RxLogic PBM Application Update
|
Update Type |
Minor |
|
Update Description |
This version update includes stabilization and performance items and various bug fixes. Added Features:
|
|
Existing Feature Behavior Changes |
None identified |
|
Version Number |
1.18.4.2 |
|
Production Release Date |
6/16/2026 |
|
UAT Release Date |
6/3/2026 |
The New Features section of the Release Notes is dedicated to work items that are new functionality that were not in previous versions of the application. If you have additional questions on any of the new functionalities, please reach out to your RxLogic CSM.
Claim Tab
Transaction Details
Addition of FormularyAction and FormularyName (32475) – A new Global Defaults option, “Transactions - Show Formulary IE Information” was added. When set to True, The ProcessRuleIEFormulayName and ProcessRuleIEFormularyAction are displayed as part of the Status box on both Paid and Rejected transactions. If the Global default is set to False or is not defined this field will be hidden.
This change was also made on the Claim Processing screen.
Claim Activity
Addition of FormularyAction and FormularyName (32462) – The ProcessRuleIEFormularyAction and ProcessRuleIEFormularyName were added as selectable fields. These are off by default but can be added via the field selector. If the transaction is a compound, the value from the first ingredient found will be displayed.
Both the Export view and Export Dataset options were updated to include the new fields.
MAC Manager
Percent of Basis – New Basis Options (32322 / 32323 / 32324 / 32325) – The ability to define WAC, NADAC, and ACAFUL as basis options for the MAC Percent of Basis was added. The default for the basis remains AWP. The Percent of Basis allows for a dynamic MAC price to be determined based on the selected Basis and % of Basis applied. If no pricing exists for the Basis, the item is considered is not on the MAC.
As a part of this update, the new Basis was added to the Mac Import layout, and related wizard screens. This is an optional field. Clients using the current MAC format without this field can continue to do so.
Member Tab
MPA Manager
New Global Option for Approve/Deny Default (32001) – A new option of “MPA - No Default Approve Deny Action” was added to the Global Defaults located under the Administration Menu. When this value is set to True, the Approve/Deny field on the MPA defaults to -Select- instead of Approve on MPA Creation. The value must be changed to Approve or Deny before the MPA can be saved.
Leaving the MPA - No Default Approve Deny Action value is false or not defined will keep the default as Approve for MPA creation.
New Global Option to Continue Processing on Denial MPAs (32444) – A new global default, “Adjudication – Continue Processing on Denied MPAs” was added. When enabled adjudication proceeds as it would for a standard reject. This means the system continues evaluating rules after the Denial MPA rejection instead of stopping processing there. This allows for rules that still fire on rejections, such as Wrap Processor Process Rules, to execute.
Even though additional rules may fire during this extended processing, the outcome does not change. If the transaction rejects, only the rejection from the Denial MPA is returned with its associated messaging, disregarding any other rejects encountered during processing.
Member Search
Member Merge New Option for Merge Coverages (32034 / 32036) – A new Merge Coverages to Destination Member option was added to the Member Merge. When enabled, coverages for the CH, Group, and Subgroup eligibility are moved from the source to the Destination member as a part of the Merge. This Merge only occurs if the coverage periods between the source and destination do not overlap. If there is an overlap, an error is shown and the merge is not performed.
This update applies to all screens that include the Merge button.
Member Setting for Ignore Dependent Cutoff Age Check (32333 / 32334) – A new “Ignore Dependent Cutoff Age Checks" option was added under the Member Adj. Options section. When enabled, the member is exempt from Child and Student Cutoff age validations configured at the group level. Rule Tracker messages also indicate when these age checks are bypassed.
This setting can only be set manually, and neither the Eligibility Import processes or APIs will change this setting.
Plan Design Tab
Group Manager
Configurable CHID Source for Surescripts Integration (31977 / 31978 / 31979 / 31980) – A new configuration option for Cardholder ID Source was added to the Integration tab. The Cardholder ID Source allows the CHID value sent to Surescripts to be selected as CHID, Alternate ID, or Previous ID. The default value is CHID.
Location Manager
Ability to Mass Delete Locations and Break Associated Group Relationships (29588) – Locations can now be multi selected for deletion, with the deletion now removing references to any associated groups. When deleting a single location, a confirmation pop up will confirm the deletion. When deleting multiple locations, the listing of the locations is shown for confirmation.
