Pharmacy Point of Sale Version D.0 Patch 42
Pharmacy Point of Sale Version D.0 Patch 42. Training Objectives Review Patch 42 changesReview Advance Setup of Insurer (ADV) optionNew security key for.
Mar 28, 2015
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Pharmacy Point of SaleVersion D.0 Patch 42
Training Objectives
Review Patch 42 changes
Review Advance Setup of Insurer (ADV) option
New security key for ADV option
How to add a new insurer using Quick Setup of Insurer (INS)
Review Summary of Insurers (SUMI) Report
How to change Insurers to D.0
IntroductionThe major help desk request for Pharmacy Point of Sale was the need
for a new format or a modification to the format. Often times a delay in the release of a patch with these changes would takes months and this would result in loss in revenue for many sites.
In patch 42, we have done away with formats and have provided
direct access to the user to make changes to BIN, PCN and NCPDP segments immediately. Once patch 42 is installed, the format layout will be moved to the ABSP insurer file. All insurers currently setup at each site will run a background conversion and user should not have to make any changes to the current layout.
Also included in patch 42 is the NCPDP version D.0 which goes into effect January 1, 2012. We have tested many top insurers such as Argus, Medco and Caremark among others. Users will have to change the version to D.0 for insurers that are ready to accept claims and for those insurers D.0 testing has been completed.
• Version D.0 is the new version of the National Council for Prescription Drug programs (NCPDP) standards for pharmacy transactions that replaces version 5.1.
• The mandatory compliance date for Version D.0 is January 1, 2012.
What is D.0?
• NCPDP version D.0• No more formats to link to insurers• Advance Insurer setup option allows edits by user• Quick and Advance Insurer setup creates a default layout based on insurer type
• New security key for ADV option• SUMI report sorts by 5.1 and D.0 version
Highlights of Patch 42
• User input needed for the following fields:• NCPDP VERSION: D.0//• BIN NUMBER: 610100//• PCN NUMBER: MEDDPRIME//• RX - Dispensing Fee:• GRACE PERIOD: 0//• RX - Help Telephone #: (888)888-8888//
• Default set for the following fields:Add Disp. Fee to Ingr. Cost: NO//*Contract Required: NO//Total exclusive of Patient Amt: N//INSURER NPI FLAG: BOTH//RX - DIAL OUT TO: ENVOY DIRECT VIA T1 LINE//RX - PRICING METHOD: STANDARD//
Advance Setup of Insurer - ADV
• MEDICARE
• MEDICARE PARTD?: Y//
• Maximum RX's Per Claim: 1//
• RX PRIORITY: 650//
• NCPDP FIELD SPECIAL CODE:
• 304, 436, 455
• MEDICAID
• MEDICARE PARTD?: N//
• Maximum RX's Per Claim: 4//
• RX PRIORITY: 5//
• NCPDP FIELD SPECIAL CODE:
• 304, 436, 455
• PRIVATE
• MEDICARE PARTD?: N//
• Maximum RX's Per Claim: 4//
• RX PRIORITY: 20//
• NCPDP FIELD SPECIAL CODE:
• 436, 455
Default for type of insurer
SUPPRESS NCPDP FIELD:115, 147, 334, 350, 354, 357, 359, 360, 361, 364, 365, 366, 367, 368, 384, 391, 420, 458, 459, 494, 495, 496, 497, 498, 499, 524, 995, 996, 997
ADV – Security Key
• ABSPZ INSURER
• NOTE: With more control, there is also concern for problems for unnecessary changes to insurer setup. A security key (ABSPZ INSURER) has been assigned to the ADV option. It is recommended the security key be allocated only to a supervisor or super user of Point of Sale. Please see your local IT person to have this key assigned to you.
Are you adding 'D-ARGUS' as a new ABSP INSURER (the 190TH)? No// Y (Yes)
NCPDP VERSION: D.0
BIN NUMBER: 123456
PCN NUMBER: TEST123
MEDICARE PARTD?: Y//
Maximum RX's Per Claim: 1//
Select the PRICING METHOD
RX - PRICING METHOD: STANDARD//
NOTE: It is recommended to use this option when setting up a new insurer before any changes are made in the Advanced Insurer Setup Option
POS - Pharmacy Point of Sale MGR - Pharmacy POS Manager Menu SET - Pharmacy Point of Sale Setup Menu INS - Edit Pharmacy POS Insurance settings INS - Quick setup of insurer
Quick Setup of Insurer - INS
NAME: D-ARGUS//
TYPE OF INSURER: PRIVATE// ??
Choose from:D MEDICAID FIP PRIVATEMD MCR PART D
TYPE OF INSURER: PRIVATE// MD MCR PART D
LONG NAME: D-ARGUS//STREET: P.O. BOX 298CITY: TROYSTATE: NEW YORK//ZIP: 12181//PHONE: (888)888-8881
REG - Patient registration TM - Table Maintenance Menu INS - Insurer File Menu EINS - Add/Edit an Insurer
Adding A New Insurer
POS - Pharmacy Point of Sale MGR - Pharmacy POS Manager Menu SET - Pharmacy Point of Sale Setup Menu SUMI - POS Setup - Summary of Insurers
Summary of Insurers – SUMI
PHARMACY ELECTRONIC CLAIMS INSURERS NOV 17,2011 16:51 PAGE 1
Grace Ins.
