Client work · Medical & pharmacy
A desktop app that lines up the pharmacy system, PBM remittances and payment summaries — so every claim’s expected and actual payment sit side by side.
The starting point
Where our client — a specialty pharmacy — started.
The pharmacy system, PBM remittance files and payment summaries each told a different story.
Finding short-paid and unpaid prescriptions meant manual matching in spreadsheets.
Offsetting duplicates, denied adjustments, missing Rx numbers and irregular codes.
It was hard to see which months’ claims were still waiting on payment.
What we built
Each step mirrors what the team used to do by hand in spreadsheets — now it runs in one click, the same way every month.
Data folder
2025-01remits · summaries
2025-02remits · summaries
2025-03remits · summaries
Sources found
Pharmacy system export
.xlsxPBM remittance files
monthlyPayment summaries
monthly01 · Import
Point the app at a folder organized by month. It reads the pharmacy-system export, the PBM remittance files and the payment summaries — each in its own format.
Match by Rx + fill date
Illustrative
02 · Clean & match
Offsetting duplicates are cancelled, denied adjustments removed and Rx numbers normalized. Then every record is matched across sources by Rx number and fill date.
Expected vs. paid
Illustrative
2 claims paid short — listed for follow-up
03 · Compare
For each claim, what the pharmacy system expected is compared with what actually arrived. Rounding differences and copays are handled, so the gaps that matter stand out.
Payment cascade
Illustrative
Rows: month of service · columns: months until payment arrived
04 · Payment cascade
Cascade tables group claims by month of service and show in which later months the payments arrived — so slow and missing payments are visible at a glance.
Export to Excel
05 · Desktop app
Choose the folder and the year, press Process, and review the results in three tabs — each exportable to Excel. Packaged as a single Windows app, so the data never leaves the building.
How we work
We worked through real exports with the team to learn every format quirk before writing rules.
The matching logic follows how staff reconciled by hand — just faster and the same every time.
Everything ships as one desktop app, so no one needs to run scripts.
Each new month surfaced edge cases; we fixed them and shipped updates.
The result
Also for medical & pharmacy
AI Front Desk
Refill status, hours and appointment requests handled by an AI front desk.
Learn more →Revenue Recovery
Follow-up lists for every underpaid or unpaid claim.
Learn more →AI Back Office
Forms, intake and reports prepared automatically.
Learn more →Customer Reactivation
Reminders for refills and check-ups that are due.
Learn more →Business Copilot & Custom Apps
“Which payer is slowest this quarter?” — answered in plain English.
Learn more →FAQ
Not unless you want it to. This client’s app runs on their own computer, and the data never leaves the building.
Yes — real-world files always are. Cleaning rules for duplicates, denials and missing identifiers are part of the build.
No. We work from the exports and files you already get.
Yes. The same approach — matching what you billed against what you were paid — applies to clinics and practices.
