Independent and retail pharmacy

Claim, DIR fee and PBM reconciliation for independent and retail pharmacies.

Fintra works beside PioneerRx, BestRx, QS/1 and Liberty, and follows clinical-services revenue from the signed note to the payment.
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Claims & Revenue

Example figures
Caremark: reconciled
$62.40
OptumRx: underwater
$9.10
Express Scripts: DIR fee
−$6.80
MTM, 99606: submitted
$68.00
11 underwater flagged, $2,140 DIR tracked, $1,360 MTM billed (illustrative)

You dispense at a loss, hope the reimbursement covers it and give the counseling away for free.

  1. Reimbursement is a black box

    Third-party remittances rarely match what was adjudicated. Underwater scripts, paid below acquisition cost, hide in the noise until the month is already lost.

  2. DIR fees claw it back

    Weeks after the sale, PBM DIR fees reach back and take margin you already counted. Without reconciliation you can’t forecast cash or dispute a cent of it.

  3. Your clinical work is free

    MTM, immunizations, and counseling get done and documented in a system that can’t code, claim, or collect them. The revenue you earned walks out the door with the patient.

What Fintra does for pharmacy

Fintra runs the money side of your pharmacy. Connect it to PioneerRx, BestRx, QS/1, or Liberty for dispensing, or let Fintra run the front-of-store and back office itself. Built for how an independent actually survives now: reimbursement you can reconcile, counseling that codes, bills, and collects itself, and an AI front desk that never misses a refill or a call.

  • Integrate your Rx system, or replace it
  • Single store or a small chain
  • HIPAA & DEA-minded by design

Payroll & Labor

Example figures
PharmD · Amara O., pharmacist, salaried + MTM bonus
$9,850
Tech · Devin R., technician, hourly
$3,528
Tech · Priya S., technician, OT this period
OT flagged
Payroll with labor cost tracked per script and clinical-service bonuses: overtime flagged for review, every pay-run release sealed.

Keep your dispensing system, or run it all on Fintra.

Dispensing, e-scripts, and the fill workflow stay in the pharmacy system your techs know: Fintra reads claim, remittance, and clinical-event data through a connector and owns reconciliation, clinical-services billing, the front desk, and the back office. Or, if you want one system, Fintra can run point-of-sale, front-of-store, and the whole back office itself.

Stays in your pharmacy system

PioneerRx, PrimeRx, BestRx, QS/1, Liberty

  • Dispensing & fill workflow
  • E-prescribing & refills
  • Adjudication & remittance data

Read through the dispensing connector, live for early customers.

Fintra runs

Finance, Trust and People, plus the two pharmacy jobs below

  • Accounting & consolidation
  • Claim, DIR & PBM reconciliation
  • Note-to-cash clinical billing
  • Ambient scribe & signed notes
  • AI front desk
  • Governance & evidence

Prefer to leave PioneerRx? Fintra can run point-of-sale, inventory, front-of-store retail, and refill and pickup communications on the AI front desk, so a store tired of stitching systems together can consolidate onto one governed platform.

Collect what payers owe you, and bill for the clinical services you already provide.

Every pharmacy has a bookkeeper and a payroll somewhere. Reconciliation and clinical-services revenue are where an independent lives or dies now, so Fintra builds them in, on one governed ledger.

Claims, DIR and PBM Reconciliation

Get paid what you were owed

Every third-party NCPDP claim matched to its remittance, underwater scripts flagged the day they happen, DIR clawbacks traced to the fill they came from, and PBM remittances reconciled per payer, so you can forecast real cash and dispute what’s wrong instead of eating it. The switch, PBM, and clearinghouse feeds are a design-partner seam; the reconciliation engine on top of them is shipped.

  • Claim-to-remittance auto-reconciliation
  • Underwater / below-cost script alerts
  • DIR-fee tracking tied to the original fill
  • Per-payer PBM reconciliation & third-party AR

Clinical-Services Revenue Loop

The counseling that pays for itself

The ambient scribe drafts the MTM or counseling note, a pharmacist signs it, and the signed note auto-codes to MTM CPT 99605, 99606, or 99607, scrubs, submits the claim, and posts the payment to the ledger. Immunizations and point-of-care services bill the same way, all on one closed loop.

  • Signed note auto-codes MTM CPT 99605/99606/99607
  • Claim scrubbed, submitted & tracked to cash
  • Immunization & point-of-care service billing
  • Every note tamper-evident, signed & sealed

Copay Plan

Example figures
Patient copay
$180
approved
soft pull
$30/mo
no hard credit hit
funded today
$174
Fewer abandoned fills, pharmacy paid upfront, Trust-guarded, every approval sealed

The same books, approvals and payroll checks, set up for pharmacy

Finance

Know the margin on every script, and bill for every service, before the month closes.

