Linking Insurers to POS format (Setting up POS) May 25, 2006

Agenda Will review steps and information needed to properly link the POS format to the Insurer. –Handout – ftp link: ftp://ftp.ihs.gov/rpms/POS/ftp://ftp.ihs.gov/rpms/POS/ POS User folder – “Instructions to set-up_Insurer in POS” POS User folder - POS Master List of Formats Medicare Part D folder – “Setting up POS Format – Medicare Part D” Review use of Emdeon Web Site, –Handout – ftp link: ftp://ftp.ihs.gov/rpms/POS/ftp://ftp.ihs.gov/rpms/POS/ Emdeon Folder – “Emdeon Web-Site”

POS Prerequisites References: ftp://ftp.ihs.gov/rpms/POS/ftp://ftp.ihs.gov/rpms/POS/ Current patches: –POS v1 patch 16 POS v1 patch 17 in testing (includes railroad) –APSA (AWP monthly patch) –Patient Reg v7.1 patch 1 RPMS Support Desk:

POS Format - Definition Built into the POS software Designed from Payer Sheet –Includes: BIN, PCN, help desk phone number, the type of provider number that will be transmitted (DEA versus Medicaid), the number of claims per transaction. Group number Format name is usually the same as the Emdeon Plan name.

Example of Payer Sheet

NCPDP fields

POS REPORTS These reports should be available when setting linking an insurer to POS format Know the RPMS Insurers that are set to transmit via POS POS / RPT / SET / SUMI Review Rx Priority Points

SUMI Report PHARMACY ELECTRONIC CLAIMS INSURERS MAY 17, :17 PAGE 1 Grace Ins. Disp Fee Per Sel. Insurer Pricing Formula Override Override Pts ===== DIAL OUT to: ENVOY DIRECT VIA T1 LINE Using electronic FORMAT: ADVANCE RX MGT SILVERSCRPT 5.1 BIN: D-SILVERSCRIPT STANDARD Using electronic FORMAT: EXPRESS SCRIPTS 5.1 BIN: BENEFIT PLANNERS, INC. STANDARD 5.00 EXPRESS SCRIPTS,INC. STANDARD EXPRESS SCRIPTS STANDARD Using electronic FORMAT: GEHA 5.1 BIN: GEHA/RX STANDARD Using electronic FORMAT: PAID 5.1 BIN: PAID PRESCRIPTIONS, L.L.C. STANDARD PAID PRESCRIPTIONS, INC. STANDARD 20.00

Survey by Insurer

Linking the Insurer to POS format Need the following: -Name of insurer (from Business office or SURVEY by INSURER report -POS Format Name – to determine, need to know: -BIN & PCN -Look up on POS Master list -If not found, look on Emdeon web site

Emdeon Web Site

Three Steps to Link POS format POS / MGR / SET / INS / * PHARMACY POINT OF SALE V1.0 * * * * Edit Pharmacy POS Insurance settings * ******************************************** SYS Insurance selection parameters (system-wide) 1. INS Quick setup of insurer 2. ADV Advanced setup of insurer 3. RPMS Enter/edit RPMS Insurance file RX settings SUMI POS Setup - Summary of Insurers

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Upcoming WebEx Sessions Registration required – up to 30 in each class –May 26 th – Rx Priority Points –June 6 th – POS Reports –June 14 th – Using the Claim Data Entry Screen –June 28 – Establishing a Pharmacy Billing Program Welcome additional topics