| DESCRIPTION OF ENHANCEMENTS |
This patch is a follow up for Outpatient Pharmacy Clinical Indicator Data
and environmental indicator (EI) questions was not set correctly for non
charge to the patient's insurance carrier.
Note: The SC question is now asked for Veterans who are SC>49% in order to
determine if the Rx can be billed to a third party insurance. These
Veterans will NOT be charged a VA copay.
Supply and investigational drugs are not charged a VA copay but could be
reimbursable by third party insurance.
Enter message action (in IN basket): Ignore//
service connected (NSC) patients, as a result the following issues were
c. In CPRS, SC/EI related questions were not asked for supply items
and investigational drugs (remedy ticket 11421). CPRS and backdoor
Outpatient Pharmacy users will be required to complete SC/EI questions for
supplies and investigational drugs. Supply items and investigational drugs
could be reimbursable by third party insurance. Also, a VA copay will not
be charged for these.
2. During use of Complete Orders from OERR option [PSO LMOE FINISH], the
default answers for SC/EI's for CPRS SC>50% renewed orders were
reported:
occasionally displaying the previous orders answers during the finish
process. A modification was made to display the SC/EI information entered
during the CPRS renewal process. This anomaly was encountered during
unit testing, and there is no associated remedy ticket.
3. For renewal orders in Complete Orders from OERR option [PSO LMOE
FINISH] and Patient Prescription Processing option [PSO LM BACKDOOR
ORDERS], a message was erroneously displayed after the SC/EI prompts for
SC>50% prescriptions. The following is an example of the message
displayed when eligibility is changed or the user enters an up arrows (^)
at an outpatient classification prompt. Note that the bracketed
information can be SERVICE CONNECTED or NON SERVICE CONNECTED depending
upon the user's response to the question. Or if the user up arrows (^)
out of the prompt, the default answer determines the value.
Was treatment for a Service Connected condition? YES// ^
This Renewal has been designated as [SERVICE CONNECTED]
Please use the 'Reset Copay Status/Cancel Charges' option to
make corrections.
a. In CPRS, the SC related questions were incorrectly prompted for NSC
The "Please use the 'Reset Copay Status/Cancel Charges' option to make
corrections" sentence will no longer be displayed for supply items,
investigational drugs, and SC>50% patients. The first sentence will
remain in order to continue to inform the user of the answer stored for
the prompt. Note that similar messages are displayed for environmental
indicator prompts and this change applies to them. The associated remedy
tickets are 11393 and 113931.
4. For CPRS prescription orders finished using the Complete Orders from
OERR option [PSO LMOE FINISH] or the Patient Prescription Processing
patients, and it should not have done so. It should prompt SC/EI question
option [PSO LM BACKDOOR ORDERS], a copay related message was displayed for
SC>50% patients, supply items and investigational drugs. The following is
an example, and please note that bracketed information can be either COPAY
or NO COPAY depending on the providers response to the clinical indicator.
Do you want to enter a Progress Note? No// NO
SC Percent: 40%
Disabilities: NONE STATED
only if applicable.(remedy ticket 114219).
This Rx has been flagged by the provider as: [NO COPAY]
Was treatment for Service Connected condition? YES
The "This Rx has been flagged by the provider as: [COPAY/NO COPAY]"
message will no longer be displayed for SC>50% patients, supply items,
and investigational drugs. There is no associated remedy ticket.
5. When an edit that creates a new order is performed in Outpatient
Pharmacy, a message is displayed to notate that the orderable item was
changed. This message is displayed in the Complete Orders from OERR
[PSO LMOE FINISH] option and the Patient Prescription Processing option
[PSO LM BACKDOOR ORDERS]. The following is an example:
CARBAMAZEPINE 100MG TAB
PROVIDER,NAME PROVIDER,NAME
# of Refills: 3
The Pharmacy Orderable Item has changed for this order. Please
review any existing medication copay exemption defaults carefully
b. Holders of the PSO COPAY key, the ordering provider, and the finishing
for appropriateness.
SC Percent: 40%
Disabilities: NONE STATED
Was treatment for Service Connected condition? YES//
The above message has been modified to the following:
The Pharmacy Orderable Item has changed for this order. Please
pharmacist were receiving increased volumes of mailman messages in
review any existing SC or Environmental Indicator defaults carefully
for appropriateness.