Real accounting for a store, inventory and COGS, bill pay and payroll, with the pharmacy pain solved: per-script margin against acquisition cost, per-payer reconciliation, and a note-to-cash loop that turns MTM, immunizations, and counseling into billed revenue. Underwater fills and DIR clawbacks show up the day they happen, not at year-end. A single store runs end to end today; multi-store roll-up is on the roadmap.

Explore pharmacy finance
  • Per-store accounting; multi-store roll-up roadmap
  • Per-script margin & NDC-level COGS
  • Note-to-cash clinical-services billing
  • AP, payroll & guarded bill pay

Trust

Every signed note, write-off, and reversal: decided and sealed.

The places money and trust leak in a pharmacy (claim reversals, returns to stock, cash refunds, copay-plan approvals, and the clinical notes you bill from) each get a verdict grounded in your real books and remittances, and each becomes hash-chained, recomputable evidence. Notes are immutable with addenda only. Governance is decide-and-prove; enforcement is staged.

See how actions are checked
  • Signed, tamper-evident clinical notes
  • Reversal / return / refund checks
  • Copay plans guarded at the counter
  • Recomputable, framework-mapped evidence

People

Pharmacists, techs, and AI agents on one org chart.

Staffing an independent is relentless, and the phone never stops. The Workforce Graph puts every pharmacist, technician, and AI teammate, including the AI front desk, on one chart, priced against the same P&L, with an AI recruiter and interviewer that are advisory, and a named human who always approves.

See people and payroll
  • Recruit pharmacists & techs faster
  • Labor cost per script & per service
  • Scheduling, staffing & the AI front desk
  • Humans + AI agents, trust-scored

The counseling note is drafted during the visit, and the pharmacist signs it.

The MTM review, immunization screening, or medication counseling is captured as it happens and drafted into a structured, codeable note. A licensed pharmacist reviews and signs. From that moment it is immutable, corrections are addenda and never silent edits, and it is hash-chained as evidence. The documentation stops being the bottleneck, and the note is already ready to bill.

Ambient capture, structured draft

The consult is captured through a speech-to-text seam and drafted into a structured MTM or counseling note with the assessment, plan, and interventions filled in, so the pharmacist reviews and approves instead of typing from scratch after a twelve-hour day.

Pharmacist signs, then it locks

A named, licensed pharmacist reviews and signs every note. Once signed it is immutable: corrections are appended addenda with their own signature and timestamp, never overwrites, so the record stays defensible under a payer or board review.

Tamper-evident and recomputable

Each signed note and addendum is hash-chained into the same evidence graph as the money actions, so verify_chain() re-derives it and proves nothing was altered after signature. Built for a HIPAA or PBM audit, not a folder of PDFs.

Adherence and med-sync from the note

The note’s interventions feed adherence and med-sync tracking, so a flagged non-adherence or a due follow-up becomes an outreach task on the AI front desk, not a sticky note that gets lost by Thursday.

From signed note to submitted claim to posted cash.

A signed note is not a filed PDF, it is the start of a revenue event. Fintra auto-codes it, scrubs and submits the claim, and posts the payment to the same ledger that runs the store. That closed loop, on one governed ledger, is the moat: the incumbent documents the visit, Fintra turns it into collected cash. The reconciliation and specialty-margin detail live here too.

Note to code to claim to cash

A signed MTM note auto-codes to CPT 99605, 99606, or 99607 by time and complexity, the claim is scrubbed against payer rules, submitted through the clearinghouse seam, and the remittance posts straight to the ledger. Auto-coding is assistive; a licensed human approves before submission.

DIR-fee & PBM reconciliation

Every third-party claim is matched to its remittance, DIR clawbacks are traced back to the exact fill that generated them, and per-payer AR shows where money is stuck, short-paid, or reversed, so you forecast cash and dispute with evidence, not a hunch.

340B & immunization billing

On the roadmap

Immunizations bill across both the medical and pharmacy benefit, including roster billing, so nothing clinical you deliver goes uncaptured. 340B awareness is on the roadmap: eligibility, split-billing against the accumulator, and the covered-entity audit trail are in design with 340B partners, not a built-in engine yet.

e-prescribing & NDC-level margin

E-prescribing and dispensing data flow in at the NDC level, so acquisition cost, reimbursement, and margin are known per script and per NDC. That is the number the month actually turns on, and it is visible before the month closes.

Keep your dispensing system, and Fintra reconciles the money it cannot.

