Chapter 2 Billing

7/31/2019 Chapter 2 Billing

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CHAPTER 2 CUSTOMER SERVICE/BILLING

2.1 BILLING

The job of the Customer Service Department is to interact with patients to ensure a

pleasant experience while using our products and services. We do this by filling

prescriptions accurately and in a timely manner. Customer Service also answers customers

questions regarding delivery times and copay amounts as well as gathering insurance

information to aid in the billing process.

The next few pages are merely a guide to aid you in the process of filling a prescription.

There will be situations that occur that we could not cover in this manual. It will be very

important that you take very good notes while working with you Trainer, there are very few

situations that they have not encountered, so their leadership will be vital to your learning

of the belling process.

The Billing Department is Managed by Jose Otero with 4 Trainers Valerie Baird, Cathy

Grissom, Bridget Jackson and Nicole Adams. You will be assigned to one of them and should

direct questions you have to them even after your training period.


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To start the billing process you will first go to Intake and sign out some Red Bins to work

with. Make sure to match the Date of Birth of the prescription to the Date of Birth on theclipboard and initial next to the Date of Birth for each Bin you take.

The next step is to scan each prescription into OPCTrack as soon as you return to your

station. You should then carefully read over each prescription and their demographics for

any pertinent information. If you notice that the prescription is a Workers Compensation

Claim IMMEDIATELY take that prescription to an Injury Claims Team member. There are

certain things that must be done to process that type of claim and they are trained in that

area of claims processing.

Make sure you cursor is located in the upper right box before scanning the prescription.

After you scan the prescription select, Received into Customer Care.


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After you have scanned all of the prescriptions you will then go to the Compounder page.

Select Patient Rx. When box opens enter the DOB from the paper copy of prescription.

At this screen choose the name that matches the name on the paper copy.


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Select F3 when screen appears to get to next screen, you will have a window that pops up

saying Prescription has scanned image do you want to view just click no. You may also

have a window that reads Patient has Note ALWAYS!! view the note.


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You will now begin the process of entering insurance information. First select the pencil

next to the patient name.

Then you will select the Insurances tab #3


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After locating the BIN number return to this screen to enter the number in this box.

Most BIN numbers will have multiple PCNs to choose from as you grow more accustomed to

the different companies you will be able to determine the correct one to choose.


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Fill in the Group and ID numbers and Relationship Code then save the information.

After you save the Insurance information you will be brought to the Patient information

screen. Select F3 to move to the next screen, and then select the Dispensed Tab to move to

the next step.


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Here you will check the Quantity Dispensed and Days Supply match what is on the

prescription. Make sure the Total Price does not exceed $1299.00. Insurance and Shipping

are entered correctly. Shipping should be 2nd

day UPS.

***Important***

Double check the total cost before saving this screen sometimes it will change when you

enter the Insurance information.


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Next go to the Compounds Tab# 3.

Here you will set Dosage description to Cream, Unit Form Indicator is set to Grams, and DUR

should be set to 3. When all these are set to the correct setting you are ready to Transmit

the Claim.


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If you get a Claim Rejected be sure to View Results to see why it was rejected. There will be

a variety of reasons the claim is rejected and you may need to either call the Patient, Doctor

or even the Patients local Pharmacy to get the information you need to process the claim.

This is what the screen will look like when you have a Paid Claim. Make sure it is not 100%

copay and Accept Payment.


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You will select the charge button to charge the Patient their copay.

Here is where you will be able to change the copay amount, you will learn more about this

process during your training. After setting the copay then click save and just follow the

prompts and you will print a prescription label and invoice.

After you have printed the invoice and prescription label you have a few more steps to

complete before transferring the prescription on to Shipping.


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First you will need to pull up the Tracker section of the PK Compounder page, and then scan

the barcode on your badge then the small barcode on the prescription label shown in the

next image. You will then need to go to OPCTrack for the last few steps.


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At the OPCTrack page you will place the cursor into the upper right box and scan the large

barcode on the back of the faxed copy of the prescription. Then you will change the Status to

Sent to Shipping and Labeling. You will then select the green arrow to finish your Open Tasks

and to finish you will select the Edit Order button.

Here you will place the cursor into the RX Number line and scan the large barcode at the

bottom of the prescription.


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You have now completed this phase of the process you will now place the invoice, prescription

label and faxed copy of the prescription all three into a green bin and transfer them to the

Shipping team.


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Documents

Chapter 2 Billing