credential gives MedMe enough signal to suggest the correct primary code, add-on codes, and modifiers — and to flag when an encounter should be coded as 99491 instead of 99490 because a credentialed pharmacist delivered the full 30 minutes.
Denial management workflow
Every 277CA and 835 ERA is parsed and reconciled. Denials land in a queue grouped by reason code (CO-50, CO-97, CO-16, etc.) with the corrected claim pre-filled, the supporting documentation attached, and a one-click resubmit. Median time from denial to corrected claim: 18 hours.
What "billing that actually works" looks like.
Heritage Rx: from spreadsheet billing to $1.4M unlocked in year one.
"We've always known our pharmacists were doing the work. MedMe is the first system that lets us prove it — and get paid for it. The first 90 days alone covered the contract for the year."
Priced as a percentage of what you collect — not a flat SaaS fee.
You don't pay until the claim is paid. We win when you win. Multi-store and enterprise pharmacies get volume tiers and dedicated revenue-cycle support.
- Single store: starts at $349/month + 4% of collected reimbursement
- Multi-store (2–10 stores): volume pricing with enterprise SSO
- Enterprise (10+ stores): custom contract, dedicated revenue cycle pod
- Implementation, eligibility setup, and clearinghouse onboarding included
For a 4-store pharmacy enrolling 800 CCM patients
Things US pharmacy operators ask before signing.
Do I need a separate clearinghouse contract?
You can keep an existing contract with Change Healthcare, Availity, or Office Ally — MedMe routes through whichever you have. Don't have one? We'll set you up with a partner clearinghouse during onboarding at no additional cost.
What states is pharmacy "incident-to" billing legal in?
Collaborative-practice and incident-to billing rules vary by state. MedMe ships with state-by-state rule packs covering scope of practice and supervising-provider requirements. Our revenue-cycle team confirms eligibility for your state during onboarding before a single claim ships.
How does MedMe handle the Rural Health Transformation Program?
The $50B/5yr RHTP rolls out starting fiscal year 2026 with $10B/yr of allocations through 2030. MedMe supports G0511 and G0512 RHC billing today, and our policy team is tracking RHTP implementation across the participating states. Read the RHTP brief for the full breakdown.
Who handles denials — me or MedMe?
Denials land in your billing console with the corrected claim pre-filled. On the multi-store and enterprise tiers, our revenue-cycle pod works the queue alongside you — your team sees the queue clear in real time, and you keep full visibility into every case.
What's the audit trail look like for time-based codes?
Every CCM and MTM minute is logged with timestamp, pharmacist, patient, and activity type — start, pause, resume, complete. The audit log is immutable, exportable, and structured to satisfy Medicare RAC and ZPIC documentation requirements.
How long does implementation take?
Single-store pharmacies are live in 2–3 weeks. Multi-store partners average 4–6 weeks including eligibility setup, clearinghouse enrollment, code-mapping, and pharmacist training. Customer median: 11 days from training complete to first billable encounter.
Show us a week of your encounter volume.
20-minute screen-share. We'll walk through your service mix, run the math live, and show you exactly which codes you're leaving on the table.