The independent pharmacy doesn’t die at the counter: it dies on reimbursement it can’t reconcile. DIR and adjudication costs run 2–4% of annual revenue, the third-largest expense hitting store cash flow. PioneerRx and PrimeRx dispense and document brilliantly; none of them turn the remittance into financial truth on a governed ledger. That is the whole wedge.

vs PioneerRx: the leading PMS

Integrate

PioneerRx owns the counter: fill workflow, integrated POS, NDC inventory, adherence, eCare/MTM, immunizations, compounding. Fintra does not chase that. It reads the fill/adjudication/remittance feed and owns what a PMS only predicts: reconciliation to a governed general ledger, per-Rx margin vs acquisition cost, DIR clawback traced to the originating fill, per-payer PBM receivables, and sealed reversal/refund approvals. Reconciliation as financial truth, not a prediction widget.

vs PrimeRx: specialty / LTC / 340B

Integrate

PrimeRx’s footprint across specialty, LTC, mail-order, and 340B makes the money wedge bigger, not smaller: specialty scripts are large dollars with complex reimbursement and accumulator economics. Same posture: keep the dispensing system, and let Fintra own the per-Rx margin, DIR, and 340B economics on the ledger.

The real reconciliation contest

In build

The competitors on the money side aren’t the PMS: they’re the reconciliation services (FDS/EnlivenHealth, Datarithm) and the 340B split-billing TPAs (Craneware). Fintra’s reconciliation engine is benchmarked against those: claim-to-remittance auto-match, DIR pulled monthly and tied to the fill, per-payer AR, and an exportable dispute/appeal packet, on one governed ledger instead of a spreadsheet or a third-party service.

Per-Rx margin & 340B

On the roadmap

Per-Rx, per-NDC margin vs acquisition cost, with an underwater-fill alert the day it happens, rides the wholesaler EDI cost feed (832/846) and NDC-level COGS; margin truth is only as good as that feed, so we say so. 340B split-billing (eligibility, accumulator, covered-entity audit trail) is a distinct category and is on the roadmap, not a weekend build.

Voice and text that never miss a refill or a call.

The phone is where an independent quietly loses patients: to voicemail, to hold, to the chain that picked up. The AI front desk answers by voice and text, works refills and reminders, texts back every missed call, books immunizations and MTM visits, and can take a copay or start a plan. It is governed, and it hands off to a named human the moment it should.

Refill reminders & med-sync outreach

Proactive refill and pickup reminders driven by real fill data and the adherence flags coming off signed clinical notes, timed to who is actually due and worth reaching, not a monthly blast to the whole patient list.

Missed-call text-back & after-hours

Every unanswered or after-hours call gets an instant text back that can refill, answer a common question, or book, so the call that used to roll to a competitor turns into a captured fill instead of a lost patient.

Booking & intake

Patients book immunizations, MTM reviews, and consults by voice or text, with intake and eligibility gathered up front, so the pharmacist walks into the room ready and the visit is billable through the note-to-cash loop.

Takes payment, then escalates

The front desk can collect a copay or start a copay plan at the counter or over text, with every rail guarded and sealed, and it escalates to a named human for anything clinical or outside policy. Convenience without letting an agent freelance.

Governed and audit-ready, from one counter to the whole chain.

Every dollar-moving action and every signed note is decided against your real books and remittances, scored, and sealed as evidence you can hand a HIPAA auditor, a PBM, or a board inspector, not a binder you update once a year and hope holds up. And it rolls up across every store.

Frameworks & controls, mapped once

HIPAA and HITECH, DEA controlled-substance recordkeeping and CSOS, SOC 2, PCI-DSS for card and copay-plan payments, and patient-data DLP: 84 frameworks and 111 controls mapped a single time, so one governed action satisfies many at once instead of restarting the mapping per audit.

Policies, attestations & licenses

Versioned policies with full change history, plus staff training and DEA and state-license tracking (who acknowledged which policy, whose license or controlled-substance re-training is due, and when) all part of the same evidence graph, not a separate spreadsheet.

AI Action Governance

Every claim reversal, return to stock, cash refund, copay-plan approval, note signature, or access change gets a verdict and an Action Trust Score before it lands. Fintra Trust decides, records, and can gate; broader automatic enforcement is staged, so today it always decides and proves.

Multi-location roll-ups

On the roadmap

The design: per-store P&L, reconciliation, and evidence consolidate into one group view, so an owner or a small chain sees underwater fills, DIR exposure, MTM revenue, and controlled-substance activity across every counter at once, then drills into a single store. Multi-store consolidation is in build with design partners; a single store runs end to end today.

Staff the counter, keep the licenses, and pay it right.

An independent lives on the pharmacists and techs it can hire, license, and pay correctly, and on the labor cost buried in every script. Fintra puts all of it on the same governed ledger as the money, so a lapsed license never becomes a compliance problem and a payroll run never becomes a dispute.

