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RPMS POS Pharmacy RPMS POS Pharmacy Billing Billing May 17, 2006 May 17, 2006

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Page 1: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

RPMS POS Pharmacy RPMS POS Pharmacy BillingBilling

May 17, 2006May 17, 2006

Page 2: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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AgendaAgenda

POS BasicsPOS Basics Patient Registration, the Eligibility Patient Registration, the Eligibility

Transaction (E1) & Medicare Part Transaction (E1) & Medicare Part DD

ReportsReports Correcting Common RejectionsCorrecting Common Rejections Upcoming sessionsUpcoming sessions

Page 3: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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POS BasicsPOS Basics

References: References: ftp://ftp.ihs.gov/rpms/POS/ftp://ftp.ihs.gov/rpms/POS/

Current patches:Current patches:– POS v1 patch 16POS v1 patch 16– APSA (AWP monthly patch)APSA (AWP monthly patch)– Patient Reg v7.1 patch 1Patient Reg v7.1 patch 1

RPMS Support Desk: RPMS Support Desk: [email protected]@ihs.gov

Page 4: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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ftp://ftp.ihs.gov/rpms/POftp://ftp.ihs.gov/rpms/POS/S/

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ftp://ftp.ihs.gov/rpms/POftp://ftp.ihs.gov/rpms/POS/POS%20User%20InformS/POS%20User%20Information/ation/

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http://home.ihs.gov/ITSC-http://home.ihs.gov/ITSC-CIO/CSMT/SRCB/patchtbl.CIO/CSMT/SRCB/patchtbl.pdfpdf

Page 7: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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APS AWP/PMI UPDATE APS AWP/PMI UPDATE STATUS STATUS Select IHS-Specific Pharmacy Options Option: APS AWP/PMI UPDATE STATUSSelect IHS-Specific Pharmacy Options Option: APS AWP/PMI UPDATE STATUS AVERAGE WHOLESALE PRICE (AWP)AVERAGE WHOLESALE PRICE (AWP) >>> UPDATE STATUS <<<>>> UPDATE STATUS <<<

Last AWP monthly update occurred on..................MAY 3,2006Last AWP monthly update occurred on..................MAY 3,2006

Most recent 'manual' AWP update was ran on...........MAY Most recent 'manual' AWP update was ran on...........MAY 15,2006@13:40:0715,2006@13:40:07

Total number of DRUGS updated with AWP...............547Total number of DRUGS updated with AWP...............547

>>> ACTIVE DRUGS STATUS <<<>>> ACTIVE DRUGS STATUS <<< The Total Number of Active Drugs.....................571The Total Number of Active Drugs.....................571

PATIENT DRUG EDUCATION DATABASE (PDED)PATIENT DRUG EDUCATION DATABASE (PDED) >>> UPDATE STATUS <<<>>> UPDATE STATUS <<<

The last quarterly PDED update occurred on...........APR 3,2006The last quarterly PDED update occurred on...........APR 3,2006

PATIENT DRUG EDUCATION DATABASE WILL EXPIRE ON.......JUL 5,2006 PATIENT DRUG EDUCATION DATABASE WILL EXPIRE ON.......JUL 5,2006

Page 8: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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Point of Sale Pharmacy Billing Real Time on-line adjudication system

3/2003 Diagram-Overview POS; PSchweitzer

RPMS system

Switch Company (Emdeon)

Third Party Billing & Accounts receivable packages

Payer or Processor Response

Pharmacy Package

RPMS Point of Sale (POS) Package

Patient Registration Package

Patient Care Component (PCC) Visit files

New Person File (Provider number)

Page 9: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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POS BasicsPOS Basics

MaintenanceMaintenance– Check for stranded claimsCheck for stranded claims

POS / RPT / CLA / STRPOS / RPT / CLA / STR START WITH START TIME: FIRST// START WITH START TIME: FIRST// If there are stranded claims; resubmit via POS If there are stranded claims; resubmit via POS

Claims Data Entry Screen (User Screen)Claims Data Entry Screen (User Screen)

Know the RPMS Insurers that are set Know the RPMS Insurers that are set to transmit via POSto transmit via POS

POS / RPT / SET / SUMIPOS / RPT / SET / SUMI Review Rx Priority PointsReview Rx Priority Points

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****************************************************************************************

* PHARMACY POINT OF SALE V1.0 * PHARMACY POINT OF SALE V1.0 * *

* Pharmacy electronic claims * Pharmacy electronic claims reports *reports *

****************************************************************************************

CLA Claim results and status ...CLA Claim results and status ... SET Setup (Configuration) reports ...SET Setup (Configuration) reports ... SURV Surveys of RPMS database ...SURV Surveys of RPMS database ... ELIG Medicare Part D Eligibility CheckELIG Medicare Part D Eligibility Check OTH Other reports ... OTH Other reports ...

