$TXT Created by ELLZEY,LINDA at SUPVBB.FO-ALBANY.MED.VA.GOV (KIDS) on Thursday, 08/14/08 at 17:58 ============================================================================= Run Date: SEP 17, 2008 Designation: PSO*7*287 Package : PSO - OUTPATIENT PHARMACY Priority: Mandatory Version : 7 SEQ #264 Status: Released Compliance Date: OCT 18, 2008 ============================================================================= Associated patches: (v)PSO*7*185 <<= must be installed BEFORE `PSO*7*287' (v)PSO*7*240 <<= must be installed BEFORE `PSO*7*287' (v)PSO*7*281 <<= must be installed BEFORE `PSO*7*287' (v)PSX*2*66 <<= must be installed BEFORE `PSO*7*287' Subject: ePharmacy Tricare Support Framework Category: - Routine - Enhancement (Mandatory) - Other - Data Dictionary Description: ============ This patch is one of four patches that 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 Central Business Office (CBO) 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 they have been activated for ePharmacy by the 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. As before, activation of the ePharmacy product will require instructions provided by the CBO, and sites are not to activate ePharmacy unless instructed specifically by the CBO. Also, sites should not start to provide outpatient pharmacy services to Tricare patients without discussions with the CBO. This patch modifies the Outpatient Pharmacy v7.0 application as described below. The modifications are labeled dormant in the software and will remain inactive until the future Tricare patch is released. 1. (Dormant) - Prescriptions where the patient is Tricare eligible will be submitted to ECME for third party insurance processing in the same manner as all other insurance types. Tricare eligibility is determined by Integrated Billing (IB). An indicator is returned to Outpatient Pharmacy PRESCRIPTION file (#52) and REFILL multiple (#52.1) to be stored in the new BILLING ELIGIBILITY INDICATOR field (#85). Because this is a set of codes field, the internal value will be T, V or C. These values will be displayed respectively to the user as TRICARE, VETERAN, or CHAMPVA. Note that CHAMPVA will not be addressed in this patch. Prescriptions with only a 'VETERAN' eligibility flag are what is currently processed through ECME. 2. (Dormant) - When a Tricare prescription has a third party rejection, the same reject notification screen will be displayed to the user as is currently done for the Veteran eligibility. Tricare Rejections will be stored in the same manner as Drug Utilization Review (DUR) and Refill-too-soon (RTS) prescription reject are currently stored. The following exceptions will apply for Tricare prescriptions: A. All Tricare rejections will be denoted as Tricare in the REJECT Information header on the Reject Information screen. B. Where DUR or RTS are one of the reject codes, the user will be able to select from (D)iscontinue the prescription, submit (O)verride codes, or (Q)uit which sends the rejection to the Third Party Payer Rejects - Worklist. Tricare rejection may not be (I)gnored. C. For prescription rejections that have non-DUR/RTS rejects, the user will be able to select from (D)iscontinue the prescription or (Q)uit which sends it to the Third Party Payer Rejects - Worklist. D. For non-billable Tricare prescriptions, an abbreviated version of the reject notification screen will be displayed. Because the prescriptions is non-billable, the insurance and ECME information that's currently provided for DUR/RTS rejects will not be displayed (i.e. insurance, group name, group #, ECME #, contact, cardholder ID). In this case, the user will only be able to (D)iscontinue the prescription due to the business rule that OP cannot fill Tricare prescriptions that are non-billable. E. Labels will not print for discontinued Tricare prescriptions. Reprint labels will not be allowed to be printed for Tricare rejected prescriptions. F. Suspended prescriptions will remain on suspense when a reject occurs, when the Rx is non-billable, or when the third party claim remains in an 'IN PROGRESS' status in ECME. Labels will not print. Once the reject is resolved, the user may pull the Rx early from suspense or wait for the next scheduled print from suspense runs at which time labels will print accordingly. This includes CMOP and local suspense. G. Rejected Tricare prescription may not have a partial fill ordered until the reject is resolved. H. When the Pull Early from Suspense [PSO PNDRX] option is used, Tricare prescriptions will be processed in the foreground and rejections will be displayed for user intervention. 