Technical Description:
----------------------
The following correlates to each sequence in the Functional Description
above and the routines modified are shown in parentheses by each function:
1. The SCNEW^PSOCP API was returning PSOTG("SC")="" variable for NSC
patients which caused CPRS to erroneously prompt for them. Also due to
Capture (CIDC) patch PSO*7*143.
Outpatient Pharmacy. Mailman messages were incorrectly sent for NSC
this, Mailman messages for "RX COPAY STATUS REVIEW NEEDED" information was
sent in error for NSC prescriptions at release of the prescription. These
issues were corrected, and the PSOCPE routine was modified to show the
patient's eligibilities and disabilities as well as impart more accurate
information.
2. Modified renewal routines to always pull SC/EI information from the
data passed on the renewed order from CPRS (PSORENW1, PSORN52, PSORN52D).
This change affects renewals from CPRS and backdoor Outpatient Pharmacy
orders.
patients upon refill, new, and renewed orders (remedy ticket 114219).
3. For SC>50% prescriptions, supply items and investigational drugs,
eliminated the display of "Please use the 'Reset Copay Status/Cancel
Charges' option to make corrections." sentence (PSOCPB, PSOMLLD2,
PSOMLLDT), but it will continue to be displayed for SC<50% prescriptions.
4. For SC>50% prescriptions, supply items and investigational drugs,
eliminated the display of "This Rx has been flagged by the provider as:
[COPAY/NO COPAY]" (PSOCPB, PSONEWF, PSORN52). This message will continue
to be displayed for SC<50% patients.
These messages have been eliminated. Mailman messages will still be
5. For SC 0-100%, supply items and investigational drugs, modified the
wording of the message displayed when a prescription edit that creates a
new order is performed (PSOCPB, PSONEWF, PSONEWG).
generated for the following scenarios:
SC percentage
- age changed E/I question
Type to >0% added? Mailman Message sent?
--------- -------------- ------------- -------------------------
NSC N N N
NSC N Y Y only if question was
not answered before
the prescription is
released
NSC Y N/A Y if question was not
answered before the
prescription is
released
Functional Description:
SC=>0%<50% N/A Y Y however, NO mailman
message will be sent
if any SC/EI = YES
on the original
prescription
For SC>50% prescriptions and if patient has a new SC/EI added, the
appropriate questions will be asked upon RENEW or COPY of the
original prescription. At release, a MailMan message will not be sent
----------------------
if the patient, patient status, or drug is exempt from copay.
Because the information requested by these Mailman messages are used to
determine the final VA copay and/or insurance billable status, the text
and format has changed. The subject line was changed from "RX COPAY
STATUS REVIEW NEEDED" to "PRESCRIPTION QUESTIONS REVIEW NEEDED" and the
body of the message has additional information. Also, the eligibility and
disability information is now included after the patient name. The
following is an example:
This Outpatient Pharmacy patch PSO*7*219 corrects the following issues:
Subj: PRESCRIPTION QUESTIONS REVIEW NEEDED (800) [#164897] 10/07/05@13:39
37 lines
From: OUTPATIENT PHARMACY PACKAGE In 'IN' basket. Page 1 *New*
-------------------------------------------------------------------------
PATIENT,TEST (XXXX)
Eligibility: SC LESS THAN 50% SC%: 10
REIMBURSABLE INSURANCE
Disabilities: ARTHRITIS-10%(SC), FOREARM CONDITION-5%(NSC),
FOREARM CONDITION-4%(NSC), BENIGN EYE GROWTH-0%(NSC),
LOSS OF FIELD OF VISION-20%(SC),
Rx# #######B (1) NO COPAY
AMITRIPTYLINE 100MG
Due to a change in criteria, additional information listed below is needed
to determine the final VA copay and/or insurance billable status for this
Rx so that appropriate action can be taken by pharmacy personnel.
1. The Application Program Interface (API) that is provided to
Is this Rx for a Service Connected Condition?
Enter RETURN to continue or '^' to exit:
Subj: PRESCRIPTION QUESTIONS REVIEW NEEDED (800) [#164897] Page 2
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This message has been sent to the provider of record, the pharmacist who
Computerized Patient Record System (CPRS) with the service connection (SC)
finished the prescription order, and all holders of the PSO COPAY key.
Providers:
Please respond with your answer to the question(s) as a reply to this
message. The prescription will be updated by the appropriate staff.
Staff assigned to update the Prescription responses:
Please use the RESET COPAY STATUS/CANCEL CHARGES option to enter the
responses to the questions above, which may result in a Rx copay status
change and/or the need to remove VA copay charges or may result in a
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