Disp Fee Per Sel.
Insurer Pricing Formula Override Override Pts.
--------------------------------------------------------------------------------
----- Using NCPDP VERSION: 5.1
BIN: 123456
NPI FLAG: BOTH
D-RX AMERICA STANDARD 4.50 0 650.00
BIN: 600428
NPI FLAG: BOTH
GROUP HEALTH RX STANDARD 4.50 0 20.00
WESTERN RX STANDARD 4.50 0 20.00
LOVELACE SALUD RX STANDARD 4.50 0 5.00
NPI FLAG: EMPTY
----- Using NCPDP VERSION: D.0
BIN: 123221
NPI FLAG: BOTH
CXX PRIVATE D.O STANDARD 20.00
BIN: 123321
NPI FLAG: BOTH
XYZ MEDICAID D.0 STANDARD 5.00
• 1. Run Fileman Report of all insurers/BIN/PCN• 2. Completed D.0 testing payer list• 3. Print list of NCPDP fields• 4. Caremark, Medco, Argus setup examples• 5. Common rejections• 6. Suppress/un-suppress NCPDP fields
D.0 checklist
OUTPUT FROM WHAT FILE: ABSP INSURER//
SORT BY: NUMBER// RX - NCPDP Record Format
START WITH RX - NCPDP Record Format: FIRST//
WITHIN RX - NCPDP Record Format, SORT BY:
FIRST PRINT FIELD: NAME;C1;L30;""
THEN PRINT FIELD: "^";C31;L1
THEN PRINT FIELD: RX - NCPDP Record Format;C32;L30;""
THEN PRINT FIELD: RX - NCPDP Record Format: <- DO NOT FORGET TO USE A COLON TO WALK OVER TO FORMAT FILE
THEN PRINT ABSP NCPDP FORMATS FIELD: "^";C62;L1
THEN PRINT ABSP NCPDP FORMATS FIELD: NDC BIN Number;C63;L15;""
THEN PRINT ABSP NCPDP FORMATS FIELD: "^";C78;L1
THEN PRINT ABSP NCPDP FORMATS FIELD: Processor Control Number;C79;L20;''
THEN PRINT ABSP NCPDP FORMATS FIELD:
THEN PRINT FIELD:
Heading (S/C)://
STORE PRINT LOGIC IN TEMPLATE:
DEVICE: ;132;5000
List of Insurers that are associated with formats
Fileman Report
File Man Report - Example• ABSP INSURER LIST DEC 15,2011 11:13 PAGE 1• Processor Control Number• ------------------------------------------------------------------------------------------------• RX NC SENIOR CARE PROGRAM ^ACS NC SENIOR CARE 5.1 ^610084 ^• RX D-SILVERSCRIPT ^ADV RX MGT MEDICARE PDP 5.1 ^004336 ^ADV HDN• RX ADVANCE RX ^ADVANCE PRSCPT MGMT ADV 5.1 ^004336 ^ADV HDN• D-SILVER SCRIPT ^ADVANCE PRSCPT MGMT ADV 5.1 ^004336 ^ADV HDN• RX AETNA US PHARMACY ^AETNA 5.1 ^610502 ^670000• RX ANTHEM ^ALASKA NATIVE TRIBAL HLTH 5.1 ^004336 ^WISRX• MAILHANDLERS ^ALTA RX 5.1 ^002286 ^6000002286• ALTA RX ^ALTA RX 5.1 ^002286 ^6000002286• PHARMANET RX ^ALTA RX 5.1 ^002286 ^6000002286• RX AMERICAN HEALTH CARE ^AMERICAN HEALTH CARE 5.1 ^610118 ^AHC TQC• RX D-CMS DUAL ^ANTHEM 5.1 ^610575 ^• RX AMERIHEALTH MERCY ^ARGUS REGENCE BCBS WA 5.1 ^600428 ^• ARGUS RX ^ARGUS REGENCE BCBS WA 5.1 ^600428 ^• D-BC/BS OF NORTH DAKOTA ^BC/BS NORTH DAKOTA 5.1 ^610455 ^NDBCS• RX BLUESCRIPT ^BLUESCRIPT BCBS ILLINOIS 5.1 ^011552 ^ILSC• MEDICAID-TEST ^CALIFORNIA MED-CAL 5.1 ^610442 ^NONE• RX CAREFIRST ^CAREFIRST BCBS 5.1 ^011834 ^03000000• CAREMARK D.0 447225 ^CAREMARK 5.1 ^610029 ^CRK• RX D-ADVANTRA RX ^CAREMARK 5.1 ^610029 ^CRK• HAMMERMILL HEALTH ^CAREMARK 5.1 ^610029 ^CRK
ftp://ftp.ihs.gov/rpms/POS/
D.0 Payer Implementation List
Argus Payer Tab
• NCPDP• FIELD• NUMBER NCPDP FIELD NAME• --------------------------------------------------------------------------------• 101 BIN NUMBER• 102 VERSION/RELEASE NUMBER• 103 TRANSACTION CODE• 104 PROCESSOR CONTROL NUMBER• 109 Transaction Count• 110 Software Vendor/Cert ID• 111 Segment Identification• 112 Transaction Response Status• 113 MEDICAID PAID AMOUNT• 114 MEDICAID SUBROGATION ICN• 115 MEDICAID ID NUMBER• 116 MEDICAID AGENCY NUMBER• 117 BILLING ENTITY TYPE IND• 118 PAY TO QUALIFIER
POS-Pharmacy Point of Sale RPT-Pharmacy electronic claims reports OTH-Other reports FLD-List NCPDP Fields
List of NCPDP fields
Caremark D.0 setupSelect Edit Pharmacy POS Insurance settings Option: ADV Advanced setup of
insurer
Select ABSP INSURER NAME: CAREMARK( CAREMARK )....
