19.1.38 NRx Enhancements

Medicare sets the Date of Service for claims within the 835 file based on the Proof of Delivery Date Signed. Updated the following to prevent a mismatch on dates and ensure transactions are reconciled when the 835 file is uploaded.

If Date of Service and 835 claim date do not match, the system checks the Date Signed from Proof of Delivery. If they match, the posting of the payment occurs. The same logic applies to adjustments and reversals. Note: This only occurs for transactions flagged as HME.

Transactions billed to HME cannot be updated. Previously, if an update was attempted, no alert displayed to state the update did not take place.

Added an Items Billed Through HME window that displays on the Rx Summary if History > Update is selected to indicate the update cannot be completed. The window displays if the Bill to HME option is selected on both the primary Price Plan as well as the Transaction.

Pharmacies need the ability to automatically populate SCCs based on the Days Supply for Short Cycles in order to submit properly to third parties.

Each of these locations were updated with the following fields allowing different SCCs to be allocated to days supply of 14, less than 7 days, as well as 8-14 days: Changed the Submission Clarification Code field to Submission Clarification Code (14 D/S) and added Submission Clarification (<7 D/S), and Submission Clarification Code (8-14 D/S) drop-down fields. Example

• Facility Management > Facility/Unit Record Management > Select Facility > General

• Facility Management > Facility/Unit Record Management > Select Facility > Fill List Options > Routine, Bulk & IV > Transaction Options

• Facility Management > Facility/Unit Record Management > Select Facility > Fill List Options > Short Cycle > Transaction Options

 

New Logic

When a prescription is filled, the Days Supply determines which Submission Clarification Code field is used to automatically populate on the prescription.

Some states may require reporting for medications regardless of class. Added an All Drugs row to Store Options > System > Log Controlled Substance Rxs > Controlled Substance Options, along with Log to File (Default = Unchecked for all states except Nebraska (State Code NE or MP)), Require ID (Default = Unchecked for all states), and PMP Consult (Default = Unchecked for all states) checkboxes. If selected, the All Drugs option overrides any other drug class options that may be selected for Data Collection, Real Time, and Date Sold reporting.

In many cases, email addresses are used as the Rx Drug Monitoring Log in ID. Expanded Login ID from 25 to 80 characters to accommodate these longer IDs.

In situations when a prescription has both a supervising prescriber and an NP/PA, the Price Plan must have the Use NP/PA when available option selected to correctly send the NP/PA credentials. To prevent audits, should this setting be overlooked, added a global Store Option for more ease of use.

Added a Use NP/PA when available option to Store Options > Rx Filling. Default = Checked. Overrides the same option in the Price Plan. If selected, and the NP/PA is linked properly to the prescriber, the NP/PA displays on the Rx Summary below the Prescriber field and the NP/PA information (NPI, DEA, address, etc.) is used as the prescriber and transmits to the third party in Prescriber segment AM03 and used for PMP reporting.

To prevent errors in calculations as well as unintentional population of xxxxx's in fields, added an Invalid Input message that displays if alpha characters or too many numeric characters are entered in the Minimum Price, Quantity, or Price fields on the Competitive Pricing Schedule screen.

To prevent the unnecessary display of the Serial Number Required prompt, updated the system for it to only display when the Serial Number Required option is selected in Store Options > Rx Legal Requirements or in the Price Plan (Store Options overrides the two) and the Rx Origin = anything other than 1.

The PUC field was printing, but without the corresponding value of the Renewal Response on the hard copy if sent in the electronic message. Updated the system to print this value unless not required by your state.

Some states require ICD10 codes for opioids. To assist with easy compliance, updated the system to automatically add ICD10 codes to the Rx Summary from New Rxs during order entry.

Added a Do Not Update Patient MRN from NewRx option to Store Options > Rx Filling > Electronic Prescribing Options. Default = Unchecked. If selected, and the Update button on the Patient Record is selected, the system does not update the existing patient MRN value.

Added a Workflow Daily Audit to Reports > Management to capture all workflow processes of a prescription in a single day to meet OH legal requirements. Note: Must have Workflow File History selected in Store Options > Store Level Options to use.

Refill Requests successful in transmission to Surescripts were incurring errors once sent to the prescriber. Updated the following to resolve:

Updated the FollowUpRequest field on Renewal Requests to only increment on subsequent electronic Renewal Requests. Printed or faxed requests are not included in the count. Example: If the first Renewal Request is printed, the count is 0 and then you send a second request electronically, the follow-up count is 0. If a third request is sent electronically, the follow-up count is 1.

