19.1.36 NRx Enhancements

Divided incoming and outgoing eRx Messages into separate tasks to improve the speed in which eRx messages are sent and received. Stores that process high volumes of eRxs will especially see reduced time receiving electronic messages, sending RxFill Messages, and processing Verify Messages and other electronic requests. No changes to screens or process steps.

 

To ensure state and federal guidelines are being met when filling C2 prescriptions written by mid-level practitioners, added an Override Req to disp C2 meds field to the Prescriber Record. Default = Unchecked. If selected and an NP/PA, NP, or PA attempts a fill on a C2 prescription, a message displays.

 

The field works with and is activated by the following setup:

 

• NP/PA, NP, or PA must be selected in the NP/PA field
  

• 2 must be selected in the Auth for Schedule field
  

• The Doctor Required for NP/PA, NP, and PA field is not selected in Store Options > Rx Filling

 

Added the Override Req to disp C2 meds field to the Prescriber Record when using Batch Record Updates.

The system now automatically checks the PRN field for electronic NewRx prescriptions when there is a Refill Quantity of 99 and a Qualifier of R. Note: The New Script (2017071) Format field in Store Options > Rx Filling must be turned on.

 

Updated the system to send a 99 as the refill value (DRU-060-02) and R for the qualifier (DRU-060-01) in the RxFill Message when entering non-electronic PRN prescriptions and the order is profiled or filled.

 

If neither the Store Level Option or Facility Record associated with the patient are enabled for 2017071, a qualifier of P is sent as it was previously.

Larger files in your system including Electronic Prescription, Transaction, Transaction Billing History, and Prescription can now be rebuilt without requiring your server to be down. This allows your pharmacy to continue operation with no interruption and alleviates any need to schedule extra time after hours for this particular maintenance.

 

Added the following for the ability to print refill records one per page on the Transfer Form to comply with legal and regulatory state requirements.

 

Store Control

 

Added a Transfers: 1 Rx per Page with Fill History option to Store Control > Store Level Options > Store Options > Rx Processing. Default = Unchecked. If selected, the new Print or Fax 1 Prescription per Page option on the Patient Record (below) defaults to checked.

 

Patient

 

Added a Print or Fax 1 Prescription per Page option to Patient Record > Rx Profile > Transfer Prescriptions to Another Pharmacy > Enter Pharmacy Information > Select Prescriptions > Transfer > Transfer and Print or Fax Details. If selected along with either the Print Transfer Detail or Fax Transfer Detail options, only one prescription per page will print or be faxed on the Prescription Transfer Details printout/fax.

 

Prescription

 

Added a Fill History option to Rx Summary > Transfer Information > Outgoing > Enter Required Information > Transfer > Transfer and Print or Fax Detail > Print Transfer Details.

 

Transfer Form Printout/Fax

 

If Print or Fax 1 Prescription per Page is turned on and printing/faxing the Transfer Form from the Patient or Rx Summary, the Fill History (active transactions) prints at the bottom of the form with as many fills that will fit on the page. Details pull from the following:

• Date Filled: Prints the date from the Transaction > General Information > Date Filled. Format: MM/DD/YYYY
  

• QTY Disp: Prints the Quantity from the Transaction > General Information > Quantity Dispensed. Maximum: Up to ten digits.
  

• QTY REM: Prints the Remaining Quantity from the Transaction > General Information > Refills Remaining. Maximum: Up to ten digits.
  

• Refill REM: Prints from Transaction > General Information > Refills Remaining. Maximum: Up to three digits.

 

Added HME Documentation functionality to the system for OmniSYS (CareCLAIM).

 

Setup

 

• Must be authorized for HME Documentation module.
  

• Enhanced printing must be used to print PHOs.
  

• The printer to be used for HME Documentation must be indicated in the Default Printer Selection.
  

• The NCPDP and NPI must be entered in Store Control > Identification. If your store has a different NPI for DME, enter the DME NPI on the Price Plan.
  