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SUMI ReportSUMI ReportPHARMACY ELECTRONIC CLAIMS INSURERS MAY 17,2006 01:17 PAGE 1PHARMACY ELECTRONIC CLAIMS INSURERS MAY 17,2006 01:17 PAGE 1 Grace Ins.Grace Ins. Disp Fee Per Sel.Disp Fee Per Sel.Insurer Pricing Formula Override Override Pts.Insurer Pricing Formula Override Override Pts.----------------------------------------------------------------------------------------------------------------------------------------------------------------

===== DIAL OUT to: ENVOY DIRECT VIA T1 LINE===== DIAL OUT to: ENVOY DIRECT VIA T1 LINE ----- Using electronic FORMAT: ADVANCE RX MGT SILVERSCRPT 5.1----- Using electronic FORMAT: ADVANCE RX MGT SILVERSCRPT 5.1 BIN: 004336BIN: 004336D-SILVERSCRIPT STANDARD 650.00D-SILVERSCRIPT STANDARD 650.00 ----- Using electronic FORMAT: EXPRESS SCRIPTS 5.1----- Using electronic FORMAT: EXPRESS SCRIPTS 5.1 BIN: 003858BIN: 003858BENEFIT PLANNERS, INC. STANDARD 5.00BENEFIT PLANNERS, INC. STANDARD 5.00EXPRESS SCRIPTS,INC. STANDARD 20.00EXPRESS SCRIPTS,INC. STANDARD 20.00EXPRESS SCRIPTS STANDARD 20.00EXPRESS SCRIPTS STANDARD 20.00 ----- Using electronic FORMAT: GEHA 5.1 ----- Using electronic FORMAT: GEHA 5.1 BIN: 610014BIN: 610014GEHA/RX STANDARD 20.00GEHA/RX STANDARD 20.00

----- Using electronic FORMAT: PAID 5.1----- Using electronic FORMAT: PAID 5.1 BIN: 610014BIN: 610014PAID PRESCRIPTIONS, L.L.C. STANDARD 20.00PAID PRESCRIPTIONS, L.L.C. STANDARD 20.00PAID PRESCRIPTIONS, INC. STANDARD 20.00PAID PRESCRIPTIONS, INC. STANDARD 20.00

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****************************************************************************************

* PHARMACY POINT OF SALE V1.0 * PHARMACY POINT OF SALE V1.0 * *

* Pharmacy electronic claims * Pharmacy electronic claims reports *reports *

****************************************************************************************

CLA Claim results and status ...CLA Claim results and status ... SET Setup (Configuration) reports ...SET Setup (Configuration) reports ... SURV Surveys of RPMS database ...SURV Surveys of RPMS database ... ELIG Medicare Part D Eligibility CheckELIG Medicare Part D Eligibility Check OTH Other reports ... OTH Other reports ...

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EXAMPLE OF SURVEY EXAMPLE OF SURVEY BY INSURERBY INSURERCount Name Now sending formatCount Name Now sending format 10909 SOUTH DAKOTA MEDICAID(`442)10909 SOUTH DAKOTA MEDICAID(`442) 1315 FIRST HEALTH(`1012) MAILHANDLERS 5.11315 FIRST HEALTH(`1012) MAILHANDLERS 5.1 901 BC/BS FEDERAL EMPLOYEE PROG(`953)901 BC/BS FEDERAL EMPLOYEE PROG(`953) 519 D-HUMANA STANDARD(`1121) CAREPLUS HP HUMANA PDP 519 D-HUMANA STANDARD(`1121) CAREPLUS HP HUMANA PDP

5.15.1 381 PAID PRESCRIPTION DRUG PROGRAM(`951) PAID 5.1381 PAID PRESCRIPTION DRUG PROGRAM(`951) PAID 5.1 319 D-SILVERSCRIPT(`1133) ADVANCE RX MGT SILVERSCRPT 319 D-SILVERSCRIPT(`1133) ADVANCE RX MGT SILVERSCRPT

