Intelligent Pharmacy Reimbursement Validation & Fraud Detection

Our CMS-aligned platform delivers up to 80% prescription cost savings for Medicaid programs and FQHCs by deploying automated claim validation, smart contracts, and agentic AI frameworks.

Explore Platform Solutions
Trusted Enterprise Infrastructure
Integrated Across Industry Pioneers & National Healthcare Ecosystems
GSK
Pharmaceutical Partner
Pfizer
Clinical Integration
PerformRx
PBM Coordination
EmblemHealth
Payer Network
AmeriHealth
Managed Medicaid Flow
CVS health
Pharmacy Network Clearing
IBC
Payer Clearinghouse
FDB First Databank
Formulary Verification
Medi-Span
Drug Data Loop

Core Platform Capabilities

Combining modern technology with over 30 years of deep expertise in Pharmacy Benefit Management (PBM) and healthcare operations to deliver a transparent, single source of truth.

Incentive Ecosystems Handshake Collaboration

Patient & Provider Shared-Savings Network

Driving clinical adherence and program participation through compliant cash rewards for patients and performance honoraria for healthcare providers. Aligns all stakeholders into an incentive-driven environment.

Claim Tokenization Blockchain Concept

Tokenized Healthcare Incentive Platform

Utilizing agentic AI and blockchain technology to tokenize pharmacy claims. This achieves complete processing transparency, hyper-efficiency, and provides an unalterable audit trail across networks.

Benefit Design & Formulation Modeling Analytics

Pharmacy Savings Participation Ecosystem

Custom, data-driven formulation modeling built by clinical pharmacy experts. Supports targeted processing integrations with industry standards such as First Databank (FDB) and Medi-Span compendia data loops.

Agentic AI Clinical Automation Dashboard

Agentic AI Prior Auth

Replacing legacy, manual prior authorization procedures with proactive AI agents. Slashes administrative drag, decreases compliance exposure, and removes friction for patients and clinics alike.

340B Pharmacy Financial Auditing Compliance

340B Program Auditing

Complete operational optimization, auditing, and "house cleaning." Purpose-built to support the new 340B Rebate Model, effectuate Maximum Fair Price (MFP) requirements, and permanently stop financial leakage.

Smart Contract Rebates Legal Document Security

Smart Contract Rebates

Modernizing legacy corporate rebate life-cycles. Uses cryptographic smart contracting mechanisms to process complex, multi-party calculations, data structures, and invoice disputes in real time.

Transforming Medicaid and FQHC Communities

Traditional pharmacy fulfillment loops systematically fail vulnerable communities due to a lack of efficient tools, patient adherence struggles, and completely unincentivized providers. This operational vacuum leads to skyrocketing operational spend and fragmented care.

RxNexa's CMS-aligned platform repairs this disconnect without disrupting patient care. By perfectly combining provider honoraria, facility splits, and patient rewards, we route tailored services and essential medical care directly to the patient's home through our client's Covered Entity pharmacy network.

  • Provider & Facility Alignment: Distributes structured honoraria and infrastructure allocations to guarantee clinical cooperation.
  • Patient Engagement: Incentivizes behavioral adherence with cash rewards for program participation.
  • CMS Evaluation Priorities: Aligns with CMS Section M priorities to guarantee technical merit, cost-effectiveness, and operational readiness.
Clinical Professional Interacting with Advanced Health Data Tablet
Cryptographic Ledger Data Networks Tokenization

Secure Processing, Smart Contracts & Claim Tokenization

Healthcare payment systems are heavily burdened by processing delays and friction. Legacy architecture makes tracking absolute payment validation loops near impossible across isolated pharmacy corridors.

RxNexa transforms claims into cryptographic tokens, ensuring every multi-tiered network calculation settles instantly. Our smart contract systems match contract terms automatedly, dropping systemic payment adjustments from weeks down to fractions of a second.

  • Immutable Audits: Guarantees a clean, unalterable record for every processed pharmacy transaction.
  • Real-time Remittance: Accelerates capital speed by settling network provider line items in real time.

340B Claims Management & Duplicate Discount Elimination

Under the rapidly shifting regulations of the 340B Drug Pricing Program, accurately identifying claims where 340B pricing and federal Maximum Fair Price (MFP) requirements intersect has become crucial. Inconsistent identifiers, erratic medical claim modifiers, and manual tracking create severe compliance risk and extensive financial leakage.

The RxNexa Approach: Our automated SaaS ecosystem leverages AI-driven claim validation and blockchain accountability to cleanly track, calculate, and invoice duplicate discounts. We permanently remove administrative blindspots and streamline dispute options for ultimate risk mitigation.

  • Automated MFP Alignment: Flags overlapping claims automatically to maintain statutory pricing transparency.
  • Dispute Resolution: Eliminates manual spreadsheets by integrating automated dispute and invoicing loops.
  • Audit Protection: Implements a unified data ledger across providers, pharmacies, and payers.
Data Analytics Interface dashboard
Agentic AI Prior Authorization System Platform

Agentic AI Prior Authorizations & Clinical Workflows

Prior authorizations remain a primary bottleneck in clinical healthcare operations, resulting in manual processing bottlenecks, administrative fatigue, and abandoned therapies.