• Price Plan: ANSI Bin # - 004303 (OmnySIS):
  

• Test ANSI Bin # - 880151 and Group - D0PAID (OmnySIS)
  

• PCN - TELE (OmnySIS)
  

• Click here for Change Health/Allwin ANSI Bin # and PCN information. Note: HME Documentation functionality for Allwin was already available previous to Service Pack 36.
  

  Change Health/Allwin:

  • ANSI Bin - 004766
  • PCN - USMCA
  • Assigned claims unless affected by Deductible Tracking Service.
  • Unassigned claims unless for a dually eligible Medicaid payment, patient has supplement insurance, or drug is billed.
  • PCN - USMCAASG
  • Claims process as assigned with any reimbursement sent to the pharmacy.
  • PCN - USMCANON
  • Claims process as unassigned with any reimbursement sent to the patient.
  • PCN - USNONCOVER
  • Disables all policy edits. For use when a denial is necessary.
  • PCN - USFLU
  • Used for flu shot claims.

• Delayed Label must be turned on.
  

• Drug Option:
  

• 2 - NDC - Used by most pharmacies for diabetic and Medicare Part B drug billing.
  

• 5 - NDC and State Code - Used when NDC and procedure code are required for billing.
  

• 6 - State Code and Procedure Code - Used when an item does not have an NDC.
  

• 7 - NDC and Procedure Code - Transmits NDC and modifier from the Procedure Code field.
  

• Send Patient Address, City, State, and Zip options must be turned on.
  

• Send Diagnosis must be turned on.
  

• Drug Record > General Information:
  

• Complete the State Code field with the Procedure Code and select 09 - HCPCS as the qualifier if needed.
  

• Complete the Procedure Code field with modifiers if necessary.
  

• Drug Record > Additional Information:
  

• Update the HME Documentation section with the brand and model if needed.
  

• Select the Physician Order to be printed for the drug/supply. If the Physician Order Code is Vaccine, then the Transaction is not marked as HME Doc and no documentation prints (OmnySIS only).
  

• Patient Record > Insurance Information for Price Plan:
  

• Policy Number
  

• Person Code
  

• Relationship to Cardholder
  

• Group - MEDIGAP if the patient has secondary insurance. This returns a zero copay.
  

• Tickler or Workflow is used to print the documentation.

 

Drug Record - New Physician Order Code (POC) Option

 

Added a Vaccine option to the Physician Order Code drop-down list on the Drug Record > Additional Information screen.  If the Physician Order Code is Vaccine, then the Transaction is not marked as HME Doc and no documentation prints (OmnySIS only).

 

How it Works

 

If a prescription is processed for OmniSYS (CareCLAIM), the Transaction is marked as an HME Documentation claim if the following criteria is met:

• System is authorized for the HME Documentation module
  

• Claim has received a paid response
  

• Third party is OmniSYS (BIN 004303, PCN TELE)
  

• POC is NOT set to Vaccine on the Drug Record (section above)

 

Click here to view the Data Collection fields sent to PowerLine®. The last three were added for OmnySIS.

 

Delayed Labeling should set the Workflow Record for Documentation Required if using Workflow and the above criteria is met.

• If using Label and Dispensing (or not) and the Auto Print Labels option is turned on, the item goes to Error Resolution.
  

• If Label and Dispensing is on and the Auto Print Labels option is turned off, the item is sent to Label and Dispensing. The HME Documentation prints on the label.
  

If using Tickler but not Workflow, the Tickler Record is set to Documentation Required.

 

In both of the above cases, whether using Workflow or not, an HME transaction is created for the claim. If one already exists in the event of a reverse/retransmit, the existing transaction is updated with the new information.

 

HME Documentation can be printed from the Rx Summary as long as the previous transaction is linked to an HME transaction: Print > HME Documentation. A window displays with options of which form/report to print.

 

When a prescription is refilled, the Prescriber Document dates are copied to the new prescription along with the Medical Release Assignment of Benefits and Supplier Standards if it was populated on the previous fill.

 

Documentation dates are not copied to the new prescription for Reassigned/Discontinued prescriptions.

