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To access the Insurance Plan File, click File → 9. Insurance Plan File, or press F5. |
Insurance Plan File
The insurance plan file is where you can store, edit, and reference information pertaining to a specific insurance plan. Before you can add an insurance plan to a patient’s file, it must be created here first.
Searching Insurance Plans
Opening the insurance plan file without an Rx open on the Rx Processing screen will bring up a search window for insurance plans. You can search by Plan Name, Plan Code, Bin #, or PCN.
This search will also let you know if the Master Insurance Plan File has any plans that match the Plan Name, BIN, or PCN. Searches must be 4 characters or more to pull Master File results. Any results from the Master File will appear in red text, as pictured below.
Clicking on an item in red text will prompt a window asking if you’d like to add the insurance plan to your local file.
Creating a New Insurance Plan
When adding a new insurance plan, make sure the Add New Plan option is selected towards the top of the screen.
Enter in the insurance plan information and click the Save button to save the information. Click the Save & Exit button save the information and go to the previous screen.
Tab Explanation
Below is a field-by-field explanation of what information can be saved in an insurance plan.
General
Insurance Plan Code (Req'd) - This code is for internal use to help you quickly find insurance plans in your system.
Name (Req'd) - Full descriptive name of the Insurance Company
Help Desk Number - Phone number to pharmacy help desk. Input the number on the card for future reference.
Plan BIN # (Req'd) - Input the BIN number of the insurance plan as indicated on the patient's card, the coupon or eligibility check.
Processor Control # - This field is required by most insurance companies. For New York Medicaid, please refer to the New York Medicaid worksheet.
Software Vendor ID - Some insurances require an additional number to be provided with the claim. Some of the common insurance plans that require this number are Blue Cross Blue Shield, Caremark and Medco. To see the full list click the lightbulb to the right of the field.
Remark - This field is for any notations you may have.
Groups: Displays and allows to add/remove any and all groups this insurance record belongs to.
Rec # - This is an internal record number of the plan in the BestRx system.
Address/State/City/ZIP - Insurance address information.
E-Mail Address - Insurance email information.
Pharmacy ID Qualifier - This number is set to 01 by default, National Provider Identifier. If an insurance company requests a different provider number to be transmitted, provide the correct qualifier in the file.
Pharmacy # - This is your pharmacy's identifier number. By default this field will be filled with your NPI. If the insurance company requires you to transmit a different number, input the number here.
Default Group Number - Some plans use a common group number for that patient. You can specify a default number to be used when adding this plan to the patient's file.
Cash Plan - This indicator is used to determine if the plan is a cash plan.
NCPDP Version - This field indicates the claim transmittal version. Default value is for version D.0; 5.1 is an old, no longer used value. TP is for Third Party billing, where a claim cannot be sent to the insurance company but is not a cash plan. This requires a report to be generated from Billing > 1. Insurance Billing Report and be sent to the company to obtain payment.
Transmit Multiple Claims - This field indicates whether or not to send multiple claims at a time of transmission. When selected "Yes", BestRx will attempt to send up to 4 claims at one time.
Pricing
Rx Brand Price Code - Specify the price code you'd like to use for Brand medication. Default value of '0' indicates no price code.
Rx Generic Price Code - Specify the price code you'd like to use for Generic medication. Default value of '0' indicates no price code.
OTC Price Code - Specify the price code you'd like to use for over-the-counter medication. Default value of '0' indicates no price code.
Minimum Copay Amount (Brand) - Indicate if you'd like to charge a minimum copay amount for Brand drugs.
Minimum Copay Amount (Generic) - Indicate if you'd like to charge a minimum copay amount for Generic drugs.
Minimum Copay Pct (Brand) - Indicate a minimum copay percentage to charge for Brand drugs.
Minimum Copay Pct (Generic) - Indicate a minimum copay percentage to charge for Generic drugs.
