| DESCRIPTION OF ENHANCEMENTS |
This patch modifies the CMOP v2.0 application as described below:
where the software did not resubmit an electronic pharmacy claim
automatically when a claim rejected for a host processing error. The
following day the prescription was transmitted to CMOP as anticipated and
was filled. The claim did appear on the ECME User Screen so it could be
manually resubmitted, which is the process facilities followed before this
patch was installed. Based upon analysis, this is an infrequent scenario
(less than 1%) and will only occur in a particular set of circumstances.
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
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.
This issue has been corrected in this patch.
1. An entry was being added to the ECME LOG every time an Rx is evaluated
3. The system was allowing rejected Tricare prescriptions to be sent to
CMOP. Tricare rejected prescriptions should be held in suspense until
the reject has been resolved. This patch corrects this issue.
for ECME claim submissions and the Rx was flagged for Bad Address. A
modification was made to only allow the Rx to be evaluated for ECME claim
submission if a Bad Address indicator is not present.
2. There is a known issue where the system may not automatically resubmit
all claims rejected due to a host processing error. A test facility found
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