2010 UBO/UBU Conference

Health Budgets & Financial Policy Briefing: E-billing for Pharmacy

Date: 23 March 2010

Time: 1610 – 1700

2010 UBO/UBU ConferenceTurning Knowledge Into Action Objectives

Preparing a pharmacy claim for electronic submission

What happens after the claim is transferred to ePREMIS©

What happens after claims are returned from the clearinghouse

How to make corrections in ePREMIS

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2010 UBO/UBU ConferenceTurning Knowledge Into Action

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Preparing a Pharmacy Claim for Electronic Submission

Contact the EDI in the insurance company– Ensure that your MTF Tax number is on file and that

your NPI number is correct Make sure you have TPOCS 3.1.6.RX BIN

– Pharmacy Payer Identification Number– This number is used to route NCPDP Pharmacy

Claims to the correct payer After saving the claim, ensure that the file has

transmitted to ePremis. Make sure that the form type is PHARM. Click Transmit and a batch number will appear; click OK. Print the batch report

2010 UBO/UBU ConferenceTurning Knowledge Into Action Payer Alias

Must be setup in the Payer Alias and tied to ‘NCPDP’ Payer name Payer name must start with NCPDP as first 5 characters in name

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2010 UBO/UBU ConferenceTurning Knowledge Into Action

What Happens After the Claim Is Transferred to ePREMIS

Open ePremis Use same procedures as when you are selecting clinic

claims for review (see example) Select the NCPDP claims, then click “view claims” (see

example) Review claims (same as with clinics) Most common errors: No BIN, wrong relationship code,

wrong vendor selected in TPOCS (see example) Release to clearinghouse (same as with clinics)

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Filtering for an NCPDP Claim

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2010 UBO/UBU ConferenceTurning Knowledge Into Action CMS1500 Claim with NCPDP data

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2010 UBO/UBU ConferenceTurning Knowledge Into Action NCPDP Tab

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2010 UBO/UBU ConferenceTurning Knowledge Into Action When Claims Return from the Clearinghouse

Next day, a report will be available (Claim Status History – All Codes – Filter: Z-NCPDP Released Claims)

Print and review. Look for any rejections (Refill too soon, Prior authorization, Exceeded supply limitations, Coverage terminated, etc.)

Correct errors Corrections are made throughout the claim using the

same process as clinic claims Make corrections and then release claims

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2010 UBO/UBU ConferenceTurning Knowledge Into Action How to Make Corrections in ePREMIS

Discussion

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2010 UBO/UBU ConferenceTurning Knowledge Into Action

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