claimRx
Real-time claims adjudication for medical reimbursement. Validate against benefit rules and formulary data, and recover revenue lost to manual processing.
How It Works
Submission to adjudication, in real time
Ingest
Claim arrives from connected insurer systems or LP origination platform. Patient identification, coverage period, and benefit limits are verified instantly.
Validate
Claim is checked against the product formulary, dispensing rules, and therapeutic category limits using GuideRx's RWE-backed intelligence.
Apply Rules
Benefit plan rules, coverage constraints, and regulatory requirements are applied in real time — automatically resolving coverage conflicts across plans.
Adjudicate
Claim is approved, denied, or sent for exception review. A complete audit trail is captured for compliance and dispute resolution.
Who It’s For
Insurers, benefits managers, and licensed producers
Insurers & Benefits Managers
Reduce claim processing costs by automating adjudication, lower rejection rates through real-time validation, and gain complete visibility into medical cannabinoid claim patterns across your member base.
Licensed Producers
Eliminate claim denials before submission, streamline reimbursement workflows, and gain data-backed insights into which products and patient profiles convert highest with insurance coverage.
Proof Points
Scale & performance
14K+
Unique Patients / Month
160K+
Claims Processed / Month
$14M+
Monthly Client Revenue Generated
Integrations
Connect to the ecosystem your claims require
Insurer claims systems
Real-time adjudication APIs for Canadian benefit carriers.
Pharmacy adjudication networks
Integration with the claims-routing and eligibility networks that benefit plans already rely on.
Licensed Producer platforms
LP origination and order-management systems for end-to-end claim generation and tracking.
Reduce claim rejections and recover revenue at scale.
See how claimRx handles high volume medical reimbursement claims for insurers, benefits managers, and licensed producers.