POC Network Technologies (TransactRx)

What POC Network Technologies (TransactRx) does

POC Network Technologies, Inc., doing business as TransactRx, is a privately held healthcare technology company founded in 2007 and headquartered in Spartanburg, South Carolina. The company operates a cloud-based transaction platform that solves the cross-benefit billing problem in U.S. healthcare — the structural mismatch between pharmacy claims (NCPDP D.0) and medical claims (X12 837) — by converting and routing claims across benefit types in real time. Its patented Cross-Benefit Clearinghouse connects medical and pharmacy transaction processing, enabling medical providers to bill under pharmacy benefits and pharmacy providers to bill under medical benefits, supported by a REST API for eligibility and claims endpoints and HL7 clinical data interconnectivity.

TransactRx's product portfolio centers on Medicare Part D and Part B vaccine billing (Part D Vaccine Manager, Medicare Part B Billing Software), pharmacy medical billing for retail pharmacies, public health department billing across Medicare/Medicaid/VFC/commercial payers, a pharmacy claim adjudication platform with the DiscountRx service, and the SpecialtyXB solution for shifting specialty drug coverage between benefit types. The company distributes primarily through a self-service web portal (myTransactRx.com) where providers enroll, complete credentialing in under 48 hours, and begin submitting claims, supplemented by online demos and inside-sales support. Pricing is transaction-based with low per-claim fees bundled into displayed reimbursement rates, no monthly platform fees, and a low one-time setup fee.

The company runs a national provider network of 40,000+ contracted medical providers across 15,000+ practice locations in all 50 states, with payer contracts covering over 90% of Medicare Part D covered lives. The platform is built on Amazon AWS with micro-service architecture deployed as redundant clusters across multiple data centers, sustaining throughput of over 1,000 transactions per second. To date, the company has facilitated reimbursement for over 500,000 patients and reports a near-100% claims payment rate among enrolled providers. Leadership consists of Jack Guinan (CEO) and Richard A. Wolpow (Founder); no institutional funding rounds, M&A, or public-market events are disclosed in the source material.

Name

POC Network Technologies (TransactRx)

Legal name

POC Network Technologies, Inc.

Website

https://transactrx.com

Company type

Private

Founded year

2007

Operating status

Operating

Headcount range

11–50 employees

Short description

TransactRx operates a patented cloud-based cross-benefit clearinghouse that converts between pharmacy (NCPDP) and medical (X12) claims, enabling physician offices, health departments, pharmacies, and payers to bill vaccines and specialty drugs across Medicare Part D, Part B, Medicaid, and commercial benefit types in the U.S.

Ownership category

akta.pro rank

Product category

Healthcare Claims Processing Platform

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

akta.pro primary industry

Claims Management, Scrubbing & Clearinghouse (HLACACAB)

akta.pro secondary industry

PBM Technology Platforms (ePA/eRx/Real-Time Benefit Tools) (HLAEAKAL)

Keywords

• Healthcare claims processing
• Medical billing software
• Pharmacy benefit management
• Cross-benefit clearinghouse
• Vaccine billing platform

Headquarters

HQ city

Miami

HQ country

Colombia

HQ region

Latin America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

Technology or R&D, Personnel, Operations, Infrastructure, Marketing or Sales

Revenue model

1. Transaction-Based Claim Processing: Low per-claim transaction-based pricing with claim transmission fees included in the reimbursement to providers. Claim transmission fees are calculated into vaccine reimbursement rates displayed in the portal.
2. One-Time Setup Fee: Low one-time setup fee for healthcare billing solutions with no monthly fees. Provides cost-effective entry point for health departments and medical providers.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels4 records

Core offering

TransactRx operates a patented cloud-based Cross-Benefit Clearinghouse that converts between NCPDP D.0 pharmacy claims and X12 837 medical claims in real time, enabling physician offices, pharmacies, and public health departments to bill Medicare Part D, Medicare Part B, Medicaid, VFC, and commercial payers for vaccines and medical services. The platform supports eligibility verification, claims submission, adjudication, and reimbursement management across both medical and pharmacy benefit types through web portals and a REST API.

Product overview

TransactRx offers a unified platform of healthcare billing solutions for vaccine and medical service reimbursement across medical and pharmacy benefit types. The core offerings include Part D Vaccine Manager for Medicare Part D vaccine billing, Medicare Part B Billing Software, the patented Cross Benefit Clearinghouse platform for seamless integration of pharmacy and medical claims standards (NCPDP D.0 and X12 837), SpecialtyXB for specialty drug benefit management, and Pharmacy Claim Adjudication Platform with DiscountRx service. Additional services include Pharmacy Medical Billing for retail pharmacies, Public Health Department Billing solutions, and provider networks (Part D Provider Network and National Immunization Network) that together encompass over 40,000 contracted providers across 15,000+ practice locations.