Bill Cost Calculator
Sell Ingredient Cost Adjustment by Basis (32316 / 32317) – The ability to reduce the final Sell Ingredient Cost determined by the Bill Cost Calculator was added. The new “Sell Ingredient Cost Adjustment by Basis” option allows for an increase or decrease based on a percentage of a selected pricing basis (AWP, WAC, MAC, NADAC, ACAFUL). The adjustment is applied after all other Bill Cost calculations and supports both transparent and non-transparent pricing setups.
An example of this behavior is a Bill Cost Calculator determining a Sell Ingredient Cost of $100 overall. If the Basis of AWP was selected and the AWP is $1 per unit, a 100 percent adjustment would add $1 per quantity dispensed to the $100. A -50 percent adjustment would subtract .50 per quantity from the $100 ingredient cost. The ingredient cost cannot be reduced to below $0. If the selected Basis has no price for the product dispensed, the adjustment is skipped.
The adjusted amount is captured in the SellIngredientCostAdjustmentTotal field on the Transactions table, as well as in the SellIngredientCostAdjustment on the TransactionItems table.
Note: As this adjustment can result in the Buy Side pricing exceeding the Sell Side pricing, it is highly recommended that setups utilizing this option are reviewed thoroughly to make sure the desired Buy and Sell side pricing are calculated.
Process Rules
Patient Pay and Eligibility Service Option (32445 / 32448 / 32449 / 32450 / 32930) – A new Eligibility and Patient Pay Service action was added to Process Rules. This option allows for selection of a related service from the dropdown. At this time, most Clients will not have an option in the list. The Patient Pay and Eligibility Service allows Clients to integrate with RxLogic, including their own service during the Adjudication process that can set the Patient Pay for the transaction, or reject the transaction entirely.
Interested Clients should reach out to their RxLogic representative for more information on integrating with RxLogic.
Files and Jobs Tab
Job Manager
Member Merge – Update for Merge Coverages (32037) – Similar to item 32034, the Member Merge import now includes an option for mergecoveragestodestinationmember. When set to Yes, the Ch, Group, and Subgroup eligibility information from the Source Member is moved to the destination member if there is no overlap in coverage. If there is an overlap, the record errors out with an error noted on the -DET file.
Billing Cycle File Export – Auto Move Files to SFTP After Receivables Run (32287) – To finish the workflow process for the Receivables automation, new options were added to the Billing Cycle File Export to move files to the SFTP. The CopyFilesToSFTP option is set with the ID of the related FTP connection, and the sftpDefaultFolder option indicates the subfolders on the SFTP that should include the Receivables files.
These options require the use of the autoPushToPayrec, AutoCalculateInvoices, and AutoGenerateInvoiceFiles to work.
On completion or failure of the file move, an email is sent to the Recipients listed on the Distribution List attached to the Payrec Org Info.
Pharmacy Card Manager
Support for Alternate and Previous CHID Selection (31897 / 31898) – The Pharmacy Card Manager was updated with a new CHID Source selection. This allows for options of Previous CHID, Alternate CHID, or CHID, with CHID being the default. The selected option is used to populate the CHID field on the export file.
Billing Manager
Warning When Saving an Entity Without Reports (10267) – A new warning was added when saving a Billing Entity set to Invoice (Is Invoiced) without any billing reports set up. This gives a reminder that no reports will be generated during the Receivables process but allows the popup to be dismissed without addressing the issue.
Payables Manager
Copy to SFTP Progress Improvements (30654 / 32501) – The Copy Files to SFTP option was improved to give a better indication of the status of the copy. A new pop-up window is now shown, providing updates on the copy progress. Keeping the progress pop up window up is not required, and the copy will continue in the background regardless. Closing the pop-up displays a message with a related Job Run ID that can be used to follow up on the status of the copy.
This change was made to all locations in Payables and Receivables that allow the Copy Files to SFTP option.
As a part of this change, the Copy to SFTP process was also improved to reduce time required to copy files.
New Pharmacy State Filter on Step 2 (32441) – Step 2 of the Payables Wizard now includes a filtering option for Pharmacy State. This filter allows for selection of one or many States.
Receivables Manager
New Batches Tab (31943) – A new Batches tab was added to Receivables, allowing visibility into the processed batches without the need to find the batch underneath the Billing Cycle Id on the Dashboard tab. The Batch ID allows for clicking to popup the details about the Batch, and the same right click actions for the batch are supported.