5.15.1 301 D-ADVANTAGE FREEDOM(`1124) MEDICARE PARTD RXAMERI 301 D-ADVANTAGE FREEDOM(`1124) MEDICARE PARTD RXAMERI

PDP 5.1PDP 5.1 284 D-YOURX PLAN(`1138) MEDCO MEDICARE PDP 5.1284 D-YOURX PLAN(`1138) MEDCO MEDICARE PDP 5.1 259 D-PACIFICARE SAVER(`1130) MEDICARE PARTD RXSOLUTIONS 259 D-PACIFICARE SAVER(`1130) MEDICARE PARTD RXSOLUTIONS

5.15.1 259 D-WELLCARE SIGNATURE(`1137) WELLCARE MEDICARERX 5.1259 D-WELLCARE SIGNATURE(`1137) WELLCARE MEDICARERX 5.1 216 D-COMMUNITY CARE RX(`1128) MEMBER HEALTH BASIC PDP 216 D-COMMUNITY CARE RX(`1128) MEMBER HEALTH BASIC PDP

5.15.1 190 D-UNITED HEALTHRX(`1135) PRIMARY MEDICARE PARTD WHI 190 D-UNITED HEALTHRX(`1135) PRIMARY MEDICARE PARTD WHI

5.5.

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Medicare Part D – Medicare Part D – Getting StartedGetting Started1. Verify patches have been installed (Patient 1. Verify patches have been installed (Patient

Reg v7.1, patch 1 and POS v1 patch 16)Reg v7.1, patch 1 and POS v1 patch 16)2. Enter Insurers (use recommended naming 2. Enter Insurers (use recommended naming

convention, i.e. D-PLAN NAME) in 3PB Table convention, i.e. D-PLAN NAME) in 3PB Table Maintenance Insurer File.Maintenance Insurer File.

3. Tie Medicare Part D POS format to appropriate 3. Tie Medicare Part D POS format to appropriate InsurerInsurer

4. Enter patient with Medicare Part D in Patient 4. Enter patient with Medicare Part D in Patient RegistrationRegistrationDetermine duel-eligible membersDetermine duel-eligible membersCan Run E1 to determine BIN, PCN & Group Can Run E1 to determine BIN, PCN & Group

number which correlates to a Plan Name.number which correlates to a Plan Name.4. Backbill 180 days4. Backbill 180 days

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Using the Eligibility Using the Eligibility Check (E1)Check (E1) **************************************************************************************** * PHARMACY POINT OF SALE V1.0 * PHARMACY POINT OF SALE V1.0

* ** Pharmacy electronic claims reports ** Pharmacy electronic claims reports * ****************************************************************************************

CLA Claim results and status ...CLA Claim results and status ... SET Setup (Configuration) reports ...SET Setup (Configuration) reports ... SURV Surveys of RPMS database ...SURV Surveys of RPMS database ... ELIG Medicare Part D Eligibility CheckELIG Medicare Part D Eligibility Check OTH Other reports ... OTH Other reports ...

Page 17: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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Eligibility Check (E1)Eligibility Check (E1)

Generate eligibility chk (Med Part D) for which patient? Generate eligibility chk (Med Part D) for which patient? DEMO PATIENTDEMO PATIENT

M 04-20-1940 154459999 WE M 04-20-1940 154459999 WE 5999959999

On: On: Patient Name: DEMO PATIENTPatient Name: DEMO PATIENT Status: AStatus: A Authorization #:Authorization #: Insurance Level: PRIMARYInsurance Level: PRIMARY BIN: 012304BIN: 012304 PCN: MPDPCN: MPD GROUP: PDA23 GROUP: PDA23 CARDHOLDER ID: 123456789CARDHOLDER ID: 123456789 PERSON CODE: 1PERSON CODE: 1 PHONE NUMBER: 8005551212PHONE NUMBER: 8005551212

Page 18: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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POS Medicare Part D POS Medicare Part D formats – sorted by formats – sorted by BINBIN

Page 19: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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Medicare Part D Medicare Part D formats sorted by Planformats sorted by Plan