3. (Dormant except for item C.) - The Third Party Payer Rejects - Worklist [PSO REJECTS WORKLIST] option and the Third Party Payer Rejects - View/Process [PSO REJECTS VIEW/PROCESS] options have been modified in the following manner: A. Non-DUR/RTS Tricare rejections will be segregated at the end of the displayed information. They will be denoted with a "TRICARE - Non-DUR/RTS" header. This header will remain regardless of whether the GI - Group by Insurance action is toggled on or off. The Tricare section will sort in the same manner as the main sort for non-Tricare prescriptions (i.e. by Rx, drug, patient, etc.). B. Tricare DUR/RTS rejects will be displayed with all other DUR/RTS rejects. When GI - Group by Insurance action is toggled on, the header "TRICARE" will be displayed, and this "TRICARE" section will sort alphabetically within the other insurances. This Tricare section is separate from the Non-DUR/RTS section that displays at the end of the listing. When GI is toggled off, these rejects will sorted in the same section as all other DUR/RTS rejects. C. (Not dormant) - The new TRI - Show/Hide Tricare toggle action has been added to the hidden menu on the Insurance Rejects screen. When toggled to Show, Tricare Non-DUR/RTS rejects will be automatically displayed at the end of the listing. Toggling the TRI action to Hide will remove them from the screen. D. The Reject Information screen has been modified to display TRICARE in the header for the Reject Information section. For DUR/RTS Tricare rejects, the IGN - Ignore Reject action will be shown but will not be selectable. For Non-DUR/RTS Tricare rejects, the FIL - Fill Rx action will be displayed. If the prescription is payable, the user will be allowed to fill the prescription and print the label. If not payable, a message will be displayed stating that the prescription must have a payable status to be filled. E. For rejects that remain in suspense, the user will be allowed to process the rejection as indicated above, however no labels will be printed until the prescription is pulled early or printed from suspense. Upon resolving the reject, the user will be notified of this information. CMOP prescriptions will function in the same manner. 4. In preparation for a future ePharmacy patch the following fields are being added to PRESCRIPTION file (#52) for original fills and refills: DATE NDC VALIDATED field (#83) and NDC VALIDATED BY field (#84). 5. For ePharmacy prescriptions, the price per dispense unit for the NDC will be saved in PRESCRIPTION file (#52). For original fills, the UNIT PRICE OF DRUG field (#17) will be updated. For refills, the CURRENT UNIT PRICE OF DRUG field (#1.2) of REFILL multiple (#52.1) will be updated. If the NDC chosen is the default NDC, the value stored will be taken from PRICE PER DISPENSE UNIT field (#16) of DRUG file (#50). If the NDC selected is a synonym, the PRICE PER DISPENSE UNIT field (#404) of SYNONYM multiple (#9) of DRUG file (#50) will be saved. In the case of CMOP fills, only the default NDC price will be stored which is taken from PRICE PER DISPENSE UNIT field (#16) of DRUG file (#50). 6. (Dormant) - If ECME's status on the claim remains in an "In Progress" state past the processing time out during finish of the prescription, Tricare prescriptions will not be allowed to be filled and must be discontinued or sent to the Third Party Payer Reject - Worklist. 7. (Dormant) - If the pharmacy is active for ePharmacy processing but the insurance plan is not linked or not active, Tricare prescription will be allowed to be filled normally. The phrase "Inactive ECME Tricare" will be displayed during Finish. Associated New Service Request (NSR): ===================================== N/A Associated Remedy Ticket(s): ============================ N/A Associated E3Rs: ================ N/A Test Sites: =========== HEARTLAND WEST, KS SAGINAW, MI LOUISVILLE, KY 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 -------------------------------------------------------------------------- 52 PRESCRIPTION YES YES NO NO Partial DD: subDD: 52 fld: 83 fld: 84 fld: 85 subDD: 52.1 fld: 83 fld: 84 fld: 85 The following is a list of fields included in this patch: Field Name (Number) File Name (Number) Subfile Name (Number) ----------------------------------- ------------------------------------ DATE NDC VALIDATED (#83) PRESCRIPTION (#52) NDC VALIDATED BY (#84) PRESCRIPTION (#52) BILLING ELIGIBILITY INDICATOR (#85) PRESCRIPTION (#52) DATE NDC VALIDATED (#83) REFILL (#52.1) OF PRESCRIPTION (#52) NDC VALIDATED BY (#84) REFILL (#52.1) OF PRESCRIPTION (#52) BILLING ELIGIBILITY INDICATOR (#85) REFILL (#52.1) OF PRESCRIPTION (#52) The following is a list of list templates included in this patch: Template Name ------------------------ PSO REJECT TRICARE PSO REJECTS VIEW/PROCESS PSO REJECTS WORKLIST The following is a list of protocols included in this patch: Protocol Name ------------------------------------------------------ PSO REJECT DISCONTINUE PSO REJECT DISPLAY ADD COMMENT PSO REJECT DISPLAY