$TXT Created by ZEIGLER,EDWARD L at SUPVBB.FO-ALBANY.MED.VA.GOV (KIDS) on Tuesday, 06/10/08 at 18:07 ============================================================================= Run Date: SEP 17, 2008 Designation: IB*2*383 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #368 Status: Released Compliance Date: OCT 18, 2008 ============================================================================= Associated patches: (v)IB*2*363 <<= must be installed BEFORE `IB*2*383' (v)IB*2*370 <<= must be installed BEFORE `IB*2*383' (v)BPS*1*6 <<= must be installed BEFORE `IB*2*383' Subject: ePHARMACY TRICARE SUPPORT FRAMEWORK Category: - Routine - Enhancement (Mandatory) - Data Dictionary Description: ============ This patch is one of four patches to enhance the ePharmacy software, to provide the framework to support Tricare and Active Duty outpatient pharmacy billing. The Tricare/Active Duty portions of this software enhancement will not be active until a future patch is released. The release of the additional patch is pending the CBO and contracting with the Tricare Fiscal Intermediary. Below is a list of all the applications involved in this project along with their associated patch number: APPLICATION/VERSION PATCH -------------------------------------------------------------- 1. CONSOLIDATED MAIL OUTPATIENT PHARMACY (CMOP) V. 2.0 PSX*2*66 2. OUTPATIENT PHARMACY (OP) V. 7.0 PSO*7*287 3. ELECTRONIC CLAIMS MANAGEMENT ENGINE (ECME) V. 1.0 BPS*1*6 4. INTEGRATED BILLING (IB) V. 2.0 IB*2*383 All four patches are being released separately with a requirement that they be installed in the order outlined above. It is important that all four patches be installed completely one right after the other. If they are not, you may see errors occur during the Outpatient prescription entry process. There are no other dependencies between these patches, except that Tricare/Active Duty billing will not be supported by ePharmacy until all 4 patches are installed. All sites should install these patches regardless of whether or not their site has been activated for ePharmacy by the Central Business Office (CBO) or are providing outpatient pharmacy services to Tricare or Active Duty patients. After the installation of these patches, the activation status of the site will not be impacted. Activation of the ePharmacy product will require instructions provided by the CBO. Sites are not to activate ePharmacy unless instructed specifically by the CBO. Also, sites should not start to provide outpatient pharmacy services to Tricare without discussions with the CBO. This patch modifies the IB v2.0 application as described below. The modifications are labeled dormant in the software will remain inactive until the future Tricare patch is released. 1. Billing Determination (dormant) ------------------------- Prior to this patch only patients with a primary eligibility type of Veteran were considered eligible for ePharmacy billing. This patch adds functionally to consider both Tricare and Sharing Agreement (Active Duty) patients eligible for ePharmacy billing. The patient must have ONLY Tricare or Sharing Agreement eligibility and have a Group Insurance Plan type of Tricare ONLY. The ePharmacy payer sheet must be linked to the group insurance plan and the payer sheet must be active at the local site, Integrated Billing will now consider these patients ePharmacy billable. This will encompass the sites that are approved for Tricare pharmacy billing and all sites if set up for Active Duty pharmacy billing. There will be an additional check to prevent ECME back billing of claims that have previously been billed through the legacy RNA or Class III systems. 2. Billing Rates (dormant) ----------------- For billable claims, when ECME calls Integrated Billing, IB will return the appropriate billing rates to ECME. The billing unit cost will be based on the current drug cost based upon the NDC plus a dispensing fee that is currently eight dollars. The computed gross amount is passed back to ECME as part of the TRICARE Pharmacy Billing Message (PBM) insurance data. 3. 3rd and 1st Party Bills (dormant) --------------------------- Upon receipt of PAID claim information, IB will create the appropriate 3rd and 1st party bills. Appropriate Billing Rates are pre-determined during the billable status check (ie Reimbursable or Tricare). 