| DESCRIPTION OF ENHANCEMENTS |
This is the Outpatient Pharmacy patch for the Transitional Pharmacy Benefit
wrong Outpatient Pharmacy prescription processing options, such as
provider the patient was not prescribed any medication, his/her
TPB eligibility remained active, when in reality it should have
been inactivated.
Solution: A Post-Install process will search for TPB eligible patients
and automatically inactivate the TPB eligibility of the
patients that fulfill both of the following
requisites:
a) Patient does not have any "active" TPB prescription(s) on
the Patient Prescription Processing [PSO LM BACKDOOR] option and Complete
file. The prescription statuses considered as "active"
are the following:
ACTIVE, NON-VERIFIED, HOLD, DRUG INTERACTIONS, SUSPENDED
and PROVIDER HOLD.
AND
b) Patient has had an appointment at a designated TPB Clinic
(determined through a set of clinic stop codes) since the
date his/her TPB benefit began.
Orders from OERR [PSO LMOE FINISH] option.
Report: At the end of this process, a Mailman message will be sent to
the new mail group PSO TPB GROUP. The patients reported on this
message were inactivated as TPB patients by the Post-Install
process The fields reported on this message are: PATIENT NAME,
LAST 4 DIGITS OF SSN, APPOINTMENT DATE/TIME, VA CLINIC NAME.
3) PATIENT'S TPB BENEFIT INACTIVATION (ENHANCEMENT - CONTINUOUS PROCESS)
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Outpatient Pharmacy software will be notified by the Scheduling software
every time a patient has an appointment at a VA clinic. If the patient
is eligible for the TPB benefit, the appointment was at a designated TPB
Clinic (determined through a set of clinic stop codes) AND the patient
does not have any "active" (see list of statuses on item #2a above) TPB
prescription(s) on file, this patient will have the TPB eligibility
automatically inactivated. A Mailman message will be sent to the PSO TPB
GROUP mail group with the following information:
The following patient had the TPB (Transitional Pharmacy Benefit)
Benefit automatically inactivated because the following appointment
b) Patients who did not wish to take advantage of the TPB benefit or who are
was found:
Patient : LAST,FIRST(9999)
VA Clinic : EAST MIDWAY CLINIC
Appointment Date: DEC 02, 2003@11:15
4) REPORT OF PATIENTS WITH TPB AND NON-TPB Rx's (NEW REPORT)
[PSO TPB PATIENT RX REPORT]
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This new report is being released as a stand-alone option. It will
not prescribed medication after a VA appointment are still active for
print a list of TPB eligible patients that have "active" TPB and
Non-TPB prescriptions on file. The report can be for ALL or selected
institutions, as well as for ALL or selected TPB patients. It will be
sorted by the INSTITUTION NAME first, then by the PATIENT NAME. There
will be a page-break for each individual institution. The column
headings on the report are: PATIENT NAME (LAST4SSN), VA Rx#, TPB Rx#,
DRUG NAME. This report should be assigned to the site TPB Coordinator,
Pharmacy ADPAC and any other individual deemed appropriate by the site.
In order to allow the unflagging of TPB prescriptions as described in 1)
the TPB benefit in the system. The inactivation of the TPB benefit is
above, the TPB RX (#201) field in the PRESCRIPTION (#52) file is being
changed from "UNEDITABLE" to "EDITABLE".
automatic when the last active TPB prescription is discontinued either
through an Outpatient Pharmacy package action or through an action taken
in CPRS. The entry of a prescription/order will not inactivate the
(TPB) project. This phase consists of automated processes and additional
benefit unless the result is that the last active TPB prescription is
discontinued as a result of the new entry.
This patch is comprised of four components that will help the sites identify
and fix the data discrepancies described above. It will also provide them
with new tools to monitor events that could have an impact on patient's TPB
eligibility. And in some cases the patient's TPB eligibity will be updated
automatically.
Below is a detailed description of each component:
tools designed to assist the sites for which Transitional Pharmacy Benefit
1) MARKING TPB PATIENT Rx's AS TPB (ONE-TIME PROCESS - POST INSTALL)
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Problem: Because some prescriptions have been entered through the
wrong menu options (see item a) above), these Rx's have not
been correctly identified as TPB prescriptions. In other
words, they have a different patient status than "NON-VA" AND
do not contain a TPB flag in PRESCRIPTION file (#52), and
therefore, are not identifiable as prescriptions filled
under the TPB program.
data have not been accurately reported.
Solution: A Post-Install process will search for prescriptions filled
under the TPB program which are not marked as such and
will mark these prescriptions as TPB. The two requisites
that must be fulfilled for a prescription to be marked as
TPB, are:
a) The prescription was entered during the period that
the patient's TPB benefit was active.
AND
b) The provider for the prescription is a "NON-VA"
provider.
If the requisites above are fulfilled, the following
updates will be done for the prescription:
a) Patient status will be changed to "NON-VA".
b) If an UNIQUE TPB clinic is identified (STOP CODE
Two of the most common events that have contributed to the discrepancies
equals 161) for the site, clinic will be changed to
this clinic.
c) The TPB flag will be set in PRESCRIPTION file (#52).
Report: At the end of this process, a Mailman message will be sent
to the newly created mail group called PSO TPB GROUP. The
patients reported on this message had at least one Prescription
edited by the Post-Install process. The sites will have the
ability to enter the coordinator of this new mail group at time
of installation of this patch. Even if the coordinator is not
in the TPB data are:
entered, this patch assures that at least the installer of the
patch is a member of the mail group. The fields reported on this
Mailman message are: PATIENT NAME(LAST4SSN), Rx#, DRUG NAME,
PROVIDER NAME, CLINIC (Old and New) and the Rx PATIENT STATUS
(Old and New).
Important: If the site identifies prescriptions on this report that
have been wrongly flagged as TPB, it is possible to manually
remove the TPB flag from such prescriptions through FileMan.
Just repeat the steps below for each prescription you wish
to remove the TPB flag (as in this example):
VA FileMan 22.0
Select OPTION: ENTER OR EDIT FILE ENTRIES
INPUT TO WHAT FILE: PRESCRIPTION
EDIT WHICH FIELD: ALL// TPB RX
THEN EDIT FIELD:
a) TPB prescriptions have been entered for TPB eligible patients via the
Select PRESCRIPTION RX #: 123457690A TYLENOL 250MG
TPB RX: YES// @
SURE YOU WANT TO DELETE? Y (Yes)
2) INACTIVATING PATIENT'S TPB BENEFIT (ONE-TIME PROCESS - POST INSTALL)
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Problem: Since not all patients eligible for the TPB program chose to
take advantage of the TPB benefit or, after seeing the VA
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