Pre- and Post-Edits

The Pre- and Post-Edit (PPE) service provides real-time reviews of all third party claims in order to reduce rejections. iManagerRx.com, the web site used to manage Pre- and Post-Edit reporting and state prescription monitoring programs, offers reports and information available to assist you in correcting submission errors and keeps you compliant with your state's prescription monitoring programs.

To take advantage of the reports and information available through iManagerRx, contact QS/1 Pharmacy Services at 800.253.8600 or [email protected]. To enroll in QS/1's Pre- and Post-Edit service, contact QS/1 at [email protected].

The process for reviewing claims is built into PowerLine. Third party acknowledgments and Pre- and Post-Edits display in the Electronic Claims Log.

When a Fastclaim response has a message attached, PPE displays until the claim is viewed through the reject detail window. The message displays on the payment or reject detail screen in the free text area. After the message is viewed, PPE changes to P.

If a claim has both a DUR and PPE, the prompt DUR&PPE Msg displays until both are viewed.

To set the PPE option in Fastclaim:

1. Access PrimeCare.

2. Click Store Control, Store Level Options.

3. The Store Level Options/System screen displays.

4. Click on the vertical icon bar. The Fastclaim Options screen displays. Under Log Scan Options, check Hold/Freeze Log Scan for PPEs.

5. Press CTRL+S or click .

To set the PPE option in Prescription Processing:

1. Access PrimeCare.

2. Click Store Control, Store Level Options.

3. The Store Level Options/System screen displays.

4. Click on the vertical icon bar. The Rx Processing screen displays. Under Processing Options, check Pre/Post Edits in Tickler Workflow.

5. Press CTRL+S or click .

NDC - Validate that the NDC is in the FDB database (exception - if the drug cost is over $9999.99 it is not stored and will reject if that NDC is sent). Reject 21 (M/I Product/Service ID) is sent to the pharmacy.

NDC - Validate if the NDC is still active based on FDB. Reject 77 (Discontinued Product/Service ID Number) is sent to the pharmacy, along with the replacement NDC in the message field.

DAW Code - Validate the appropriateness of the DAW based on the generic indicator supplied by FDB. Reject *1 (Inappropriate DAW Use) is sent to the pharmacy.

DAW Code - Validate the DAW code is a valid code. Reject 22 (M/I Dispense As Written/Product Selection Code) is sent to the pharmacy.

Date of Birth - Validate that a date of birth is sent and that it is not greater than the current date. Reject 09 (M/I Birth Date) is sent to the pharmacy.

Gender - Validate that the patient gender is 0 (not specified), 1 (male) or 2 (female). Reject 10 (M/I Patient Gender Code) is sent to the pharmacy.

Relationship to Cardholder - Validate that the relationship to cardholder is 0 (not specified), 1 (self), 2 (spouse), 3 (child) or 4 (other). Reject 11 (M/I Patient Relationship Code) is sent to the pharmacy.

Prescriber - Validate that the prescriber ID is present. If an NPI or DEA number is sent, validate that the number is properly formatted (we do not validate whether it is a valid ID). Reject 25 (M/I Prescriber ID) is sent to the pharmacy.

Part D - Validate that the NDC is not on the Part D exclusion list if the Price Code is flagged as Part D Reject 54 (Non-Matched Product/Service ID Number) is sent to the pharmacy.

Cardholder ID - Validate that a cardholder ID is sent on the claim. Reject 07 (M/I Cardholder ID) is sent to the pharmacy.

Group ID - Validate that a group ID is sent on the claim. Reject 06 (M/I Group ID) is sent to the pharmacy.

Ingredient Cost - Increase the ingredient AWP cost to the AWP price we have on file if submitted lower. Adjust Gross Amount Due as appropriate. This is only performed if the cost is based on AWP. There is an option to adjust the cost if pricing at U&C. QS/1 does not adjust the U&C sent on a claim. A message is returned to the store, i.e. **QS/1 Pre-Edit: Cost changed form 123.45 to 134.56 **.

Prescription Origin Code - Validate that the prescription origin code is 1 (Written), 2 (Telephone), 3 (Electronic), 4 (Fax) or 5 (Pharmacy). Reject 33 (M/I Prescription Origin Code) is sent to the pharmacy.