| $$FIND(RX,RFL,REJDATA,CODE,BESC,RRRFLAG) |
This API returns whether a specific prescription/fill
has any OPEN/UNRESOLVED rejects. If so, it can also return the information
about the reject.
|
| VARIABLES |
TYPE |
VARIABLES DESCRIPTION |
RX |
Input |
Pointer to the PRESCRIPTION file (#52).
|
RFL |
Input |
Pointer to the REFILL multiple (#52.1) in the
PRESCRIPTION file (#52).
|
REJDATA |
Output |
Array contains the Reject(s) data:
REJDATA("FIELD")=VALUE
"CODE" - Reject Code (79 or 88)
"DATE/TIME" - DATE/TIME Reject was detected
"PAYER MESSAGE" - Message returned by the payer
"REASON" - Reject Reason description (from payer)
"INSURANCE NAME" - Patient's Insurance Company Name
"GROUP NAME" - Patient's Insurance Group Name
"GROUP NUMBER" - Patient's Insurance Group Number
"CARDHOLDER ID" - Patient's Insurance Cardholder ID
"PLAN CONTACT" - Plan's Contact (eg., "1-800-...")
"PLAN PREVIOUS FILL DATE" - Last time Rx was paid by payer
"STATUS" - REJECTS status ("OPEN/UNRESOLVED" or "CLOSED/RESOLVED")
"DUR TEXT" - Payer's DUR description
"OTHER REJECTS" - Other Rejects on the same response
If REJECT is closed, the following fields will be returned:
"CLOSED DATE/TIME" - DATE/TIME Reject was closed
"CLOSED BY" - Name of the user responsible for closing Reject
"CLOSE REASON" - Reason for closing Reject (text)
"CLOSE COMMENTS" - User entered comments
|
CODE |
Input |
This specify which reject code should be looked for
(e.g., 79, 88).
|
$$FIND |
Output |
Returns 1 if a DUR/REFILL TOO SOON reject was found
for the prescription/fill passed in. Otherwise, returns 0 (zero).
|
BESC |
Input |
This specifies that RX is TRICARE/CHAMPVA and ECME
status check for refills is not performed.
|
RRRFLAG |
Input |
Pass a 1 in this parameter to also look for any
unresolved Reject Resolution Required (RRR) rejects when CODE is also passed.
If CODE is not passed in, then pass a 1 to ONLY look for unresolved RRR
rejects.
The default is 0 if not passed.
|
|
SYNC(RX,RFL,USR,RXCOB) |
This API is used to synchronize the information about
DUR and REFILL TOO SOON rejects from third party payers between Outpatient
Pharmacy and ECME. It should be called by ECME every time it receives a
response from a third party payer.
|
| VARIABLES |
TYPE |
VARIABLES DESCRIPTION |
RX |
Input |
Pointer to the PRESCRIPTION file (#52).
|
RFL |
Input |
(Optional) Pointer to the REFILL multiple (#52.1) in
the PRESCRIPTION file (#52). If this information is not passed, the latest
fill for the prescription is assumed.
|
USR |
Input |
(Optional) User using the system when this API is
called.
|
RXCOB |
Input |
(Optional) Coordination of benefits indicator may
contain a value of 1 (one) for primary, 2 (two) for secondary, or 3 (three)
for tertiary.
|
|
CLSALL(RX,RFL,USR,REA,COM,COD1,COD2,COD3,CLA,PA) |
This procedure closes any open/unresolved rejects on
the REJECT INFO sub-file (52.25) of the PRESCRIPTION file (52).
|
| VARIABLES |
TYPE |
VARIABLES DESCRIPTION |
RX |
Input |
Prescription, pointer to file 52.
|
RFL |
Input |
Refill #, 0 if original fill. If not passed, the
most recent fill will be used.
|
USR |
Input |
The DUZ of the user to be cited as closing the
rejects.
|
REA |
Input |
Close reason code.
|
COM |
Input |
Close comments.
|
COD1 |
Input |
First set of DUR overrides, in the format of Reason
Code ^ Professional Service Code ^ Result Code
|
COD2 |
Input |
Second set of DUR overrides, in the format of Reason
Code ^ Professional Service Code ^ Result Code
|
COD3 |
Input |
Third set of DUR overrides, in the format of Reason
Code ^ Professional Service Code ^ Result Code
|
CLA |
Input |
NCPDP Submission Clarification Code.
|
PA |
Input |
NCPDP Prior Authorization code.
|
|