Release History
1.18.3 Notes Added (32352) – Release notes for version 1.18.3 were added.
Knowledge Center
New Knowledge Center Articles and Videos are available for the following locations:
- Billing & Fee Mgmt
- PayRec Introduction
- Payment Adjustment Management Overview & How to Create Payment Adjustments
- Plan Design
- Plan Design Introduction
- Hierarchy Detail Overview
- Organization Manager Overview
- How to Create an Organization?
- Admin
- Portal Admin Overview
- Location – allowing retrieval (GET), creation (POST), and modification (PUT) for the Name, Location Code, Description, Effective Date, and Termination date of the Location Code.
- LocationGroup – allowing retrieval (GET), creation (POST), and modification (PUT) of group attachments to Location codes.
Member Merge
Merge Coverages Option (32038) – A new updateCoverages option was added to the Member Merge API. When sent as True, coverages for the CH, Group, and Subgroup eligibility are moved from the source to the Destination member as a part of the Merge. This Merge will only occur if the coverage periods between the source and destination do not overlap. If there is an overlap, an error is shown and the merge is not performed.
Locations
New Locations and LocationGroup Endpoints (32041 / 32042) – New APIs for the retrieval and maintenance of Location Code related information were added. The two endpoints are:
For additional information on these endpoints, please consult the updated RxLogic API documentation.
Subgroups
New Subgroup Endpoint (32043) – A new API for the retrieval and update of Subgroup information was added. This endpoint supports retrieval (GET), creation (POST), and modification (PUT) of Subgroup information. For additional details, please consult the updated RxLogic API documentation.
Process Transactions
Addition of Formulay Fields on Response (32407) – The ProcessRuleIEFormularyName and ProcessRuleIEFormularyAction were added to the DrugInformation Object Array on the response. These fields are populated with the same values as currently captured on the Transaction Items database table.
New Fields
The following new fields were added as part of this release:
|
Database |
Table |
Field |
Data Type |
Length |
|
Enrollment |
Groups |
CardholderIdSource |
tinyint |
|
|
Enrollment |
Members |
IgnoreDependentCutoffAgeChecks |
BIT |
|
|
Enrollment |
BillCalculatorRuleConfigs |
SellIngredientCostAdjustmentBaseType |
TINYINT |
|
|
Enrollment |
BillCalculatorRuleConfigs |
SellIngredientCostAdjustmentMacListId |
INT |
|
|
Enrollment |
BillCalculatorRuleConfigs |
SellIngredientCostAdjustmentPercent |
Decimal |
18,4 |
|
Tx |
Transactions |
SellIngredientCostAdjustmentTotal |
Decimal |
18,6 |
|
Tx |
TransactionItems |
SellIngredientCostAdjustment |
Decimal |
18,6 |
Bug Fixes and Minor Enhancements
The Bug Fixes and Minor Enhancements section of the Release Notes documentation is dedicated to existing functionality of the application that had an issue or received a minor update or improvement.
Claim Tab
Adjudication
• Fixed an issue where Compounds with an SCC 8 and at least one unknown NDC that were sent to the RxlClient External Adjudicators were rejecting for an 85. The unknown ingredient is now ignored due to SCC 8 and excluded from the pricing of the transaction. (32007)
Claim Processing
• Updated the Days Supply field to allow Blanks as it is an optional value on reversals. (32839)
Drug Tab
MAC Manager
• Fixed an issue that prevented the MAC List Clone from succeeding. (33039)
Formulary Manager
• Fixed an issue that prevented editing of a Formulary Program. (32833)
Rules & Calculators Tab
Bill Cost Calculator
• Fixed an issue where a group has a deductible along with a 100% copay would cause a transaction processed before the deductible is met to apply processing fees incorrectly to the member instead of the plan. This fix ensures the plan is properly charged per transaction while maintaining correct deductible and copay behavior. (30048)
Cost Calculator
• Resolved an issue where transactions were incorrectly returning reject code 92 when the cost calculator referenced a submitted value that was not included on the claim. The missing value is now ignored instead with no rejection. (31071)
Process Rules
• Fixed a filtering issue where the Wrap Processor rule group would not filter as expected on the Rules Library page. (32307)
Files and Jobs Tab
Job Manager
• The Medispan import and Medispan History Import processes were updated with extended timeouts to allow for more reliable operation on lower power Azure environments. (30898 / 31377)
• Network Rates Import - Resolved an issue where the job failed when multiple rows existed in the FieldReferences table with SegmentId = '07' and FieldId = 'D5'. This was an uncommon scenario where this option for Days Supply was listed more than once in Process Rules Dynamic Conditions. (32454)