Page 20: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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Linking Insurer to POS Linking Insurer to POS formatformat **************************************************************************************** * PHARMACY POINT OF SALE V1.0 ** PHARMACY POINT OF SALE V1.0 * * ** * * Edit Pharmacy POS Insurance settings ** Edit Pharmacy POS Insurance settings * **************************************************************************************** SYS Insurance selection parameters (system-wide)SYS Insurance selection parameters (system-wide) INS Quick setup of insurerINS Quick setup of insurer ADV Advanced setup of insurerADV Advanced setup of insurer RPMS Enter/edit RPMS Insurance file RX RPMS Enter/edit RPMS Insurance file RX

settingssettings SUMI POS Setup - Summary of InsurersSUMI POS Setup - Summary of Insurers

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SUMI ReportSUMI ReportPHARMACY ELECTRONIC CLAIMS INSURERS MAY 17,2006 01:17 PAGE 1PHARMACY ELECTRONIC CLAIMS INSURERS MAY 17,2006 01:17 PAGE 1 Grace Ins.Grace Ins. Disp Fee Per Sel.Disp Fee Per Sel.Insurer Pricing Formula Override Override Pts.Insurer Pricing Formula Override Override Pts.----------------------------------------------------------------------------------------------------------------------------------------------------------------

===== DIAL OUT to: ENVOY DIRECT VIA T1 LINE===== DIAL OUT to: ENVOY DIRECT VIA T1 LINE ----- Using electronic FORMAT: ADVANCE RX MGT SILVERSCRPT 5.1----- Using electronic FORMAT: ADVANCE RX MGT SILVERSCRPT 5.1 BIN: 004336BIN: 004336D-SILVERSCRIPT STANDARD 650.00D-SILVERSCRIPT STANDARD 650.00 ----- Using electronic FORMAT: EXPRESS SCRIPTS 5.1----- Using electronic FORMAT: EXPRESS SCRIPTS 5.1 BIN: 003858BIN: 003858BENEFIT PLANNERS, INC. STANDARD 5.00BENEFIT PLANNERS, INC. STANDARD 5.00EXPRESS SCRIPTS,INC. STANDARD 20.00EXPRESS SCRIPTS,INC. STANDARD 20.00EXPRESS SCRIPTS STANDARD 20.00EXPRESS SCRIPTS STANDARD 20.00 ----- Using electronic FORMAT: GEHA 5.1 ----- Using electronic FORMAT: GEHA 5.1 BIN: 610014BIN: 610014GEHA/RX STANDARD 20.00GEHA/RX STANDARD 20.00

----- Using electronic FORMAT: PAID 5.1----- Using electronic FORMAT: PAID 5.1 BIN: 610014BIN: 610014PAID PRESCRIPTIONS, L.L.C. STANDARD 20.00PAID PRESCRIPTIONS, L.L.C. STANDARD 20.00PAID PRESCRIPTIONS, INC. STANDARD 20.00PAID PRESCRIPTIONS, INC. STANDARD 20.00

Page 22: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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Medicare Part D insurers Medicare Part D insurers set up to POS formatset up to POS format POS / RPT / CLA / MPDPOS / RPT / CLA / MPD

– MPD TOTALS – MEDICARE PART D INSURERSMPD TOTALS – MEDICARE PART D INSURERS Any insurers/plans listed on this report are tied to a Any insurers/plans listed on this report are tied to a

format that is “tagged” as Medicare Part D.format that is “tagged” as Medicare Part D.

        PAYABLE      ADJUSTED      PAPER       REJECTED    RX CNTPAYABLE      ADJUSTED      PAPER       REJECTED    RX CNT----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------D-PACIFICARE SAVERD-PACIFICARE SAVER                      283.10        77.87         0.00           0.00         6283.10        77.87         0.00           0.00         6--------------------------------------------------------------------------------------------------------------------------------------------------------------D-PRESCRIPTION PATHWAYD-PRESCRIPTION PATHWAY                        15.54         5.01          0.00       10.75         215.54         5.01          0.00       10.75         2

Page 23: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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Entering Information on Entering Information on Page 4 of Patient Page 4 of Patient RegistrationRegistration

Page 24: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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Adding Medicare Part Adding Medicare Part D Plan on page 4D Plan on page 4

Page 25: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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Completed Patient Reg Completed Patient Reg page 4page 4

Page 26: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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****************************************************************************************

* PHARMACY POINT OF SALE V1.0 * PHARMACY POINT OF SALE V1.0 * *

* Pharmacy electronic claims * Pharmacy electronic claims reports *reports *

****************************************************************************************

CLA Claim results and status ...CLA Claim results and status ... SET Setup (Configuration) reports ...SET Setup (Configuration) reports ... SURV Surveys of RPMS database ...SURV Surveys of RPMS database ... ELIG Medicare Part D Eligibility CheckELIG Medicare Part D Eligibility Check OTH Other reports ... OTH Other reports ...

