| DESCRIPTION OF ENHANCEMENTS |
DThis patch has enhancements which extend the capabilities of the Veterans
OUTPATIENT PHARMACY (OP) V. 7.0 PSO*7*289
The system will not hold a prescription for 3/4 days supply when:
- the previous fill was not ECME billable
- the Rx is flagged for SC or EI
- the DEA special Handling code is non billable (i.e. has M or 0
(zero) or (I, S, N, and/or 9)) without and E.
- the Rx is a zero fill on a renewal
- the patient does not currently have insurance
6. A modification was made to PRESCRIPTION file (#52), REJECT INFO
INTEGRATED BILLING (IB) V. 2.0 IB*2*384
sub-file (#52.25), CLARIFICATION CODE field (#24). This was a set of codes
field. It is now a pointer to file #9002313.25 (BPS NCPDP CLARIFICATION
CODE). A post install routine will go through the reject info subfile and
convert the old set of code values to the appropriate new pointer values.
The post install will send a mail message to the person installing the
build which details the affected rejected prescriptions. The 'Submit
Clarif. Code' protocol [PSO REJECT DISPLAY CLARIFICATION CODE] has been
altered to use the new pointer value.
7. The 'Edit NDC and DAW Code of Discontinued/Expired Prescriptions'
ELECTRONIC CLAIMS MANAGEMENT ENGINE (ECME) V. 1.0 BPS*1*7
functionality introduced in PSO*7.0*281 has been extended to also allow
edits of prescriptions with a status of DISCONTINUED BY PROVIDER and
DISCONTINUED (EDIT).
8. New functionality was added to create a nightly background mail
message regarding open/unresolved rejects on the reject worklist. The
'Third Party Payer Rejects - Nightly Message' option [PSO REJECTS
BACKGROUND MESSAGE] will be queued to run every 24 hours by the post
install routine. This option is intended to be a stand alone option and
should not be placed on any menu. The message will be delivered to the
'PSO REJECTS BACKGROUND MESSAGE' mailgroup; this mailgroup should be
populated with appropriate ePharmacy users to receive the information.
Mail messages are generated for each division. Sites may alter EPHARMACY
SITE PARAMETERS file (#52.86) REJECT WORKLIST DAYS field (#4) for each
division using the ePharmacy Site Parameters option [PSO EPHARM SITE
PARAMETERS] of the ePharmacy Menu. If no sites are defined in the
EPHARMACY SITE PARAMETERS file (#52.86), no message will be generated.
This parameter may be defined to be 1 to 30 days that an uncommented
reject can remain on the reject worklist without being included in the
nightly reject worklist alert mail message. The following are the
The last three patches (PSO*7*289, IB*2*384 and BPS*1*7) will be released
criteria for a reject to be included in the mail message:
a. The prescription is active, suspensed, expired, or on hold.
b. The prescription is unreleased.
c. The claim has been on the Reject Worklist for more days than the
value in the REJECT WORKLIST DAYS field for the division.
d. The claim has no comments added within the date range.
9. New functionality was added to allow NDC validation of third party
payable prescriptions by pharmacy technicians. Current functionality
in the Kernel Installation and Distribution System (KIDS) multi-build
requires a pharmacist to perform this task. In addition, for the
PRESCRIPTION file(#52) and the REFILL sub-file (#52.1), the DATE NDC
VALIDATED field (#83) and NDC VALIDATED BY field (#84) will be captured
when the NDC is validated for a prescription or refill; this validation
information will be displayed when prescriptions are released; if the NDCs
have not been validated, that information will be displayed instead. The
'NDC Validation' option [PSO NDC VALIDATE] has been added to the ePharmacy
Menu for use by technicians. The option will work as follows:
a. The technician will be prompted to scan or enter a prescription
distribution BPS PSO IB BUNDLE 3.0. Patches PSX*2*65 and PSS*1*131 will
number. An '^' may be entered to halt the option.
b. The system will evaluate the Rx. If the Rx NDC has already been
validated, the technician will be prompted if they wish to
revalidate. If the answer is yes, the technician will be allowed to
proceed. If the answer is no, the technician will be returned to
the select a prescription prompt.
c. If the Rx is CMOP, external interface or released, the user will
not be allowed to verify the Rx.
d. The system will display information about the Rx, notate that the
Rx has not been previously verified and will prompt for PRODUCT
be released as stand-alone patches. Since there is an implementation
NDC. A valid PRODUCT NDC must be entered for this prompt. Valid
PRODUCT NDC's are those defined for the drug in Drug file (#50) as
an NDC of a synonym or the default NDC.
e. The system will compare the Rx NDC to the PRODUCT NDC submitted on
the ePharmacy claim. If the NDCs do not match, the system will
reverse and resubmit a third party claim with the new NDC and
store the new NDC on the fill.
f. If the prescription is defined as TRICARE and is not payable, the
system will display an appropriate message and the technician will
be returned to the select a prescription prompt.
dependency between the multi-build distribution and the stand-alone
g. If the prescription is defined as TRICARE and the reversed claim
returns not payable, the system will display an appropriate
message and the technician will be returned to the select a
prescription prompt.
h. Otherwise, the system will update the NDC validation fields for the
Rx/Fill, and the technician will be returned to the select a
prescription prompt.