Dispensing Fee (Brand) - Indicate whether or not you have a set fee for dispensing brand medication
Dispensing Fee (Generic) - Indicate whether or not you have a set fee for dispensing generic medication
Tax Percentage - Indicate the minimum percentage tax to be charged
Flat Tax Amount - Indicate if you require a flat tax amount to be charged
Discount Percentage - Indicate whether or not medication billed under this plan should be discounted
COB / Dual Billing
Send Other Payer Amount Paid (OPAP) Info - Indicate if the insurance company requires the OPAP information to be sent in the segment. This is typically associated to other coverage code two (2) and four (4) for accepted claims or three (3) for rejected claims. Choosing NO will default the other coverage code to eight (8).
Send OP Patient Responsibility Amount (OPPRA) Info - Indicate if the insurance company requires the OPPRA amount to be sent in the segment. This is typically associated to other coverage code two (2), four (4) and eight (8) for accepted claims or three (3) for rejected claims.
Send OPPRA component Amounts - Indicate if the insurance company requires the breakdown of the OPPRA component amounts to be sent in the segment. This is typically associated to other coverage code two (2), four (4) and eight (8) for accepted claims or three (3) for rejected claims.
Send OPPRA Total Amount - Indicate if the insurance company requires the OPPRA Total Amount to be sent in the segment. This is typically associated to other coverage code two (2), four (4) and eight (8) for accepted claims or three (3) for rejected claims.
Send Benefit Stage Info - Indicate if the insurance company requires Benefit Stage info to be sent in the segment.
Send Payment Info for Rejected Claims - Indicate if the insurance company requires payment information to be transmitted for rejected claims.
Send COB Info on Reversals - Indicate if the insurance company requires COB info on claim reversals.
Common COB Combinations
These are some of the most common combinations; please take note that these will not always work as these settings can sometimes be insurance company dependent.
OCC 2 (Primary Paid) | OCC 8 Epic (Copay only) | OCC 8 Standard (Copay only) | OCC 3 (No payment info) | ||||
OPAP Info | Yes | OPAP Info | No | OPAP Info | No | OPAP Info | No |
OPPRA Info | Yes | OPPRA Info | Yes | OPPRA Info | Yes | OPPRA Info | No |
Components | No | Components | Yes | Components | No | Components | No |
Total | Yes | Total | No | Total | Yes | Total | No |
Compound
Send compound segment - Indicate whether or not to send the compound segment to the insurance company.
Product ID Qualifier to Send - Indicate what Product ID qualifier to send. Typically this will be 00 - Not Specified.
Product ID to Send - Indicate the Product ID to send. Typically this will be Just 1 Zero ("0")
Calculate Cost Using - Indicate how to calculate the compound cost. You can choose cost from drug file, or sum of ingredient costs.
Compounding Fee - Indicate if you'd like a flat compounding fee to be submitted during transmittal of compounds.
Miscellaneous
Provider ID Qualifier: Indicate the qualifier for the additional provider ID the insurance company is requesting you to send.
Provider ID: Indicate the additional provider ID the insurance company is requesting you to send.
Worker's Compensation Plan: Indicate if this is a workman's comp plan. This selection will send the Workman's Comp segment as indicated in the Patient File.
Prompt to enter DUR's: Indicate if you'd like to be prompted to input DURs when filling prescriptions for this insurance plan.
Pharmacy Service Type: Indicate how to send the pharmacy service type code.
Accepts B3 Transactions: Indicate whether the insurance accepts B3 transactions.
Send Control Triplicate #: Indicate whether or not to send the Control Triplicate Number.
Send 12-Character Rx Serial #: Indicate whether or not to send the 12 digit Control Triplicate Number. Selecting no will send the 8 digit code instead.
Prescriber ID to Transmit: By default this field is set to NPI#. On some occasions the insurance company will request a different number for the doctor. You can change your selection by clicking in the dropdown box.
Refills Expire In: Default time for refills to expire is 12 months. If this insurance requires otherwise, choose from available options or alternatively choose the custom option and indicate the expiration time.