Page 27: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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Reports: Claims Reports: Claims Results and StatusResults and Status **************************************************************************************** * PHARMACY POINT OF SALE V1.0 ** PHARMACY POINT OF SALE V1.0 * * Claim results and status ** Claim results and status * ****************************************************************************************

PAY Payable claims reportPAY Payable claims report REJ Rejected claims reportREJ Rejected claims report CAP Captured claims reportCAP Captured claims report PAP Paper claims reportPAP Paper claims report UN Uninsured claims reportUN Uninsured claims report DUP Duplicate claims report (should be none)DUP Duplicate claims report (should be none) MISS Find prescriptions missed by POSMISS Find prescriptions missed by POS NRV Reversals neededNRV Reversals needed URM Update Report Master File for a date rangeURM Update Report Master File for a date range REC Recent transactionsREC Recent transactions STR List possibly stranded claimsSTR List possibly stranded claims DAY TOTALS - by RELEASED DATEDAY TOTALS - by RELEASED DATE INS TOTALS - by INSURERINS TOTALS - by INSURER MPD TOTALS - MEDICARE PART D INSURERS MPD TOTALS - MEDICARE PART D INSURERS

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REPORTSREPORTS

Before running any reports, run the Update Report Before running any reports, run the Update Report Master File (URM).Master File (URM).

If backbilling, run report at least as far back as claims If backbilling, run report at least as far back as claims were being re-submitted.were being re-submitted.

Corrected claims will display on the Release date Corrected claims will display on the Release date (equivalent to fill date)(equivalent to fill date)

Recommended schedule of running reports:Recommended schedule of running reports:– Rejection – dailyRejection – daily– Payable – daily – to review how much plans are paying.Payable – daily – to review how much plans are paying.– URM – after correcting rejections; before running URM – after correcting rejections; before running

rejection report.rejection report.– Stranded Claim – weekly or if POS “not working”Stranded Claim – weekly or if POS “not working”– Management reports – monthlyManagement reports – monthly

DAY – totals by release dateDAY – totals by release date MCD – totals by medicare Part D insurer;MCD – totals by medicare Part D insurer;

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Rejection CodesRejection Codes

Complete list of rejection codes is Complete list of rejection codes is located on the ftp site (NCPDP located on the ftp site (NCPDP folder)folder)

M/I = Means Missing/InvalidM/I = Means Missing/Invalid Rejection codes are NCPDP standard Rejection codes are NCPDP standard

codes used by processors. codes used by processors. Not all processors use the codes the Not all processors use the codes the

same way.same way.

Page 30: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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Rejection codesRejection codes

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Rejection – M/I BIN Rejection – M/I BIN PCN GroupPCN Group

REJECTION:REJECTION:MAR 28,2006 10:20 P06-610468-100173 `1050039/0 MAR 28,2006 10:20 P06-610468-100173 `1050039/0

1234512341212345123412

123456789 150 185.80 CARBAMAZEPINE123456789 150 185.80 CARBAMAZEPINE 04:M/I Processor Control Number04:M/I Processor Control Number

06:M/I Group Number06:M/I Group Number 01:M/I Bin01:M/I Bin

To Correct:To Correct:If commercial plan – contact processor help desk to verify BIN/PCN If commercial plan – contact processor help desk to verify BIN/PCN

and group number. and group number. For Medicare part D plan – try E1For Medicare part D plan – try E1

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Rejection – M/I BIN PCN Rejection – M/I BIN PCN GroupGroup

Patient Name: DEMO PATIENTPatient Name: DEMO PATIENT Status: AStatus: A Authorization #:Authorization #: Insurance Level: PRIMARYInsurance Level: PRIMARY BIN: 610468BIN: 610468 PCN: UAFCPCN: UAFC GROUP: 8310000GROUP: 8310000 CARDHOLDER ID: 123456789CARDHOLDER ID: 123456789 PERSON CODE: 1PERSON CODE: 1 PHONE NUMBER: 8006988394PHONE NUMBER: 8006988394

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Rejection – M/I BIN Rejection – M/I BIN PCN GroupPCN Group

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Rejection – M/I Rejection – M/I Transaction CodeTransaction Code Ø3: M/I Transaction CodeØ3: M/I Transaction Code

If this is a Medicare Part D If this is a Medicare Part D insurer, this usually means that a insurer, this usually means that a non-Medicare Part D format is non-Medicare Part D format is being used. Refer to Part D plans being used. Refer to Part D plans by BIN to find a different POS by BIN to find a different POS format.format.