NAME: RX D-CAREMARK//NCPDP VERSION: 5.1// D.0 BIN NUMBER: 610029//PCN NUMBER: CRK//
Select NCPDP FIELD SPECIAL CODE: 455// 110 Software Vendor/Cert ID
SPECIAL CODE: S ABSP("X")=“D012000084"
Argus D.0 SetupSelect Edit Pharmacy POS Insurance settings Option: ADV Advanced setup of
insurer
Select ABSP INSURER NAME: ARGUS( ARGUS )...
NAME: ARGUS RX//
NCPDP VERSION: 5.1// D.0
BIN NUMBER: 600428//
PCN NUMBER: 03020000
Select NCPDP FIELD SPECIAL CODE: 455// 110 Software Vendor/Cert ID
SPECIAL CODE: S ABSP("X")="601DN30Y"
Medco D.0 SetupSelect Edit Pharmacy POS Insurance settings Option: adv Advanced setup of
insurer
Select ABSP INSURER NAME: medco( MEDCO/MEDCOST )......
NAME: MEDCO RX//
NCPDP VERSION: 5.1// D.0
BIN NUMBER: 003585//
PCN NUMBER: 49110//
Select NCPDP FIELD SPECIAL CODE: 455// 110 Software Vendor/Cert ID
SPECIAL CODE: S ABSP("X")="INF"
M/I Gross Amount DueUnsuppress Field 430
Value In Gross Amount Due Does Not Follow Pricing FormularyUnsuppress field 412
M/I Patient Last NameUnsuppress field 311
M/I Cardholder IDUnsuppress field 313
Express Scripts – TricareGroup Number change from TRRX to DODA
Correcting the top 5 rejectionsCorrecting Rejections
Example Rejection
- - Prescription - -Authorization Number: 113145297006024999Medication Order: 1Prescription/Service Ref Num: 815214Prescription/Srvc Ref Num Qual: 1Prior Auth Processed Date: NOV 10,2011Reject code: 20 M/I Cardholder Last NameReject Count:1Response Status (Prescription): RTransaction Response Status: REJECTED CLAIM
Suppressed – The NCPDP field is not going across on the claim
Unsuppressed – The NCPDP field will cross over on the claim
Suppressed vs. UnsuppressedDefinitions
Unsuppress NCPDP Fields
Select SUPPRESS NCPDP SEGMENT: Narrative//
Select SUPPRESS NCPDP FIELD: 997// 313 CARDHOLDER LAST NAME
...OK? Yes// Y (Yes)
SUPPRESS NCPDP FIELD: 313// @
SURE YOU WANT TO DELETE THE ENTIRE SUPPRESS NCPDP FIELD? Y (Yes)
Select SUPPRESS NCPDP FIELD:
Note: Anytime a field is unsuppressed use the option NEW to resubmit your claim
POS - Pharmacy Point of Sale MGR - Pharmacy POS Manager Menu SET - Pharmacy Point of Sale Setup Menu INS - Edit Pharmacy POS Insurance settings RPMS - Enter/edit RPMS Insurance file RX settings
Enter/Edit RPMS Insurance File Rx Settings
Select INSURER NAME: D-ARGUS NEW YORK 12181 ...OK? Yes// Yes
RX BILLING STATUS: ??
These codes identify how to process pharmacy charges for a payer.
Code "U" means drugs are not billable. Code "O" means only outpatient drugs are billable. Code "P" means the drugs are billable through Point Of Sale.
Choose from:
U UNBILLABLE O OUTPATIENT DRUGS ONLY P BILLED POINT OF SALE
RX BILLING STATUS: BILLED POINT OF SALE
Three Tiered Support Structure
Help Desk
Area IT Support
Local Support
Phone: 888-830-7280E-mail:
Questions
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