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/

• 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, http://www.emdeon.com/tcc-rxweb– Handout – ftp link: ftp://ftp.ihs.gov/rpms/POS/

• Emdeon Folder – “Emdeon Web-Site”

POS Prerequisites

• References: 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: rpmshelp@ihs.gov

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 ReportPHARMACY ELECTRONIC CLAIMS INSURERS MAY 17,2006 01:17 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: 004336D-SILVERSCRIPT STANDARD 650.00 ----- Using electronic FORMAT: EXPRESS SCRIPTS 5.1 BIN: 003858BENEFIT PLANNERS, INC. STANDARD 5.00EXPRESS SCRIPTS,INC. STANDARD 20.00EXPRESS SCRIPTS STANDARD 20.00 ----- Using electronic FORMAT: GEHA 5.1 BIN: 610014GEHA/RX STANDARD 20.00

----- Using electronic FORMAT: PAID 5.1 BIN: 610014PAID PRESCRIPTIONS, L.L.C. STANDARD 20.00PAID 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 formatPOS / 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

See any problems?

Upcoming WebEx Sessions• Registration required – up to 30 in each class• https://ihs-training.webex.com/

– May 26th – Rx Priority Points– June 6th – POS Reports– June 14th – Using the Claim Data Entry Screen– June 28 – Establishing a Pharmacy Billing Program

• Welcome additional topics