Controlled Refills Expire In: Default time for refills to expire is 6 months. If this insurance requires otherwise, choose from available options or alternatively choose the custom option and indicate the expiration time.
340B Plan Type: Indicate if this is a 340B plan and the type.
Switch for Sending Claims: Indicate which switching vendor you'd like to use; this is useful when billing plans through specific switches, or when contractually obligated to do so.
Send Patient Residence Code: Indicate how to transmit the patient residence code. Choose 'Use Value from Patient File' if you'd like to send the value as indicated in the Patient File, or if you'd like to over write a value for all patients select the appropriate corresponding number.
Price Formulary: Indicate if you'd like to attach any of the created drug formularies to use for this particular insurance plan.
Send Patient Residence Code: Indicate how you'd like to send the residence code. Default is to Use Value from Patient File, but this can be overwritten if required.
Send Patient ID: Indicate if you'd like to send the patient ID with a claim.
Send Patient Email: Indicate if you'd like to send the patient email with a claim.
Calculate U&C Charges by: Indicate how to calculate U&C charges by. Default is to Use value from Pharmacy Setup, but can also be set to Use Cash Price or Use Percentage Markup.
Diagnosis Code Type: Choose which ICD type the insurance plan requires when sending diagnosis codes. The default setting is ICD-10 if filled after transition date.
Send Decimal Point in Diagnosis Codes: Indicate if this insurance plan requires a decimal point to be sent for diagnosis codes.
Pharmacy Service Type: Indicate what pharmacy service type you'd like to use. This is useful for pharmacies that are running parallel NPI numbers (such as one for retail and one for LTC).
Documents
The Documents screen will display all the documents that have been created/attached to the particular patient. This currently supports any document that can be scanned with your BestRx compatible scanner. If your pharmacy does not currently have the RX Scanning / Document feature, please inquire for more information.
To add a document, click the "Add Document" button..
Name the document you're adding with any remarks; alternatively choose if you'd like to scan both sides, multiple pages, and/or in color.
Scan
The scan will begin promptly afterward clicking the Scan button, and the image will display in the right section of the page when it's finished if scanning the document.
Capture
Any document or photograph can be captured into the software by utilizing a camera attached to the computer, as long as the computer recognizes and is able to capture the image from your camera. Click the Capture button to start image capture.
You can change the camera using the Device Name drop down box if the image is not displaying or capturing from a different device; you can also change the Resolution of the image with the appropriate drop down box of its own. In order to change or adjust any additional camera options, click the Settings Gear.
Import
You can also import eligible documents from your computer into the BestRx system by clicking "Import Saved Documents".
The supported file formats are listed as shown above; PDF, GIF, BMP, JPG, JPEG, PNG, TIF, TIFF, and TXT are all supported. Select your documents by pressing the "Add Documents" button for each document you wish to import. When done, simply click "Finish Importing" and to get back to the previous menu click "Back to Scan".
You can view, Print, Download, Fax or Delete any of the added documents simply by clicking the desired document from the list and selecting the appropriate function in the button segment below the preview pane.
Faxing (Internet Faxing customers only)
Fax control appears in every document tab; it may be disabled until a document in the left pane is selected. The feature may also be accessed from the dashboard or the notification bar, if configured as such.
Clicking the button opens another window where you will have the opportunity to enter the Receiver's information, include a coversheet, add additional documents from outside of BestRx, and finally an option to scan any document on the fly to include with the fax. Before sending the fax, you are also able to preview it prior to sending by selecting "Preview & Send". Otherwise, you may press "Send" when ready.
The documents feature is duplex compatible just like the regular scanning features for prescription, and additional pages can be scrolled through using the "<" and ">" buttons. You can also zoom in and out on the document using the corresponding (+) and (-) icons.
The Options button will display options for your scanner device.
To go back to the Patient Info screen, click the "Back to Main" button or simply press F8 on your keyboard.