Linking Insurers to POS format (Setting up POS) May 25, 2006.
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Transcript of Linking Insurers to POS format (Setting up POS) May 25, 2006.
Linking Insurers to POS format (Setting up POS)
May 25, 2006
Agenda• Will review steps and information needed to
properly link the POS format to the Insurer.– Handout – ftp link: ftp://ftp.ihs.gov/rpms/POS/
• POS User folder – “Instructions to set-up_Insurer in POS”• POS User folder - POS Master List of Formats• Medicare Part D folder – “Setting up POS Format – Medicare
Part D”
• Review use of Emdeon Web Site, http://www.emdeon.com/tcc-rxweb– Handout – ftp link: ftp://ftp.ihs.gov/rpms/POS/
• Emdeon Folder – “Emdeon Web-Site”
POS Prerequisites
• References: ftp://ftp.ihs.gov/rpms/POS/• Current patches:
– POS v1 patch 16• POS v1 patch 17 in testing (includes railroad)
– APSA (AWP monthly patch)– Patient Reg v7.1 patch 1
• RPMS Support Desk: [email protected]
POS Format - Definition
• Built into the POS software• Designed from Payer Sheet
– Includes: BIN, PCN, help desk phone number, the type of provider number that will be transmitted (DEA versus Medicaid), the number of claims per transaction.
• Group number• Format name is usually the same as the
Emdeon Plan name.
Example of Payer Sheet
NCPDP fields
POS REPORTS
• These reports should be available when setting linking an insurer to POS format
• Know the RPMS Insurers that are set to transmit via POS
• POS / RPT / SET / SUMI• Review Rx Priority Points
SUMI ReportPHARMACY ELECTRONIC CLAIMS INSURERS MAY 17,2006 01:17 PAGE 1 Grace Ins. Disp Fee Per Sel.Insurer Pricing Formula Override Override Pts.--------------------------------------------------------------------------------
===== DIAL OUT to: ENVOY DIRECT VIA T1 LINE ----- Using electronic FORMAT: ADVANCE RX MGT SILVERSCRPT 5.1 BIN: 004336D-SILVERSCRIPT STANDARD 650.00 ----- Using electronic FORMAT: EXPRESS SCRIPTS 5.1 BIN: 003858BENEFIT PLANNERS, INC. STANDARD 5.00EXPRESS SCRIPTS,INC. STANDARD 20.00EXPRESS SCRIPTS STANDARD 20.00 ----- Using electronic FORMAT: GEHA 5.1 BIN: 610014GEHA/RX STANDARD 20.00
----- Using electronic FORMAT: PAID 5.1 BIN: 610014PAID PRESCRIPTIONS, L.L.C. STANDARD 20.00PAID PRESCRIPTIONS, INC. STANDARD 20.00
Survey by Insurer
Linking the Insurer to POS format
Need the following:- Name of insurer (from Business office or
SURVEY by INSURER report- POS Format Name – to determine, need
to know:- BIN & PCN- Look up on POS Master list
- If not found, look on Emdeon web site
Emdeon Web Site
Three Steps to Link POS formatPOS / MGR / SET / INS /
* 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
See any problems?
Upcoming WebEx Sessions• Registration required – up to 30 in each class• https://ihs-training.webex.com/
– May 26th – Rx Priority Points– June 6th – POS Reports– June 14th – Using the Claim Data Entry Screen– June 28 – Establishing a Pharmacy Billing Program
• Welcome additional topics