Recruit pharmacists and techs faster

Every pharmacist, technician, and AI teammate sits on one workforce graph priced against the same P&L, with an AI recruiter and interviewer that stay advisory and a named human who always approves, so filling an open shift or a new hire does not stall the counter.

DEA, state license & CE tracking

Track each staff member's pharmacist and technician licenses, DEA registration, controlled-substance training, and continuing-education deadlines with expiration alerts, so a lapsed credential is caught before it becomes a board finding or a dispensing stop.

Labor cost per script and per service

Scheduling and hours flow into labor cost measured per script filled and per clinical service delivered, so you can see where the counter is over- or under-staffed against real volume instead of guessing from a flat hourly total.

Payroll with clinical-service bonuses

Salaried pharmacists, hourly techs, and MTM and immunization bonuses run on one payroll computed from connected fill and service data, with overtime flagged and every pay run guarded and sealed as evidence before it releases.

More scripts and billed services, with the staff who deliver them paid on the same books.

Security keeps the money you already earned; growth brings in more of it. Fintra runs script-transfer acquisition, refill reactivation, clinical-service enrollment, and staff incentives on the same books, the same front desk, and the same governance, so a new patient becomes a filled, billed, funded relationship without leaving the platform.

Acquisition & refill reactivation

Win script transfers, recover lapsed refills, and run med-sync and adherence campaigns off real fill data through the AI front desk, targeted by who is overdue and what the fill is worth, not a blast to the whole list.

Clinical-service enrollment

Move eligible patients into MTM, med-sync, and immunization programs, then bill the work through the note-to-cash loop, so a growth motion becomes booked, coded, and collected revenue rather than unpaid goodwill.

Referrals & reviews

Track prescriber relationships, member-get-member transfers, and post-pickup reviews, attributed to the fills, services, and margin they produced, so you invest where script and service count actually grow.

Service & staff incentives, guarded

Immunization, MTM, and point-of-care incentives computed straight from connected service and fill data, with clawbacks on reversals and returns: every run scored and sealed as evidence like any other pay run.

Continuous controls for pharmacies.

Fintra tests every transaction, not a sample; only the items that fail open an exception; each exception carries a sealed record of what was checked; the record is mapped to the SOX 404 control it tests; an auditor reviews it through time-limited access.

ControlHow it is checkedFrameworkStatus
Wholesaler bank-change reviewTested continuously by the vendor bank-detail change-review handler on every wholesaler and supplier.SOX-CA-09 · Vendor bank-changeTested today
Bank / deposit reconciliationTested continuously by the bank-reconciliation handler: every deposit reconciles to a posted journal.SOX-CA-06 · ReconciliationTested today
Dispensing / inventory reconciliationPlanned: dispensing and inventory reconciliation; the inventory population is not yet wired.Roadmap · inventoryPlanned

Only the controls marked tested today run against your real transactions now. Planned and attestation controls are listed so you can see the full scope; where Fintra cannot test something, it says so instead of reporting a pass. It works beside your GRC tool and your external audit, not instead of them.

How continuous testing works

Fintra for pharmacy today

The Money · Trust · People engines are the shipped Fintra platform. Fintra’s pharmacy play is deliberately NOT to replace the counter: dispensing, adjudication (NCPDP D.0), POS, NDC inventory, will-call, delivery, and compounding stay in PioneerRx, PrimeRx, BestRx, QS/1, or Liberty. Fintra owns the money layer those systems only predict: DIR/PBM reconciliation (claim-to-remittance auto-match, DIR traced to the originating fill, per-payer AR, dispute packet), per-Rx / per-NDC margin, and the governed ledger, benchmarked against the reconciliation vendors (FDS/EnlivenHealth, Datarithm) and the 340B TPAs (Craneware), not against a PMS. The pharmacy-system connectors, the switch and PBM feeds, the NCPDP dispensing-claim and clearinghouse feeds, the wholesaler EDI cost feed (832/846) that per-Rx margin depends on, the ambient-scribe speech-to-text, and the patient-financing and payment rails are pluggable provider seams: live for design partners and on the near-term roadmap, not a one-click integration for every store yet. MTM billing (99605-07) rides the real medical 837P engine; a licensed pharmacist signs, auto-coding is assistive, and a human approves before any claim goes out. 340B split-billing and multi-store consolidation are on the roadmap, and today Fintra runs a single store per set of books. We will always tell you what is production-ready versus what we are building with you. In demos, no real money moves and no PHI is used.

Pages by role

One set of books runs the whole back office. These pages start from the job you do.

See Fintra run your pharmacy's money.

Bring one store or your whole chain. We'll show claim and DIR reconciliation, a signed MTM note billed to cash, the AI front desk, and the evidence trail on your payer mix.

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