3rd and 1st party bills will only be established if there is an amount due for each of them. Example: Active Duty patients currently have a $0.00 copayment, therefore no 1st party bill would be established. 4. Charge Master Update ------------------------ Installation of this patch, will update the Charge Master with nationally standard VA Cost Charge Sets and Rate Schedules, inactivating locally created ones, for both Prescription and Prosthetic cost. The new nationally standard VA Cost Charge Sets are: RX COST PI COST The new nationally standard Rate Schedules for Tricare Pharmacy are: TR-RX (Tricare) TRRI-RX (Tricare Reimbursable Insurance) After install is completed you should review any locally created or modified Charge Sets and Rate Schedules. This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- There is no NSR associated with this patch. This patch addresses the following Remedy Ticket(s): ---------------------------------------------------- There are no Remedy tickets associated with this patch. Components Sent With Patch -------------------------- The following is a list of files included in this patch: UP SEND DATA USER DATE SEC. COMES SITE RSLV OVER FILE # NAME DD CODE W/FILE DATA PTS RIDE ------------------------------------------------------------------------ 366.14 IB NCPDP EVENT LOG YES NO NO NO Partial DD: subDD: 366.141 fld: .311 DATA SCREEN: 366.15 IB NCPDP PRESCRIPTION YES YES NO Test Sites: ----------- HEARTLAND WEST HCS LOUISVILLE,KY SAGINAW, MI ================== INSTALLATION INSTRUCTIONS ================== If installed during the normal workday, it is recommended that the following selection(s) in the OPTION (#19) file, and all of their descendants be disabled to prevent possible conflicts while running the KIDS Install. Other VISTA users will not be affected. - None Install time - less than 2 minutes. 1. LOAD TRANSPORT GLOBAL --------------------- Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. START UP KIDS ------------- Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: INStallation --- Load a Distribution Print Transport Global Compare Transport Global to Current System Verify Checksums in Transport Global Install Package(s) Restart Install of Package(s) Unload a Distribution Backup a Transport Global 3. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter IB*2.0*383): a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DD's, templates, etc.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 4. Select Installation Option: Install Package(s) ------------------ **This is the step to start the installation of this KIDS patch: a. Choose the Install Package(s) option to start the patch install. b. When prompted "Want KIDS to INHIBIT LOGONs during the install? NO//" answer NO c. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer NO. 5. Clean-up Post-Init Routine -------------------------- Optional - Once this patch has been successfully installed you may delete the post init routine: IB20P383 Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 11 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IB20P383 Before: n/a After: B59153997 **383** Routine Name: IBCRCC Before: B26741603 After: B28233162 **52,80,106,138,245,223,309, 347,370,383** Routine Name: IBNCPDP Before: B1668933 After: B1881095 **223,276,363,383** Routine Name: IBNCPDP1 Before: B56920205 After: B67408703 **223,276,339,363,383** Routine Name: IBNCPDP2 Before: B35333171 After: B53296275 **223,276,342,347,363,383** Routine Name: IBNCPDP3 Before: B29885103 After: B30635379 **223,276,342,363,383** Routine Name: IBNCPDP6 Before: n/a After: B11789689 **383** Routine Name: IBNCPDPI Before: B8352830 After: B8589835 **276,383** Routine Name: IBNCPDPU Before: B59313586 After: B68802824 **223,276,347,383** Routine Name: IBNCPEV Before: B83555880 After: B84966832 **342,363,383** Routine Name: IBNCPLOG Before: B61207907 After: B61812598 **342,339,363,383** Routine Name: IBRXUTL Before: B74287218 After: B74176189 **309,347,383** Routine list of preceding patches: 363, 370 ============================================================================= User Information: Entered By : ZEIGLER,EDWARD L Date Entered : SEP 28, 2007 Completed By: ELLZEY,LINDA Date Completed: SEP 17, 2008 Released By : BOTTINI,STEVE Date Released : SEP 17, 2008 ============================================================================= Packman Mail Message: ===================== $END TXT