2010 UBO/UBU Conference Health Budgets & Financial Policy Briefing: E-billing for Pharmacy Date: 23 March 2010 Time: 1610 – 1700

2010 UBO/UBU Conference Turning 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 2

2010 UBO/UBU Conference Turning Knowledge Into Action 3 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 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 Conference Turning 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 4

2010 UBO/UBU Conference Turning 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) 5

2010 UBO/UBU Conference Turning Knowledge Into Action Filtering for an NCPDP Claim 6

2010 UBO/UBU Conference Turning Knowledge Into Action CMS1500 Claim with NCPDP data 7

2010 UBO/UBU Conference Turning Knowledge Into Action NCPDP Tab 8

2010 UBO/UBU Conference Turning 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 9

2010 UBO/UBU Conference Turning Knowledge Into Action How to Make Corrections in ePREMIS Discussion 10

2010 UBO/UBU Conference Turning Knowledge Into Action 11 Show me the money