10. The RES - Resubmit Claim action was added to the Reject Information
(TRICARE) screen of the Third Party Payer Rejects - Worklist [PSO REJECTS
patches, PSX*2*65 and PSS*1*131 must be installed prior to the
WORKLIST] option.
11. The following functionality will work only if the REGISTRATION
package V.5.3 patch DG*5.3*688 that introduces the COUNTRY field to the
PATIENT file (#2) is installed:
When using the Print from Suspense File [PSO PNDLBL] option, if the
routing is MAIL and the address is Foreign, it will be treated just
like the BAD ADDRESS INDICATOR or DO NOT MAIL order where:
Health Information Systems and Technology Architecture (VistA) electronic
installation of the multi-build. For more specific instructions please
a. The prescription will not be sent to the automated filling equipment
and/or to the label printer. The fill will remain on suspense until
it is pulled early, the routing is changed to window, or the address
is changed.
b. For the first time attempt to print from suspense, an entry will be
added to the activity log and a MailMan message will be generated to
the user who queued the job to print from suspense and the members
of the PSO EXTERNAL DISPENSE ALERTS mail group.
refer to the installation steps provided in each of the patches.
12. When the NDC changes during auto-release of the prescription for CMOP
or OPAI fills, the fill date on the fill be updated to become the same as
the release date. An entry will be made in the activity log for the fill
to denote the changed date.
This patch modifies the Outpatient Pharmacy v7.0 application as described
below:
1. A modification was made to prevent users from entering a suspense date
that is greater than the fill date plus 90 days. Dates where the fill
date plus 90 days is greater than the expiration date will not be allowed.
pharmacy (ePharmacy) billing system. Below is a list of all the
2. Functionality to allow non-DUR/RTS reject to be placed on Third Party
Payer Rejects - Worklist [PSO REJECTS WORKLIST] option was added. To
accomplish this the following additions were made:
a. A new EPHARMACY SITE PARAMETERS FILE (#52.86) was added to store
ePharmacy specific parameters by division. Along with this file,
a new EPHARMACY SITE PARAMETERS [PSO ePHARM SITE PARAMATERS]
option was added for entry/edit of parameters. Regardless of any
parameters defined in this new file, Refill-Too-Soon (RTS), Drug
Utilization Review(DUR) and Tricare rejects will always be placed
applications involved in this project along with their patch number:
on the Pharmacy Reject Worklist.
Sites will have the ability to select to allow all third party
rejects to pass to the the Third Party Payer Rejects - Worklist
which is also referred to as the Pharmacy Reject Worklist or they
can choose to specify individual reject codes. Individual third
party reject codes can be defined to be automatically placed on
the worklist or defined to require OPECC intervention. If the site
chooses to allow all rejects to be placed on the worklist,
individual codes are overridden but not deleted from the file.
b. For display of non-DUR/RTS rejects for the Third Party Payer
Rejects - Worklist [PSO REJECTS WORKLIST] option, rejects passed
via OPECC manual intervention will be denoted in the comment
section of the Reject Information screen as:
- JUN 09, 2008@14:04:18 - Transferred by OPECC. (user,name)
Rejects passed automatically will be denoted in the comments
APPLICATION/VERSION PATCH
section of the Reject Information Screen as
- JUN 09, 2008@16:00:09 - Automatically transferred due to override
for reject code. (user,name)
All rejects other than Refill-Too-Soon, DUR, and Tricare will be
displayed at the end of the listing under "OTHER REJECTS"
header. The "OTHER REJECTS" header will be displayed regardless of
whether the GI - Group Insurance action is toggled on or off.
--------------------------------------------------------------
Non-DUR/RTS rejections will be resolved with the existing
functionality and will be resubmitted to ECME in the same manner
as DUR/RTS rejections.
3. A modification was made to not allow a claim to be reversed through
ECME for an unreleased CMOP fill when the prescription/fill is
discontinued. If the fill is either a CMOP released or Non-CMOP released
fill the reversal will be performed. Because the software already
performs a reversal for unsuccessful/not dispensed claims, no changes are
needed for reversing discontinued non-dispensed fills. Also, no changes
CONSOLIDATED MAIL OUTPATIENT PHARMACY (CMOP) V. 2.0 PSX*2*65
are needed when the NDC from CMOP differs from the NDC on the claim
because this function is already performed by existing software.
4. New functionality was added to prevent prescriptions from being
filled/sent to CMOP when a host processing error occurs when a claim is
submitted through ECME. The host processing errors are identified by
reject codes M6, M8, NN, and 99. The following conditions apply when this
scenario occurs.
a. The transmission of the Rx/fill will be delayed 1 day in hopes
PHARMACY DATA MANAGEMENT (PDM) V. 1.0 PSS*1*131
that the host processing issues will be resolved.
b. An activity log entry will be defined to state the date/time
along with a comment stating that the Rx/fill was left in suspense
hold due to a host processing error.
c. This added functionality does not include the Pull Early from
Suspense function.
5. New functionality was added to the Print from Suspense File [PSO
PNDLBL] option to prevent ePharmacy prescriptions from being pulled early
from suspense until 3/4 of the days supply of the Rx/fill has elapsed.
|