Our proactive AI system securely scans electronic medical data (EMR) to pre-populate and authorize complex clinical parameters. By connecting diagnostics directly to your formulary rulesets, approvals process without delays.

  • Admin Efficiency: Cuts standard clinical authorization wait times down to minutes.
  • FDB Integration: Syncs instantly with First Databank (FDB) databases for absolute formulary modeling accuracy.
80%
Medicaid & FQHC Cost Reduction
10%
Provider Alignment Honoraria
5%
Healthcare Facility Share
2%
Patient Adherence Rewards

Integrated Home-Delivery Services

Connecting high-risk patient pools to custom clinical supplies and specialized wellness initiatives right at their doorstep.

Remote Patient Monitoring

RPM & Care Tracking

Customized Remote Patient Monitoring programs and Transitional Care Management to safely guide patients from inpatient settings back home.

Meals as Medicine

Wellness & Nutritional Support

supporting patients moving from inpatient to outpatient care.

Diabetes Care Programs

Transitional Care Managemen

Helping patients transition safely from hospital to home through coordinated post-discharge care and ongoing clinical support.

Specialty Medical Supplies

Access to CGMs, GLP for Underserved Patients

Lower-Cost DME, CGM & Specialty Therapeutics for FQHC & Medicaid Networks

Technical Integration & Cloud Engine

Architected to deploy within heavily regulated enterprise environments, leveraging advanced multi-cloud networks to process healthcare workloads with maximum defense security.

Advanced Data Center Cloud Infrastructure Network

Multi-Cloud Modernization

Fully redundant deployment profiles spanning AWS Healthcare Blueprint, Azure for Health, and Google Cloud (GCP) Healthcare API. Dynamically balances high-throughput claims data streams across geographically separated server fabrics.

AWS Landing Zone Azure FHIR GCP Anthos
Hyperconnected Server Interoperability Telemetry

Clinical Interoperability

Real-time data synchronization across leading electronic medical record systems (Epic, Cerner). Executes secure web-hook loops translating unstructured data streams directly into active Disease Track Management (DTM) logs.

HL7 / FHIR v4 Smart on FHIR RESTful APIs
Cybersecurity Cryptographic Key Biometric Interface

Zero-Trust Data Shield

Enforces military-grade, end-to-end data encryption loops (AES-256) both at rest and in transit. Proactively guarded by isolated tokenization modules to isolate and safeguard Protected Health Information (PHI).

HITRUST CSF SOC 2 Type II E2EE Cryptography
HIPAA
Full Regulatory Security
NIST SP 800-66
Risk Management Framework
FHIR 4.0.1
Standard Data Pipeline
CMS-M
Federal Core Alignment
Core System Summary: EMR Architecture Loops • Real-Time Automated Claims Verification Logs • Multi-Network Transaction Splicing • Medication Therapy Management (MTM) Real-Time Data Pipelines • Fully Redundant multi-cloud architectures.

Executive Leadership Team

Veteran healthcare executives, technologists, and clinical leaders driving transparency and modernization across the country.

Ken Burkett - Founder & CEO

Ken Burkett

Founder & CEO

Accomplished payer strategy executive with 25+ years in national contracting, rebate negotiations, and value-based design. Secured $100M+ in corporate rebate guarantees and drove clinical adherence gains of over 200%+ across commercial and Medicaid populations.

Tarek Hajri - Co-founder & CIO

Tarek Hajri

Co-founder & CIO

Seasoned enterprise transformation architect with comprehensive expertise designing secure large-scale data structures, cybersecurity, and cloud environments. Led deployment of 200+ technology solutions supporting Pfizer, GSK, AstraZeneca, and EmblemHealth.

Raymond Purnomo, PharmD - Co-founder & CMO

Raymond Purnomo, PharmD

Co-founder & CMO

Doctor of Pharmacy specializing in advanced Clinical Pharmacy Program Management. Oversees medical strategy, formulary integrity, clinical network rulesets, and pharmacy provider alignment parameters across the platform.

Alejandro De Luna - Exec. Director Clinical Production

Alejandro "Alex" De Luna

Exec. Director Clinical Production Management

Drives the operational execution vectors of the platform. Integrates technology pipelines, production management protocols, and multi-network transactional logistics to maintain system stability.

Benjamin Woo - Design Director

Benjamin Woo

Design Director

Directs the visual system layout, user interface (UI) components, and overall platform data accessibility models, ensuring intricate tracking statistics read clearly for clinical operators.

Olivia Hartman - Customer Service Manager

Olivia Hartman

Customer Service Manager

Coordinates day-to-day global stakeholder support structures and client onboarding protocols, maintaining excellent data alignment and engagement metrics across facilities.

Connect With Our Experts

Learn how RxNexa can design, automate, and protect your pharmacy benefits network while driving unprecedented program savings.

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Enterprise Solutions

Medicaid Programs, FQHC Networks, and PBM Consultation Loops.

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Electronic Communication

inquiry@rxnexa.com