2010 UBO/UBU Conference Title: MEPRS Strategic Plan Update Session: W-4-0800.
2010 UBO/UBU Conference Health Budgets & Financial Policy Briefing: E-billing for Pharmacy Date: 23...
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Transcript of 2010 UBO/UBU Conference Health Budgets & Financial Policy Briefing: E-billing for Pharmacy Date: 23...
2010 UBO/UBU Conference
Health Budgets & Financial Policy Briefing: E-billing for Pharmacy
Date: 23 March 2010
Time: 1610 – 1700
2010 UBO/UBU ConferenceTurning Knowledge Into Action Objectives
Preparing a pharmacy claim for electronic submission
What happens after the claim is transferred to ePREMIS©
What happens after claims are returned from the clearinghouse
How to make corrections in ePREMIS
Show me the money
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2010 UBO/UBU ConferenceTurning Knowledge Into Action
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Preparing a Pharmacy Claim for Electronic Submission
Contact the EDI in the insurance company– Ensure that your MTF Tax number is on file and that
your NPI number is correct Make sure you have TPOCS 3.1.6.RX BIN
– Pharmacy Payer Identification Number– This number is used to route NCPDP Pharmacy
Claims to the correct payer After saving the claim, ensure that the file has
transmitted to ePremis. Make sure that the form type is PHARM. Click Transmit and a batch number will appear; click OK. Print the batch report
2010 UBO/UBU ConferenceTurning Knowledge Into Action Payer Alias
Must be setup in the Payer Alias and tied to ‘NCPDP’ Payer name Payer name must start with NCPDP as first 5 characters in name
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2010 UBO/UBU ConferenceTurning Knowledge Into Action
What Happens After the Claim Is Transferred to ePREMIS
Open ePremis Use same procedures as when you are selecting clinic
claims for review (see example) Select the NCPDP claims, then click “view claims” (see
example) Review claims (same as with clinics) Most common errors: No BIN, wrong relationship code,
wrong vendor selected in TPOCS (see example) Release to clearinghouse (same as with clinics)
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2010 UBO/UBU ConferenceTurning Knowledge Into Action When Claims Return from the Clearinghouse
Next day, a report will be available (Claim Status History – All Codes – Filter: Z-NCPDP Released Claims)
Print and review. Look for any rejections (Refill too soon, Prior authorization, Exceeded supply limitations, Coverage terminated, etc.)
Correct errors Corrections are made throughout the claim using the
same process as clinic claims Make corrections and then release claims
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2010 UBO/UBU ConferenceTurning Knowledge Into Action How to Make Corrections in ePREMIS
Discussion
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