Integration Guidelines

OVERVIEW

RxUtility is a claim processing system that enables TPAs (Third-Party Administrators) to submit and process pharmacy and medical claims through a secure SFTP server. This guide will walk you through the setup process and explain how to use the system effectively.

Organization Onboarding

To begin using RxUtility, your TPA organization must first be onboarded with the help of our customer support team. During the initial setup, you'll need to provide:

  • Organization name
  • Organization identifier (unique ID for your organization)
  • Organization email addresses (for system notifications)
  • Secret tokens for Beacon and ESP (for submission)

Once your registration is complete, you will receive an email from rx_file containing:

  • Onboarding confirmation
  • SFTP folder structure specific to your organization
  • Instructions for obtaining SFTP credentials securely through customer support

After receiving your secure credentials from customer support, you can log in to the SFTP server. Your organization will have a dedicated folder structure organized as follows:

organization_identifier/

├── in/

│   ├── pharmacy/

│   └── medical/

└── out/

    ├── pharmacy/

    └── medical/

 

Folder Structure Explained
  • in/ folder: Upload your claim files here for processing
    • pharmacy/: For pharmacy claim submissions
    • medical/: For medical claim submissions
  • out/ folder: System responses and notifications appear here
    • pharmacy/: Results for pharmacy claims
    • medical/: Results for medical claims
File Requirements

RxUtility only accepts CSV files with strict format validation. You must use the provided templates exactly as specified.

Download Templates

Pharmacy Claims Template:
 Download Pharmacy Template

Medical Claims Template:
 Download Medical Template

Submission Process
  1. Download the appropriate template (pharmacy or medical)
  2. Fill in your claim data following the template format exactly
  3. Save the file as a CSV
  4. Upload the file to the corresponding folder in the in/ directory:
    • Pharmacy claims → in/pharmacy/
    • Medical claims → in/medical/

Important: Template compliance is mandatory. Any deviation from the template format will result in processing errors.

After submitting your claims, the system will process your files and provide feedback through the out/ folder. You'll receive notifications for various scenarios:

Response File Types

The system generates different response files based on processing outcomes:

1. Template Mismatch

File naming format: filename_invalid_template_timestamp.csv

This file appears when your submitted file doesn't match the required template format. Review the template requirements and resubmit with the correct structure.

2. Invalid Data

File naming format: filename_invalid_data_timestamp.csv

This file contains rows that failed validation due to data quality issues (e.g., missing required fields, incorrect data types, invalid values). Review the flagged rows, correct the errors, and resubmit.
3. Rebate Platform Responses

File naming format: filename_rebate_submission_platform(beacon|esp)_timestamp.csv

These files contain responses from rebate platforms (such as Beacon or ESP) regarding your claim submissions. Review these files to confirm successful processing or identify any issues with rebate submissions.

  • Always use the latest templates provided by RxUtility
  • Validate your data before submission to minimize errors
  • Monitor the out/ folders regularly for system responses
  • Keep track of timestamps in response files to match them with your submissions

Contact customer support if you encounter persistent issues or need assistance

For technical assistance, onboarding support, or questions about claim processing, please contact RxUtility customer support through your registered organization email addresses.

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