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Rejection – M/I Birth Rejection – M/I Birth DateDate 09:M/I Birth Date09:M/I Birth Date

– Contact processor to determine which Contact processor to determine which birthdate they have in their system.birthdate they have in their system.

– For Medicare Part D patients – enter For Medicare Part D patients – enter birthdate information on page 4 of birthdate information on page 4 of Medicare Part D page.Medicare Part D page.

– To over-ride birth date field:To over-ride birth date field: POS / N / Override / Field 304POS / N / Override / Field 304 Enter birthdate as: YYYYMMDDEnter birthdate as: YYYYMMDD

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Rejection – 85: Claim Rejection – 85: Claim not processednot processed

MAR 23,2006 10:00 P06-610459-108961 `104700/1 MAR 23,2006 10:00 P06-610459-108961 `104700/1 0009306700500093067005

0123456 60 75.74 GEMFIBROZIL 600MG TAB0123456 60 75.74 GEMFIBROZIL 600MG TAB

85:Claim Not Processed85:Claim Not Processed

NN:Transaction Rejected At Switch Or IntermediaryNN:Transaction Rejected At Switch Or Intermediary

98:Connection98:Connection To Payer Is DownTo Payer Is Down

These type of rejections are more common with some of the These type of rejections are more common with some of the processors with the implementation of Medicare Part D. processors with the implementation of Medicare Part D.

Try Resubmitting the claim – POS / U / EV / 3 – Single Patient / RESTry Resubmitting the claim – POS / U / EV / 3 – Single Patient / RES

Page 37: RPMS POS Pharmacy Billing May 17, 2006. 2 Agenda POS Basics POS Basics Patient Registration, the Eligibility Transaction (E1) & Medicare Part D Patient

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Upcoming WebEx Upcoming WebEx SessionsSessions Registration required – up to 30 in each Registration required – up to 30 in each

classclass https://ihs-training.webex.com/https://ihs-training.webex.com/

– May 25 – Set up Insurers to POS formatMay 25 – Set up Insurers to POS format– May 26May 26thth – Rx Priority Points – Rx Priority Points– June 14June 14thth – Using the Claim Data Entry – Using the Claim Data Entry

ScreenScreen– June 28 – Establishing a Pharmacy Billing June 28 – Establishing a Pharmacy Billing

ProgramProgram– Welcome additional topicsWelcome additional topics

Train-the-Trainer – Area experts actively Train-the-Trainer – Area experts actively using POS – refer to Elmerusing POS – refer to Elmer


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Best Practices in Point-of-service (POS) Collections · Best Practices in Point-of-service (POS) Collections Jonathan G. Wiik, MSHA, MBA Director of Patient Access Boulder Community

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ESC/POS - · PDF fileesc/pos esc/pos esc/pos esc/pos esc/pos esc/pos esc/pos esc/pos esc/pos esc/ pos by using this document, you agree to abide by the terms of this agreement

Hereditary C7 Deficiency...tis (Strumpell-Marie) was made, and there is a pos-sibility that the patient maydevelop scleroderma. Medicalhistory ofthe twohomozygoussisters ofthe patient

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The Basics of Patient Safety How You Can Improve the Safety of Patient Care

34: Geriatric Assessment and Management. 1.Describe the following basics of patient assessment for the geriatric patient: Scene size-up Initial assessment

Module 5 Transcript · Use the basics of patient care to ensure patient safety, including protocols, venipuncture, contrast administration and informed consent

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Educational slide deck: The Basics of Patient Positioning

in the critically ill patient BASICS · 2016-10-18 · Lung ultrasound in the critically ill patient BASICS Rohit Patel, MD ... Basic terminology -- was a free field, made sure no

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Using Health Literacy Basics to Improve Interpretations, Translations, and Patient Outcomes

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