 

Tickler

 

After a claim is adjudicated and paid, a Tickler Record is created as Documentation Required if Workflow is not being used. To print the documentation, choose the item in the Tickler Queue and select Process. Once a Documentation Required Type is selected, the necessary documentation is printed and the item is set to Documentation Pending and the next item selected in the Tickler is queued.

 

Once a Document Pending Type is selected, the pharmacy transaction displays for editing. Once editing is complete and the Transaction window is closed, the next selected item in the Tickler is queued.

 

Items are not removed from the Documentation Pending status until the physician PHO and sign and expiration (or lifetime) is set.

 

Once both physician forms have been updated, the prescription is removed from Documentation Pending status. The MAE dates should only be required for mobility PHOs (CAN - cane or WLK - walker types only).

 

In addition to the physician dates, if the patient has signed the proof of delivery form, the transaction is ready for data collection.

 

Workflow

 

HME Documentation prints at the same time as the label if Label and Dispensing is turned on and the Auto Print Labels option is not being used.

 

When the following are processed through Label and Dispensing, all the necessary documents print:

New Prescriptions

• Proof of Delivery
  

• Supplier Standards
  

• Medical Release
  

• Assignment of Benefits
  

• Physician Order
  

• MAE - Print only for mobility PHOs (types CAN and WLK)
  

Refills

• Proof of Delivery

 

Otherwise, the claim is adjudicated as paid, the Workflow Record is flagged as Documentation Required, and it moves to Error Resolution.

 

Select and process the items through Error Resolution to print the documentation.

 

If the QA and Delivery/Will Call Queues are not being used, the items still move to Error Resolution until the documentation is updated appropriately. The item is marked complete once this is done.

 

Delivery/Checkout

 

If the Documentation Pending flag is on for the Workflow Record at the time the Workflow Record is marked as Delivered, the item is not completed, but moved to Error Resolution for the prescriber information to be captured.

 

Error Resolution

 

Added HME Documentation Required and HME Documentation Pending (also added to QA and Delivery Queues) status types to Task Types in the Error Resolution Queue.

 

When a Documentation Required type is selected, the necessary documentation is printed, the documentation pending flag is set, the error flag is turned off, and the next Workflow item is selected.

 

When a Documentation Pending type is selected, the pharmacy Transaction Record displays for editing of the HME Documentation.

 

Once editing is complete and the Transaction window is closed, the next Workflow item is queued.

 

• Items are not removed from Documentation Pending status until the physician PHO sign and expiration (or lifetime) is set and the MAE (if printed) sign and expiration (or lifetime) is set.

 

Once both physician forms have been updated, the prescription is removed from Documentation Pending status. MAE dates are only required for mobility PHOs.

 

If QA and Delivery/Will Call Queues are not being used, the item is marked as complete once documentation is updated appropriately.

 

In addition to the physician dates, if the patient has signed the Proof of Delivery form, the transaction is ready for data collection.

 

Prescription Status

 

The Prescription Status window displays the applicable status for items: Documentation Required or Documentation.

 

POS   

 

POS Checkout prompts the HME Documentation signature when checking out a prescription that requires HME documentation.

 

When the proof of delivery signature date, the PHO sign and expiration dates, or lifetime, and the MAE sign and expiration dates or lifetime are set, the transaction is ready for data collection. The MAE dates are only required for mobility PHOs.

Added a HealthMinder Rx option to the Rx Summary > Additional Information screen. Select if the item is a HealthMinder Rx prescription. This ensures the value on the prescription is returned in the RxQuery and RxProfile API calls.

Removed the Queue Refills button under Queue Refills > Rx Intake. It's presence was unintentional. Added logic that returns to the Queue Refills screen from the Rx Intake screen by pressing escape.

Changed the button on the Mail Scan when a deactivated IVR Refill is selected, to read Reactivate instead of Deactivate, allowing a deactivated IVR Refill to be reactivated.

Updated the enhanced A01 Physician Order to print the patient's general orders each time the form splits by prescriber, listing the complete diagnosis, allergies, diet, etc. under each prescriber. For each patient, the orders grouped by prescriber print on separate pages.

