Bridging the pharmacy–physician data gap to identify, perform, and bill clinical services — driving better outcomes and revenue
By addressing the previously unsolved data gap between pharmacists and providers, the SaaS platform PatientRicity allows pharmacies to perform and bill for clinical services more effectively, leveraging Algorithm-driven recommendations, guided workflows, and automated billing.
With features like credentialing management, enterprise-wide workload balancing, and real-time data access, PatientRicity empowers pharmacists and providers to enhance care quality, boost performance metrics, collaborate more efficiently, and recapture missed revenue opportunities.
The modular software platform is customizable to meet the unique needs of both pharmacies and providers:
Three PatientRicity Modules to Choose From
Pharmacy Clinical Module
Empower your pharmacy team to work at the top of their license by creating custom clinical programs that meet payor requirements—without adding administrative burden. The Pharmacy Clinical Module automates the identification of MTM and other interventions, while giving you full control over how your team engages with patients.
Build the Clinical Programs That Drive Growth
Easily create and manage clinical programs with built-in support for payor fulfillment. Customize fields, workflows, and staff instructions to match your goals. Popular program types include:
Gap-in-care interventions
Medication Therapy Management (MTM)
First-fill counseling
Transitional Care Management (TCM)
Preventative Health Screenings
Prescriber outreach
Chronic Disease Management
Adherence reminders
Immunizations
Point-of-Care Testing
Simplified Staff Training and Oversight
The platform is set up to walk users through every step. The guided workflows are intuitive and easy to use, making it easy to teach staff to quickly learn and leverage the platform.
Support Pharmacists as Clinical Providers
PatientRicity helps your pharmacists deliver clinical services within their licensed scope by tracking licensure by service area and sending license renewal reminders—so your team stays compliant and patient-ready.
Clinical Service Performance and Billing: As Easy as 1-2-3
Our platform automatically submits fully populated claims as soon as clinical services are completed—no manual entry required. This speeds up your revenue cycle and ensures payor requirements are met. And it really boils down to these three steps:
1. Identify
Identify care gaps via EHR/pharmacy data
2. Perform
Perform services via guided, compliance ready workflows
3. Bill
Bill automatically with accurate CPT* pairing
The Pharmacy Clinical Module is how pharmacies can easily identify, provide, and bill for expanded clinical services without adding staff ─ and drive revenue growth. See how your pharmacy can benefit.
Pharmacy Workflow Module
Our web-based Pharmacy Workflow Module helps you unlock hidden labor capacity by enabling Rx verification workload sharing across your entire pharmacy network. Designed for busy pharmacies, it gives teams real-time visibility into tasks and helps manage workflows more efficiently—improving service delivery and reducing operational friction.
Key benefits include:
Real-Time Verification
& Integration
Seamlessly connects with your Pharmacy Information System (PhIS) to support Rx verification and provide live data access.
Enterprise-Wide
Workload Balancing
Optimize staffing and task distribution across all locations for improved efficiency and clinical service consistency.
Real-Time
API Updates
Easily update patient status, reject order entry errors, and adjust workflows on the fly.
If you’d like to optimize staffing across pharmacy locations, streamline task management, and ensure timely medication delivery through real-time data integration, workload balancing, and automated patient tracking, let’s talk.
Physician Module
Stop losing revenue to missed service opportunities and manual reconciliations. The Physician Module from PatientRicity integrates directly with your EHR to identify care gaps, match diagnoses to billable services, and automate CPT* code selection—streamlining billing while boosting HEDIS scores and star ratings.
Smarter Service Identification. Less Manual Work.
Our intelligent engine scans patient data in real time to:
Identify missed CPT* billing opportunities tied to existing diagnosis codes
Recommend program-based interventions to address gaps in care
Automatically surface actionable opportunities without burdening staff
Generate reports highlighting missed billing opportunities to quantify revenue impact
Physician Revenue Discovery
Discover revenue often lost to underbilling or overlooked services. PatientRicity aligns diagnosis and billing codes for accurate, compliant reimbursement—no manual matching or spreadsheet audits required.
Boost Performance Metrics with Confidence
Improve HEDIS scores, star ratings, and overall patient outcomes through guided, data-driven workflows that help providers close care gaps efficiently and consistently.
Additional Benefits:
Seamless integration with existing EHR platforms
Real-time opportunity alerts for point-of-care action
Configurable program criteria to support payor-specific initiatives
Built-in compliance checks to reduce billing risk
See how you can leverage the Physician’s Module to automatically identify CPT codes and targeted interventions—closing care gaps, advancing patient outcomes, and supporting stronger quality measures.
PatientRicity Features that Allow for Pharmacy and Practice Growth through Clinical Service Expansion
Identify Patient Eligibility
Our advanced technology effortlessly identifies patients eligible for multiple clinical services using physician-based, algorithm ‑driven clinical recommendations, maximizing enrollment and ensuring continuous engagement.
Simplified Clinical Service Delivery
PatientRicity seamlessly interfaces with your payors, ensuring all requirements for each clinical service are automatically provided. Clear, easy-to-follow prompts guide staff step-by-step through service execution, simplifying every task to ensure efficient and accurate completion. The unique platform allows for the creation of any type of clinical service program.
Automated Medical Billing
You can automate billing for all clinical services. Our platform ensures that every claim is fully populated with the information required by your payors upon completing the clinical service. Once services are finished, claims are automatically submitted, eliminating manual entry and accelerating revenue cycle management.
Operate From One Unified Platform
PatientRicity seamlessly integrates with most pharmacy operating systems and EHRs, allowing staff to efficiently perform identified clinical services and avoid missed billable opportunities through DX‑CPT* matching.
Workload Balance
Enterprise workload balancing streamlines labor across multiple locations, enhancing operational performance. This helps pharmacies increase revenue and manage staff efficiently, all without significantly increasing workload.
Advanced Reporting & Analytics
Insights and customizable reports enable data-driven decision-making. Our advanced analytics track performance, optimize care, and identify opportunities for improvement, driving better patient outcomes and operational efficiency.
Pharmacy Workflow
Streamline pharmacy operations with Rx verification for accurate medication management. An integrated API connects directly to the Pharmacy Information System for real-time data access and efficient workflow.
Support Tools
Simplified patient outreach, scheduling, and credential management ensure seamless staff resource allocation, while keeping employees up to date with licensing, training, and patient engagement.
Driving Outcomes
In a field study with a retail pharmacy that conducted over 140,000 MTM, workflow, and LTC-based clinical interventions, the PatientRicity platform demonstrated strong scalability and adoption across multiple care settings.
The Numbers Speak For Themselves:
PatientRicity Increases Gaps Identified
And Increases Gaps Closed
CARE GAPS FOUND Identified Across 1946 Patients
INTERVENTIONS Completed By Pharmacists
Superior Clinical Outcomes
The platform achieved a >90% completion rate for targeted interventions, averaging the closure of three care gaps per patient, contributing to a 5-Star performance in medication reviews and improved quality outcomes.
Financial & Operational Impact
Increase average payer reimbursement from
$80 to $150
compared to the leading MTM solutions.
By enabling pharmacies to identify and complete more billable opportunities, the platform generates an average of $150 in payer-eligible services per patient and over $100,000 in additional pharmacy-driven revenue–without changing payer reimbursement rates.
Only PatientRicity…