Differentiator

Problem solved

Functional benefit

Brands

• SpecialtyXB: Innovative Cross-Benefit solution for moving coverage of medical provider administered specialty drugs from the medical benefit to the pharmacy benefit.
• DiscountRx
• Part D Vaccine Manager

Products and services

• Part D Vaccine Manager Web-based Medicare Part D billing system that enables healthcare providers such as physician offices, health departments, visiting nurses, and urgent care centers to bill for Part D-covered vaccines. The product checks patient Part D plan eligibility, identifies the correct plan to bill, calculates patient financial responsibility, and submits real-time claims before vaccine administration.
• Medicare Part B Billing Software Web-based Medicare Part B claims submission software for public health departments, visiting nurses, shot clinics, and healthcare organizations administering vaccines. Automates the billing process and provides eligibility verification and payment tracking.
• Cross Benefit Clearinghouse Patented cloud-based transaction platform that seamlessly integrates X12 batch and real-time medical claims infrastructure with NCPDP real-time pharmacy claims infrastructure and HL7 clinical data interconnectivity. Supports cross-benefit transaction processing at speeds of over 1,000 transactions per second and enables bidirectional conversion between NCPDP D.0 pharmacy claims and X12 837 medical claims.
• SpecialtyXB Innovative cross-benefit solution that manages specialty drug costs by shifting coverage of medical provider-administered specialty drugs from the medical benefit to the pharmacy benefit across all places of service.
• Pharmacy Claim Adjudication Platform Cloud-based platform for adjudicating pharmacy and medical claims according to plan designs and program-specific rules, enabling healthcare entities such as Discount Rx Card companies, Copay Assistance Programs, and Private Label PBMs to control claims processing without outsourcing to a PBM.
• DiscountRx Prescription processing and adjudication service with flexible plan design options enabling pharmacy chains or discount Rx program providers to operate their own prescription discount programs.
• Pharmacy Medical Billing Services Medical insurance billing solutions for pharmacies enabling claims submission for vaccines, wellness services, and medical services using NCPDP D.0 format through the Cross Benefit Clearinghouse, allowing pharmacies to bill Medicare Part B, Medicaid, and commercial payers.
• Public Health Department Billing Complete web-based billing solution for health departments to bill for pediatric and adult vaccines and healthcare services across Medicare Part B, Medicare Part D, Medicaid, Medicaid VFC, and commercial payers.
• Part D Provider Network National provider network enabling medical providers to submit claims to contracted Medicare Part D plans representing over 90% of all Part D covered lives across all 50 states.
• National Immunization Network National provider network of pharmacies, public/community health centers, shot clinics, visiting nurse associations, and other non-medical office healthcare providers for administering immunizations to members of contracted payers.
• Eligibility and Claim REST API REST API with a large number of endpoints supporting both pharmacy and medical eligibility and claims submission. Eligibility includes Medicare Part D and Medicare Part B, enabling real-time eligibility verification and claims processing.

Quantifiable outcome

• Claims payment rate near 100%
• +2 more outcomes

Named customers5 records

Segments5 records

Ideal customer profiles5 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Partnerships

One partnership is on record.

• Amazon AWScore infrastructureTechnology or IntegrationCloud infrastructure provider hosting the TransactRx platform. Uses dynamically provisioned server instances enabling extreme scalability. Platform deployed as redundant clusters across multiple data centers ensuring 100% uptime.

Scale indicators8 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Waystar: Healthcare revenue cycle management platform providing claims management, eligibility verification, and remittance for providers — overlaps with TransactRx's eligibility/claims workflows but as part of a broader RCM suite.
• Availity: Large multi-payer healthcare clearinghouse that processes eligibility, claims, and prior authorization transactions between providers and health plans — overlapping TransactRx's clearinghouse function but at a much broader scope and payer roster.
• Change Healthcare (Optum): One of the largest U.S. medical and pharmacy clearinghouses, handling eligibility, claims, and remittance across X12 and NCPDP rails — directly competes with TransactRx's claims-routing and clearinghouse capability from a much larger footprint.
• Trizetto (Cognizant): Cognizant's healthcare claims management and payer-side benefits administration platform handling X12 medical claims and benefits processing — broad incumbent that competes with TransactRx in the claims-management/clearinghouse space.
• SSI Group: Healthcare clearinghouse providing claims management, eligibility verification, and remittance services across multiple payer connections — competes with TransactRx's clearinghouse role with a broader enterprise customer base.

Direct peers

• CoverMyMeds (McKesson): McKesson-owned prior authorization and real-time benefit tools platform that connects providers, pharmacies, and payers for electronic prior authorization and benefit verification — directly overlapping TransactRx's eligibility/real-time benefit tooling for pharmacy and medical claims.
• Surescripts: Operates the dominant ePrescribing network connecting clinicians, pharmacies, payers, and PBMs, processing both NCPDP pharmacy transactions and clinical benefit information — directly analogous to TransactRx's NCPDP/X12 routing role at network scale.
• Office Ally: Healthcare clearinghouse providing EDI claims submission, eligibility verification, and remittance for physician offices and other providers — directly comparable clearinghouse functionality for the same SMB provider base TransactRx targets.
• RxBenefits: Pharmacy benefit administrator focused on employer and health-plan clients, operating PBM-adjacent technology and benefit administration services — comparable PBM-technology positioning to TransactRx's pharmacy benefit claim processing tools.
• DoseSpot: ePrescribing platform integrated into EHRs and pharmacy systems that handles NCPDP-based prescription routing and real-time benefit checks — closely comparable to TransactRx's real-time benefit tooling and ePrescribing-adjacent workflows.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/transactrx
• Facebookfacebook.com/TransactRx

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about POC Network Technologies (TransactRx)