Documentation

Overview

Solstice Accrue is infrastructure that bridges transparent pharmacies (Cost Plus, Amazon Pharmacy, GoodRx) with TPAs and carriers. When patients purchase medications from transparent pharmacies, Accrue ensures those purchases count toward their annual deductible and out-of-pocket maximum.

The Problem We Solve

When patients buy from transparent pharmacies, PBMs classify these as "cash pay" and exclude them from benefit accumulators. A $20 drug at Cost Plus becomes economically irrational if it doesn't reduce the patient's $3,000 deductible.

Accrue solves this by translating transparent pharmacy receipts into standard EDI 837P claims and submitting them to TPAs for accumulator credit.

Quick Start

Get up and running with Accrue in minutes.

1. Get API Credentials

Contact us to receive your API key and configure your employer/TPA settings.

2. Submit a Test Transaction

curl -X POST https://api.solsticeaccrue.com/v1/transactions \
  -H "Authorization: Bearer YOUR_API_KEY" \
  -H "Content-Type: application/json" \
  -d '{
    "source": "costplus",
    "source_transaction_id": "CP-2025-123456",
    "ndc": "00093-7212-01",
    "drug_name": "Metformin HCL 500mg",
    "quantity": 90,
    "days_supply": 90,
    "fill_date": "2025-12-20",
    "patient_paid": 12.50,
    "pharmacy_name": "Cost Plus Drugs",
    "patient_first_name": "John",
    "patient_last_name": "Doe",
    "patient_dob": "1985-03-15",
    "group_number": "GRP12345"
  }'

3. Check Transaction Status

curl https://api.solsticeaccrue.com/v1/transactions/txn_abc123 \
  -H "Authorization: Bearer YOUR_API_KEY"

Architecture

Accrue sits between transparent pharmacies and TPAs/carriers, handling the translation and submission of accumulator credit requests.

Processing Pipeline

1. Ingest — Receive transaction from pharmacy API, webhook, or manual upload
2. Validate — Verify NDC format, check pricing against benchmarks
3. Match — Find enrolled member by name, DOB, and group number
4. Translate — Generate ANSI X12 837P professional claim with accumulator flags
5. Submit — Send to TPA via direct integration or clearinghouse
6. Reconcile — Parse 835 response and confirm accumulator credit

For Employers

Self-insured employers can enable Accrue to ensure transparent pharmacy purchases count toward employee deductibles.

Requirements

• Self-insured health plan
• TPA with Accrue integration (or willingness to accept EDI claims)
• Plan document amendment recognizing transparent pharmacy purchases

Plan Document Language

Your plan document should include language similar to:

// Sample Amendment Language

"Covered Pharmacy Expenses shall include purchases from
Transparent Pharmacy Providers, defined as pharmacies
operating on a cost-plus or transparent pricing model,
including but not limited to Cost Plus Drugs, Amazon
Pharmacy, and similar providers.

Such purchases shall be credited toward the Member's
Annual Deductible and Out-of-Pocket Maximum upon
submission of valid claim documentation through the
Plan's designated accumulator integration service."

Employer Dashboard

Track transparent pharmacy adoption, savings, and accumulator credits across your workforce:

• Transaction volume and status
• Total accumulator credits submitted/confirmed
• Savings vs. PBM benchmark pricing
• Member adoption metrics

For TPAs

TPAs can accept Accrue claims through standard EDI channels or direct API integration.

Integration Options

Claim Processing

Accrue claims arrive as standard 837P professional claims with specific flags indicating accumulator-only processing:

• No payment is requested (patient paid at point of sale)
• NTE segment contains ACCUMULATOR_CREDIT_REQUEST
• Patient responsibility = $0
• Accumulator credit amount = patient paid amount

For Pharmacies

Transparent pharmacies can integrate with Accrue to automatically route transactions for accumulator credit.

Integration Methods

• Webhook — Push order completion events to Accrue endpoint
• API Pull — Accrue polls your order API for new transactions
• Batch File — Daily SFTP upload of completed orders

Required Data

Transaction Flow

Understanding the lifecycle of an Accrue transaction.

Transaction States

EDI 837P Claims

Accrue generates ANSI X12 837P Professional Claims formatted for accumulator credit requests.

Key Segments

• CLM — Claim information with patient control number
• NTE — Note segment with ACCUMULATOR_CREDIT_REQUEST flag
• SV1 — Service line with NDC and patient paid amount
• DTP — Service date (fill date)

Webhooks

Subscribe to real-time notifications for transaction status changes.

Available Events

Webhook Payload

{
  "event": "accumulator.credited",
  "timestamp": "2025-12-20T14:30:00Z",
  "data": {
    "transaction_id": "txn_abc123",
    "member_id": "MEM001234",
    "deductible_credited": 12.50,
    "oop_credited": 12.50
  }
}

Data Models

Core data structures used throughout the Accrue system.

Transaction

{
  "id": "txn_abc123",
  "source": "costplus",
  "status": "credited",
  "ndc11": "00093721201",
  "drug_name": "Metformin HCL 500mg",
  "quantity": 90,
  "days_supply": 90,
  "fill_date": "2025-12-20",
  "patient_paid": 12.50,
  "member_id": "MEM001234",
  "deductible_credited": 12.50,
  "oop_credited": 12.50,
  "confidence_score": 95,
  "created_at": "2025-12-20T10:30:00Z"
}

Member Accumulator

{
  "member_id": "MEM001234",
  "plan_year": 2025,
  "deductible_limit": 3000.00,
  "deductible_met": 1560.00,
  "deductible_remaining": 1440.00,
  "oop_limit": 6000.00,
  "oop_met": 1560.00,
  "oop_remaining": 4440.00,
  "pending_amount": 25.00
}

Error Codes

Common error codes and their meanings.