Billing & Fee Mgmt Tab
Payables Manager
• Updated the Payables Dashboard to automatically refresh when returning from any step of the Payables wizard. (30113)
• Updated NACHA file generation to limit included payments to only ones set as ACH with a Pay To Media option of 835 or Both. (31484)
• Improved input validation of Bank Routing and Destination Bank Routing numbers on the Payables Organization screen to prevent entry of values that are below the minimum length or exceed the maximum length allowed for 835s. (32339 / 32368)
• Added the Payables Adjustment template to the Adjustment Mgmt tab. (32452)
• Fixed an issue where the Check Summary file (PDF or Excel) was omitting records with a Payment Type of Credit. Now all Check Summary formats, including the .txt include these records. The Payment Type field for all reports contains “CRD” for Credit records. (31171)
• Fixed an error where changing the status of a Payment to Voided in the Payables module was failing. (31404)
• Corrected the AdjustmentsApplied file to properly display multiple adjustments for the same PayTo when more than one applies to a batch. Adjustments are now listed accurately instead of repeating the same value. (31896)
• Removed a message at the bottom of pages where an API key and module were displayed. This was also removed from the Receivables application. (32281)
Receivables Manager
• Fixed an issue with Date of Service related filters on Step 2 of the process. (30177)
The HotFixes section includes both Enhancement and Bug related information applied to an earlier version after the publication of their Release Notes.
Adjudication
• 1.18.3.2 – Updated processing with the Capture All Rejects for Non Compounds option set to On to execute Network Process Rules even if a rejection has occurred prior to these rules. (32402)
• 1.18.3.2 – Updated processing with the Capture All Rejects for Non Compounds option set to On to properly use the Custom Reject code for Group Max Dollar rejections. (32496)
• 1.18.3.2 – Addressed an issue where a transaction for a member with terminated CH Elig but active Group Eligibility could result in a Paid transaction with a rejection code also returned if the plan uses the Capture All Rejects for Non Compounds setting. This was introduced in 1.18.3.2 and is now fixed to reject the transaction appropriately. (32877)
Paid Claim Lookup
• 1.18.3.2 – Fixed an issue that prevented the Pharmacy Payment Info from displaying on the Internal Details tab. (33036)
Claim Processing
• 1.18.2.2 – Changed behavior on screen to keep unknown NDCs in both the NDC, and Compound Product ID fields instead of replacing them with 0’s. (32003)
• 1.18.3.2 – Fixed an issue where both the Claim Processing and Transaction Detail screens experienced load issues if the user had a Group Restriction defined. (32447)
MPA Manager
• Fixed an issue where a User with a Group restriction could not create an MPA. (32884)
File Manager
• 1.18.3.2 - Fixed an issue where Zip file downloading was downloading an empty zip file. (32973)
• 1.18.3.2 – Fixed an issue where the File Manager would not load for a client if they had a completely empty file (no name or contents) at their blob storage root. (33141)
Job Manager
• 1.18.3.2 Claim Reprocessing – Increased timeout on Job to allow for better handling of larger files. (32879)
Invoice Manager
• 1.18.3.2 - Fixed an issue where the Refund Via Check and Reassign Payment options were blocked by a “You Must Enter an Invoice From Id” error. (33062 / 33075)
• 1.18.3.2 – Fixed an issue where applying balances from one invoice to another was causing a Ref Number error. (33179)
Ticket Tracker
• 1.18.3.2 – Fixed an issue where a user with a Group restriction could not see Ticket Tracker information. (32966)
• 1.18.3.2 – Resolved a configuration issue that prevented Ticket Tracker emails from being sent for some clients. (33064)
ApiKey Management
- 1.18.3.2 – Fixed the API Cache Refresh button to properly refresh instead of hanging the screen. (33121)
Knowledge Center
- 1.18.3.2 – Fixed an issue where the Knowledge Center option was not visible in some environments. (32776)
Process Transaction
- 1.18.3.2 – Fixed an issue where a “PayToId Submitted Without PayToType” error was returned if both the PayToType and PayToId fields were omitted. The endpoint now allows submission without either of these fields. (32453)
Pricing Request
- 1.18.3.2 – Fixed an issue where URL Encoded Pricing Requests were receiving an HTTP 415 Unsupported Media Type error. (33061)
Member Summary
- 1.18.3.2 – Fixed an issue where URL Encoded Pricing Requests were receiving an HTTP 415 Unsupported Media Type error for the MemberSummary and MemberSummary/Search endpoints. (33065)