 

Added a Bypass Patient Interface Priority Override option to Store Options > Rx Processing. Default = Unchecked. This prevents the Priority field on the Patient from inadvertently being updated.

 

Currently when the Priority field is populated on the Patient Record, the Priority is updated on the Filling Options. If the new option is used, and the Priority on the Filling Options screen is updated, the Priority on the Patient Record > Interface Options is not updated.

To accommodate de-identification of PEMs, Added a Print on PEM section to Store Options > Patient Education Options. Moved existing fields to the section: Print Drug Color and Shape, Drug Imprint Information, Patient Name, Pharmacist Name, Patient Allergies, and Consultation Notice. Added new fields to the section: Rx Number, Rx Date, Drug Dispensed, Quantity Dispensed, SIG, Doctor Name, and Room Number.

To ensure state compliancy, added the following details for the supervising physician to the NewRx hard copy: DEA #, NPI #, LIC #, Address, and Phone.

Troubleshooting various events with A/R accounts can be time consuming. Added an A/R Security Journal along with the following items to pinpoint changes and save valuable time.

 

Added an A/R Security Journal to log the following changes to patient A/R profiles: Date and Time Change, User Initials, Field Change, Before, and After.

 

Added ARFILE - RX AR Detail and ARFILE - RX AR Summary options to Store Control > Security Access > Security Journals.

 

Added a Security Journal button to the Patient Record > AR Profile. Click to display the A/R Change Journal. Details of changes made to the associated A/R Account display, along with any and all changes made to the A/R Account as specified by the user in Security Journal Options (e.g. Log File, Updates, Log New, All Fields). Double click any line-item entry to view Journal Details and File/Field Details tabs and corresponding information.

 

Reports

 

Added A/R Security Journal, A/R RX Detail, and A/R RX Summary options to Custom Reports.

 

Added a Security Journal report to A/R > Reports. Print for A/R Cust, Initials, Date Chg, Time Chg, Field Changed, Before, After details.

 

File Maintenance

 

Added an A/R Security Journal option to Verify, Rebuild Keys, Copy, Clear, Reload, Purge, and Compress options under System Utilities > File Maintenance.

 

A/R

 

Added a Log A/R when Aging option to A/R > Options > General Information. Default = Unchecked. Select to log A/R changes during the aging process.

To prevent CancelRx Messages from being inadvertently processed multiple times from the initial message and multiple prescriptions being canceled that should have remained active, added the following:

 

Updated the system so that when the system automatically responds to a CancelRx Request, the CancelRx in the Mail Queue is marked as Processed (#). Once the CancelRx Request is Processed (#), it is automatically completed in the Tickler Queue if the CancelRx Tickler is enabled in Store Level Options.

Updated the system with logic to report third dose boosters for COVID-19 when reporting to SMP.

 

If the Immunization Record is linked to a prescription and the CVX code on the Immunization Record matches a COVID CVX applicable code, the system checks the Submission Clarification #1 field on the Rx Record. If the Primary Submission Clarification #1 field is set to 02, then a 1 is sent for the dose number. If the Primary Submission Clarification #1 field is set to 06, then a 2 is sent for the dose number. If the Primary Submission Clarification #1 is set to 07, then a 3 is sent for the dose number. Otherwise, dose number is blank.

 

Updated the system to send PMP reporting for Florida with all the newly required fields using ASAP version 4.2A to comply with legal requirements.

Updated the system to send PMP reporting for Mississippi (PM4) with all the required fields using ASAP version 4.2B to comply with legal requirements.

Updated the system to send PMP reporting for Connecticut with all the required fields using ASAP version 4.2A to comply with legal requirements

Added a Network Reimbursement ID field to the Primary, Secondary, and Tertiary sections of the Transaction Record. Custom and Data Exports include the new field to aid in negotiations with PBMs for better reimbursement depending on the network reimbursement ID.

 

Embedded the barcode that prints on the A01 form into the web server. Updated the A01 to print in PDF format to resolve an issue with the barcode not printing when the form is printed from WebConnect.

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