CLARIFICATION CODE PSO REJECT DISPLAY HIDDEN MENU PSO REJECT DISPLAY MED PROFILE PSO REJECT DISPLAY OVERRIDE PSO REJECT DISPLAY PRIOR AUTHORIZATION PSO REJECT DISPLAY RX EDIT PSO REJECT DISPLAY RX VIEW PSO REJECT DISPLAY SUSPENSE DATE PSO REJECT FILL RX PSO REJECT TRICARE MENU PSO REJECTS HIDDEN ACTIONS #1 PSO REJECTS TRICARE ON/OFF VALM DOWN A LINE VALM FIRST SCREEN VALM GOTO PAGE VALM LAST SCREEN VALM NEXT SCREEN VALM PREVIOUS SCREEN VALM PRINT LIST VALM PRINT SCREEN VALM QUIT VALM REFRESH VALM SEARCH LIST VALM TURN ON/OFF MENUS VALM UP ONE LINE Documentation Retrieval: ======================== Sites may retrieve documentation in one of the following ways: 1. The preferred method is to FTP the files from download.vista.med.va.gov, which will transmit the files from the first available FTP server. 2. Sites may also elect to retrieve documentation directly from a specific server as follows: Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov 3. Documentation can also be retrieved from the VistA Documentation Library (VDL) on the Internet at the following address, http://www.va.gov/vdl. The documentation distribution includes: FILE NAME DESCRIPTION -------------------------------------------------------------------- PSO_7_P287.RN.PDF ePharmacy Release Notes Installation Instructions: ========================== It is recommended that this patch be installed while no Outpatient Pharmacy users are on the system. The installation time should be less than 2 minutes. 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu. [Note: TEXT PRINT/DISPLAY option in the PackMan menu will display the patch text only]. 2. From the Kernel Installation and Distribution System (KIDS) menu, select the Installation menu. 3. From this menu, you may elect to use the following options: (when prompted for INSTALL NAME, enter PSO*7.0*287) a. Backup a Transport Global - this option will create a backup message of any routines exported with the patch. It will NOT backup any other changes such as DDs or templates. b. Compare Transport Global to Current System - this option will allow you to view all changes that will be made when the patch is installed. It compares all components of the patch (routines, DDs, 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. d. Print Transport Global - this option will allow you to view the components of the KIDS build. 4. Use the Install Package(s) option and select the package PSO*7.0*287. 5. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', respond NO. 6. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//', respond NO. Routine Information: ==================== The second line of each of these routines now looks like: ;;7.0;OUTPATIENT PHARMACY;**[Patch List]**;DEC 1997;Build 77 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: PSOBPSU1 Before: B48317388 After: B48456113 **148,260,281,287** Routine Name: PSOBPSU2 Before: B7051944 After: B9046002 **260,287** Routine Name: PSOBPSUT Before: B50262877 After: B55060216 **148,247,260,281,287** Routine Name: PSOCAN2 Before: B70872222 After: B71168070 **8,18,62,46,88,164,235,148, 259,281,287** Routine Name: PSONDCUT Before: B19534590 After: B36454398 **148,287** Routine Name: PSOORAL1 Before: B55719386 After: B57201257 **71,156,148,247,240,287** Routine Name: PSOREJP0 Before: B65585833 After: B73243704 **148,260,287** Routine Name: PSOREJP1 Before: B84159921 After: B65850431 **148,247,260,281,287** Routine Name: PSOREJP2 Before: B62487288 After: B64671783 **148,247,260,287** Routine Name: PSOREJP3 Before: B10158946 After: B46633183 **260,287** Routine Name: PSOREJU1 Before: B58727208 After: B57802096 **148,247,260,287** Routine Name: PSOREJU2 Before: B47862203 After: B47862203 **148,260,287** Routine Name: PSOREJU3 Before: n/a After: B40813416 **287** Routine Name: PSOREJUT Before: B34569551 After: B37708205 **148,247,260,287** Routine Name: PSORXL Before: B71179264 After: B73286227 **8,21,24,32,47,135,148,287** Routine Name: PSORXL1 Before: B42826017 After: B50145342 **36,46,148,260,274,287** Routine Name: PSORXPA1 Before: B25082444 After: B26228658 **11,27,56,77,130,152,181,174,287** Routine Name: PSOSULBL Before: B68549461 After: B68925127 **139,173,174,148,200,260,264,287** Routine Name: PSOSUPOE Before: B53974846 After: B58352805 **8,21,27,34,130,148,281,287** Routine Name: PSOSUPRX Before: B45474972 After: B46093260 **8,36,130,185,148,287** Routine list of preceding patches: 240, 264, 274, 281 ============================================================================= User Information: Entered By : ELLZEY,LINDA Date Entered : OCT 19, 2007 Completed By: ZEIGLER,EDWARD L Date Completed: SEP 17, 2008 Released By : VECE,VIRGINIA Date Released : SEP 17, 2008 ============================================================================= Packman Mail Message: ===================== $END TXT