medicare part d - setting up insurer in pos you will need: * name of medicare part d insurer, i.e. d-humana standard *

Medicare Part D - Setting up Insurer in POS
You will need:
*
Name of Medicare Part D insurer, i.e. D-HUMANA STANDARD
*
POS Format Name, i.e. refer to either POS format list or Emdeon
web site ftp://ftp.ihs.gov/rpms/POS/; for this example, the format
for this insurer is CAREPLUS HP HUMANA PDP 5.1
*
Patient Registration v7.1 patch 1 and prerequisite patches (AUT*98.1*18
& AUPN*99.1*16)
*
POS version 1 patch 16
*
POS Manager Menu
*
Outpatient Pharmacy Manager Menu
********************************************
* PHARMACY POINT OF SALE V1.0 *
* *
* Main Menu *
********************************************
U Pharmacy POS User Menu ...
MGR Pharmacy POS Manager Menu ...
BILL RX Point of Sale Billing Menu ...
RPT Pharmacy electronic claims reports ...
Select Pharmacy Point of Sale Option: MGR Pharmacy POS Manager Menu
********************************************
* PHARMACY POINT OF SALE V1.0 *
* *
* Manager Menu *
********************************************
SET Pharmacy Point of Sale Setup Menu ...
MGR Statistics & misc. options screen...
RPT Pharmacy electronic claims reports ...
COMM Communications - View Dial Out Log File
BACK Pharmacy POS background scan ...
USER Claims data entry screen...
TEST Test it (send claim, receive response)
Select Pharmacy POS Manager Menu Option: SET Pharmacy Point of Sale
Setup Menu
A. Setting up the RPMS Insurer with the correct POS Format
********************************************
* PHARMACY POINT OF SALE V1.0 *
* *
* Pharmacy Point of Sale Setup Menu *
********************************************
BAS Edit basic pharmacy POS parameters
ILC Edit pharmacy POS ILC A/R settings
DIAL Edit pharmacy POS dial out settings ...
PHAR Edit pharmacy POS pharmacy data
INS Edit Pharmacy POS Insurance settings ...
USER Edit pharmacy POS user preferences
BILL Unbillable/Billable POS items menu ...
PRI Enter/edit Pricing formulas
MISC Miscellaneous setup programs ...
PROV Enter/Edit providers' ID #s
SUMI POS Setup - Summary of Insurers
SETD POS Setup - Detailed Report
Select Pharmacy Point of Sale Setup Menu Option: INS Edit Pharmacy POS
Insurance settings
********************************************
* PHARMACY POINT OF SALE V1.0 *
* *
* Edit Pharmacy POS Insurance settings *
********************************************
SYS Insurance selection parameters (system-wide)
INS Quick setup of insurer
ADV Advanced setup of insurer
RPMS Enter/edit RPMS Insurance file RX settings
SUMI POS Setup - Summary of Insurers
Select Edit Pharmacy POS Insurance settings Option: INS Quick setup of
insurer
Select ABSP INSURER NAME: D-HUMANA STANDARD KENTUCKY 40202
Are you adding 'D-HUMANA STANDARD' as a new ABSP INSURER (the 3RD)?
No// Y
(Yes)
Select the electronic claim FORMAT
RX - NCPDP Record Format: CARE
1 CAREMARK
2 CAREMARK 5.1
3 CAREPLUS HP HUMANA PDP 5.1
CHOOSE 1-3: 3 CAREPLUS HP HUMANA PDP 5.1
Select the PRICING METHOD
RX - PRICING METHOD: STANDARD//
Select ABSP INSURER NAME:
B. Assigning Priority Points:
This ensures that POS uses the Medicare Part D insurer in case the
cardholder also has active Medicaid, Medicare or a private insurance
(for billing non-pharmacy plans) set up on page 4 of Patient
Registration.
SYS Insurance selection parameters (system-wide)
INS Quick setup of insurer
ADV Advanced setup of insurer
RPMS Enter/edit RPMS Insurance file RX settings
SUMI POS Setup - Summary of Insurers
Select Edit Pharmacy POS Insurance settings Option: ADV Advanced setup
of insurer
Select ABSP INSURER NAME: D-HUMANA STANDARD
NAME: D-HUMANA STANDARD//
RX - NCPDP Record Format: CAREPLUS HP HUMANA PDP 5.1
//
RX - DIAL OUT TO:
RX - PRICING METHOD: STANDARD//
RX - Dispensing Fee:
GRACE PERIOD:
RX - Help Telephone #:
RX PRIORITY: 650 (A minimum of 605 points will be needed because the
base points for Medicare 300; Private insurance base = 900)
WORKERS COMP INSURANCE:
Select ABSP INSURER NAME:
SYS Insurance selection parameters (system-wide)
INS Quick setup of insurer
ADV Advanced setup of insurer
RPMS Enter/edit RPMS Insurance file RX settings
SUMI POS Setup - Summary of Insurers
C. Change the RX BILLING STATUS
Select Edit Pharmacy POS Insurance settings Option: RPMS Enter/edit
RPMS Insurance file RX settings
Select INSURER NAME: D-HUMANA STANDARD KENTUCKY 40202
...OK? Yes// (Yes)
RX BILLING STATUS: P BILLED POINT OF SALE
Select INSURER NAME:
SYS Insurance selection parameters (system-wide)
INS Quick setup of insurer
ADV Advanced setup of insurer
RPMS Enter/edit RPMS Insurance file RX settings
SUMI POS Setup - Summary of Insurers
D. Verify list of RPMS Insurers that are set up to transmit via RPMS
POS
Select Edit Pharmacy POS Insurance settings Option: SUMI POS Setup -
Summary of Insurers
DEVICE: Virtual Right Margin: 80//
...EXCUSE ME, LET ME THINK ABOUT THAT A MOMENT….
PHARMACY ELECTRONIC CLAIMS INSURERS JAN 5,2006 09:58 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: CAREPLUS HP HUMANA PDP 5.1
BIN: 610649
D-HUMANA STANDARD STANDARD 650.00
----- Using electronic FORMAT: RX AMERICA 5.1
BIN: 610473
ARIZONA MEDICAID STANDARD
----- Using electronic FORMAT: SIERRA HEALTH SERVICES 5.1
BIN: 007382
HEALTH PLAN OF NEVADA STANDARD 5.00
4
4/20/2006

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