 

Included the MessageID of the original electronic Refill Request for the RelatesToMessageID on the follow-up Renewal Request. Example: Original NewRx has a MessageID of 1234; the first Renewal Request that is sent contains a MessageID of 5678 and a RelatesToMessageID of 1234. A second electronic Renewal Request is sent the next day; it contains a RelatesToMessageID of 5678 (the MessageID of the prior Renewal Request) and a FollowUpRequest of 1.

Updated the following to comply with state requirements that request that the animal owner's gender be transmitted for PMP:

Animal Owner/Scan Patients

 

Added a Sex (e.g., Male, Female, Non Binary) drop-down field to the Animal Owner window. Default = blank.

 

Updated the Scan Patients screen accessed from the Animal's Owner window so that any patient that is an animal cannot be selected as the animal's owner.

 

Store-Side Reporting/Data Collection

 

Updated store-side manual reporting for ASAP formats 4.2, 4.2A, and 4.2B for state codes PM4 and PM7 as well as Data Collection to send the entry selected in the Animal Owner's Sex field in field PAT19. If the entry is blank, U is sent as it has been in the past.

 

PowerLine

 

Added the Animal Owner's Sex entry to field AMXX segment for claims transmissions to PowerLine.

Added Prescriber Address, Patient Address, Dose, Administration Site, and Administration Route to the non-enhanced (printed), enhanced (printed), and faxed Physician Notification of Immunization printed forms.

The user entering a prescription at Order Entry may be different than the user verifying the prescription or approving the clinical bypass during New Order Verification. Updated the system to always check for and prompt the Non-Matched/TE Code alert in New Order Verification when the Clinical Checking Store Level Option is selected so that the pharmacist can verify all clinical checking.

If the Clinical Checking Store Level Option, Non-Matched/Blank TE is selected, the system always checks and prompts for the Non-Matched/TE Code alert at the New Order Verification Workflow step.

 

The RPH Login window prompts to bypass if the Require RPH Approval/Login for Clinical Bypass is selected for Non-Matched/Blank TE Code.

 

The system logs the user or RPH that bypasses the Non-Matched/Blank TE alert and displays the user's initials under the Verification column for Non-Matched TE on the Clinical Bypass Information window.

The following addresses the need to maintain space in the Tickler File for only relevant items.

Added a Remove ALL tickler items entered before this number of days regardless of status option to the File Maintenance Scheduler. Default = Blank. Enter a numerical value up to 999. The system purges all tickler items entered before the number of days entered regardless of status whenever the File Maintenance Scheduler is run for the Tickler File. Note: This option ignores pharmacy and patient tickler items, as these act as notes and alerts and can be deleted individually if chosen not to display.

PMP Analysis Checks were displaying in the prescriber's PMP Search History rather than the pharmacist's due to the Role as Physician being sent in the request with the prescriber's information instead of the pharmacist. To correct this, the system was updated to change the Provider information in the Patient Requests to the pharmacist's information rather than the prescriber's information.

When using Controlled Substance Editing under Store Control > Store Options > Rx Filling Options, the system would historically prompt for the Doctor DEA Number to be entered for both controlled substances as well as drugs of concern. However, states such as Louisiana do not require the doctor DEA for drugs of concern. Updated the Controlled Substance Editing prompt for drugs of concern to display only for the states that require it. The prompt continues to display requiring the doctor DEA for controlled substances for all states.

Updated the Level of Service drop-down menu on the Rx Summary > Claim Information and Transaction > Primary, Secondary, and Tertiary Billing with the following to comply with NCPDP:

• 05 Patient Consultation regarding generic product selection. Professional service involving discussion of alternatives to brand name medications. Former value description changed from Pat Consultation of Selection.

• 07 Medical at home with special pharmacy services identical to Long Term Care beneficiaries with the exception of emergency kits. NEW

Synmed has the capability to accept partial refills for its automated system for preparing and dispensing oral medications in blister cards. Updated the system to use partial fill calculation and pull the Refills Remaining from the Rx Summary for batch formats 8 and 8S when submitting data to Synmed.

Previously, the Test Web Service button was removed from the CoverMyMeds® Prior Authorization Request Web Services Options window, as they were no longer supported by CMM. Along with that, the Login ID and Password was removed from the window. Added the Login ID and Password back so that new customers have an opportunity to enter their credentials to be stored rather than entering them each time the CMM webpage is launched for a prior authorization request.

For continued compliance, updated the expiration date on the CMS Notice of Appeals form printout for English and Spanish.

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