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BestRx pharmacies now can fill, administer, and report the COVID-19 vaccine within the software. This feature will be rolled out to both SQL and PSQL database pharmacies. Please find the important information regarding COVID-19 below.
As you all may aware that two vaccines from Pfizer and Moderna have been approved for COVID-19
Each patient requires to take multiple (2 doses) of the vaccine.
Pfizer's second shot will be given 21 days apart from the first dose.
Moderna's second shot will be given 28 days apart from the first dose.
The cost of the drug is $0 (for Express Scripts we will set 0.01 because they are not accepting claims if it is $0). There is an Incentive Fee that should be equal to or greater than $28.39.
Immunization Type File
:We have added the default “COVID-19 Immunization” in the immunization type file. We have added some new fields for this immunization type which pharmacies can customize. So, when they bill for the vaccine the DUR codes and incentive fees get added automatically to the prescription.
You can get to this screen from File --> C. Immunization Type File.
This is a default immunization type, so we are not allowing to delete this record, we are also not allowing to edit the first three fields on this screen.
If the user tries to change the Default incentive fees lower than $28.39 then we will display a warning message as shown in the image below.
Drug File: There is nothing different in the drug file but just so you all know we would like to make you aware that all these COVID vaccines have no cost so in the drug file you will notice that by default all prices are set to $ 0.00 or $0.01.
BestRx will automatically add the COVID-19 Immunization type to all COVID drugs.
Patient File: We have added few new fields in the patient file which are required for COVID-19 vaccine billing i.e County, Race, and Ethnicity.
The County field should be found next to the Zip code field.
Race and Ethnicity are under the “More” button.
Pharmacy either add them to the patient file before entering the COVID-19 vaccine or they can add them later from the Immunization Information screen.
COVID-19 Prescription First Dose:
The covid-19 vaccine requires multiple doses so we will prompt to select the dose message when the COVID-19 drug is selected while entering prescription information.
As mentioned earlier, these vaccines are no cost so the Cost to Bill will appear as $ 0.00 most of the time except Express Script because they have some specific billing guidelines.
The Express script may reject the claims if the Cost to the bill is sent as $0.00 so BestRx would automatically change them to $0.01. We will warn if someone still tries to change it to $0.00 manually.
We will set the Basis of cost value as 00-Default for all Express script claims.
All Covid-19 vaccine will automatically add day supply as 1.
As per the guidelines, the Rx Incentive fee should be greater or equal to $28.39. We will display a warning message if the user tries to change the incentive fee to a lower amount than $28.39 from there a user can select the appropriate option to continue filling a prescription.
The submission Clarification code will be “02” for the first dose and “06” for the second dose. We will display a warning message when the user tries to change the Submission Clarification Code.
Once the prescription is saved, it will display the Immunization Administration Information screen where the pharmacy must enter Immunization related patient’s information.
Patient’s County, Race & Ethnicity are required fields for COVID-19 reporting, BestRx will get this information from the patient file and if not found then the pharmacy must enter it on the Immunization information screen. Once information is entered on the Immunization information screen it will be updated into the patient file.
Pharmacist ID qualifier and Pharmacist ID are also required fields, Users who do not have access rights to administer vaccine will be prompted for Pharmacist’s authorization. If Pharmacist’s ID qualifier and Pharmacist ID is not updated in the user file then the user must manually enter on the immunization information screen, once it is saved it will prompt to update in the user file.
Prescription for the first dose is successfully created after clicking the Save button on the immunization information screen.
We are working on the COVID-19 queue which will help the user to remind when patients are due for the second dose, there will be settings in which it will either prompt the users to schedule the second dose and add to the COVID-19 patient queue or add automatically in the queue.
Users will be able to see scheduled prescriptions due for the second dose and fill those from the queue using the Fill New Rx button.
COVID-19 Prescription Second Dose:
The user will be first prompted for the previous dose information with options to select which dose is being administered when BestRx finds previous COVID-19 prescriptions filled for the patient.
As mentioned earlier, the Submission clarification code will be automatically selected as 06- Starter Dose for the second dose
Once again Immunization information screen will appear for the second dose, most of the information will be automatically available on the immunization information screen except few required fields needs to be manually selected.
Prescription for the second dose is successfully created after clicking the Save button on the immunization information screen.
Note:
Provider ID Qualifier and Provider ID field from Immunization screen will be used sent to the insurance under field # 465 – EY and 444 – E9, you can find this in the claim data.
The COVID-19 prescription would not have Bill to Cost so we are not going to display low-cost warning on both RX processing screen and Claim response screen.