Referral capture
Compliant 340B revenue
you aren’t capturing today.
Specialty prescriptions written beyond your walls are often eligible for 340B—and usually missed. Referral capture finds them, verifies them against your policies, and routes them for savings.
How it works
Designed to minimize the work your team does to verify eligible claims.
Four steps from raw feeds to a captured, compliant claim—with an AI-driven matching engine doing the heavy lifting and your team reviewing only what needs a human.
Data in
OptimSync ingests your covered-entity EMR feeds.
- Claims
- Referrals & encounters
- Prescriptions
Match
The AI engine builds a workable capture.
- Patient match (EMR + Rx claim)
- Referral match
- Active patient at Rx-written date
Verify
Compliance-first review, before anything is submitted.
- Retrieve consult note (fax / email / HIE)
- Tasks created for your team's review
- Six compliance review questions
Capture
Verified as 340B eligible and routed for savings.
- Meets your entity's 340B policies & procedures
- Eligible claim captured
- Routed for 340B replenishment
Compliance first
Nothing is submitted without passing every one of these.
Each capture is validated against your entity’s 340B policies and procedures. The six compliance review questions every claim must answer:
- Is there a documented referral from a covered-entity provider to the specialist?
- Does the consult note tie back to the originating provider or encounter?
- Is the prescribed drug consistent with the referred condition or diagnosis?
- Was the patient an active patient of the covered entity at the Rx-written date?
- Does the covered entity retain responsibility for the patient's ongoing care?
- Is the service within the entity's scope and 340B policies & procedures?
Revenue you’re leaving on the table