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RPMS POS

RPMS POS. Setting up an Insurer (Medco Health) July 29, 2005. Objectives.

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RPMS POS

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  1. RPMS POS Setting up an Insurer (Medco Health) July 29, 2005

  2. 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

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

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

  5. 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

  6. Pharmacy Contract Info

  7. Medco Health Web Site

  8. Medco Health Web Site

  9. 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 ...

  10. 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

  11. 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.

  12. 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 formats DEVICE: VIRTUAL PHARMACY ELECTRONIC CLAIMS FORMATS JUL 29,2005 07:43 PAGE 1 Contr Format BIN Plan # Help Telephone # Req'd -------------------------------------------------------------------------------- Production/Testing Status: PRODUCTION ACS NC SENIOR CARE 5.1 610084 4624 ADVANCE PARADIGM NASE 004336 4374 (800) 364-6331 YES ADVANCE PARADIGM NASE 5.1 004336 4374 (800) 364-6331 YES ADVANCE PRESCRIPTION MGMT 004336 2447 YES ADVANCE PRSCPT MGMT ADV 5 004336 2447 YES ADVANCEPCS 004336 6850 1-800-600-8065 YES ADVANCEPCS 5.1 004336 6850 (800) 600-8065 YES

  13. 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

  14. 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:

  15. Testing a Claim – Backbilling User POS Paper Report to find claims: POS / RPT / CLA / PAP Paper 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 8,2005 START 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// F DEVICE: Right Margin: 80// POS PAPER claims for prescriptions RELEASED on JUL 14,2005 07/15@07:56 HEART 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 --------

  16. 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 • _______________________________________________________________________________ • COMMAND: Press <PF1>H for he

  17. Resources: \\Interftp\pos

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