RPMS POSSetting up an Insurer

(Medco Health)

July 29, 2005

Objectives By the end of the session, the attendee will be

able to: 1. Determine which insurers are set up to transmit prescription claims through POS. 2. Identify at least three elements that are needed to determine the correct format. 3. Set up an insurer in POS 4. Understand the difference between a "paper claim" and one that was sent electronically

Handouts Setting up an Insurer - WORD Format List – EXCEL Spreadsheet Medco Health Provider Manual List of Processor Web Links

Topics to Cover Medco Health Agreement Setting up an Insurer the software Pharmacy Network Agreements

Medco Health Agreement – Refer to Pharmacy Services Manual Reimbursement every two weeks 90 day fills for maintenance meds – if plan allows Requires Signature Log Medications must be returned to stock within 14 days if not

picked up. Section 2.6 - Clarification field 420 Section 3.1 – DAW – 408 AUDITS – section 6 Payment address – part of agreement

Address changes Medco Health Account Number

Pharmacy Contract Info

Medco Health Web Site

Medco Health Web Site

Setting up an Insurer in POS RPMS POS Patch 12 – allows person with Pharmacy Manager key

(Fileman access pP) to set-up POS insurer. The most current POS is 13. Menu needed – POS Manager:

******************************************** * PHARMACY POINT OF SALE V1.0 * * BROWNING HO * * Main Menu * ********************************************

U Pharmacy POS User Menu ... MGR Pharmacy POS Manager Menu ... BILL RX Point of Sale Billing Menu ... RPT Pharmacy electronic claims reports ...

Information Needed to Set-Up Format in RPMS POS Insurer in RPMS POS Format Name

Need at least 3 elements to determine correct POS FORMAT NAME: Processor BIN number Processor Control Number

POS Reports to Review Insurers Summary of Insurer Report – SUMI

Lists insurers set up to transmit claims electronically through RPMS POS

POS / RPT / SET / SUMI Survey of Insurers

POS / RPT / SURV / INS Lists ALL insurers from recent prescriptions; also

displays insurers set-up in POS.

Determining Format Name POS / RPT / OTH / FMT PHARMACY POINT OF SALE V1.0 * * FT. YUMA HOSP * * Other reports * ********************************************

FMT List electronic claims formats FLD List NCPDP Fields

Select Other reports Option: FMT List electronic claims formatsDEVICE: VIRTUALPHARMACY ELECTRONIC CLAIMS FORMATS JUL 29,2005 07:43 PAGE 1 ContrFormat BIN Plan # Help Telephone # Req'd--------------------------------------------------------------------------------

Production/Testing Status: PRODUCTIONACS NC SENIOR CARE 5.1 610084 4624ADVANCE PARADIGM NASE 004336 4374 (800) 364-6331 YESADVANCE PARADIGM NASE 5.1 004336 4374 (800) 364-6331 YESADVANCE PRESCRIPTION MGMT 004336 2447 YESADVANCE PRSCPT MGMT ADV 5 004336 2447 YESADVANCEPCS 004336 6850 1-800-600-8065 YESADVANCEPCS 5.1 004336 6850 (800) 600-8065 YES

Medco Health Processor Information BIN Number: 610014 Processor Control Number: NONE GEHA Group Number: GEHA4HEALTH Help Desk Phone number: (800)922-1557 POS Format Name: PAID 5.1

Setting up the Insurer in POS POS / MGR / SET / INS Three steps:

******************************************** * PHARMACY POINT OF SALE V1.0 * * * Edit Pharmacy POS Insurance settings * ********************************************

SYS Insurance selection parameters (system-wide) 1. INS Quick setup of insurer 2. ADV Advanced setup of insurer 3. RPMS Enter/edit RPMS Insurance file RX settings SUMI POS Setup - Summary of Insurers

Select Edit Pharmacy POS Insurance settings Option:

Testing a Claim – BackbillingUser POS Paper Report to find claims:POS / RPT / CLA / PAPPaper Report - not sent electronically; claims that would be processed in

Third Party Billing;

Select Claim results and status Option: PAP Paper claims report...updating the Report Master file, please stand by...

* Previous selection: RELEASED DATE from Jul 8,2005START WITH RELEASED DATE: Jul 8,2005// T-3 (JUL 12, 2005)GO TO RELEASED DATE: LAST// * Previous selection: TRANSACTION:INSURER from A START WITH TRANSACTION:INSURER: A// EX GO TO TRANSACTION:INSURER: LAST// FDEVICE: Right Margin: 80//POS PAPER claims for prescriptions RELEASED on JUL 14,2005 07/15@07:56HEART BUTTE HEALTH STATION NCPDP (NABP) #2763197 Medicaid #EXPRESS SCRIPTS,INC. Help Desk:(800) 235-4357

Trans. Date Presc/Fill $amount

JUL 14,2005 EXAMPLE PATIENT `1414879/4 18.72LEVOTHYROXINE 100MCG TAB--------

Send as NEW Claim Ask Insurance? NO +--------------+ <PF1> E when done, to file claims Ask Preauth #? NO | PHARMACY | <PF1> Q to quit without filing claims Ask Qty/Price? NO | POINT OF | <PF3> insert/overstrike modes Ask Fill Date? NO | SALE | <PF4> to go back one field Ask Overrides? NO | DATA ENTRY | Arrow keys may be used, too +--------------+ Prescription NDC/CPT/HCPCS - Patient - - - - Drug - - - - - - - - Fill Date 1 `1414879 00074-6624-19 EXAMPLE, PATIENT LEVOTHYROXINE 100MCG TAB JUL 14 2 3 4 5 6 7 8 9

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COMMAND: Press <PF1>H for he

Resources: \\Interftp\pos