BestRx Video Password: bestrx310

• Insurance Plan Code (Required) - Internal code used to quickly identify and locate insurance plans in the system.

• Name (Required) - Full descriptive name of the insurance company.

• Help Desk Number - Phone number for the pharmacy help desk as listed on the insurance card for future reference.

• Plan BIN # (Required) - BIN number of the insurance plan as indicated on the patient’s card, coupon, or eligibility check.

• Master File Plan Type - Default plan type used by BestRx to determine how the plan is classified.

• Custom Plan Type - Optional override field; blank by default. If populated, BestRx will use this value instead of the Master File Plan Type.

  • Plan Type Behavior - BestRx first checks the Custom Plan Type; if it is blank, the system falls back to the Master File Plan Type. If a Custom Plan Type value is entered, it overrides and the Master value is ignored.

• Processor Control # - Required by most insurance companies; for New York Medicaid, refer to the New York Medicaid worksheet.

• Software Vendor ID - Additional identifier required by some insurance plans (e.g., Blue Cross Blue Shield, Caremark, Medco); use the lightbulb icon to view the full list.

• Remark - Used to enter any notes or additional information.

• Groups - Displays and allows adding or removing groups associated with the insurance record.

• Rec # - Internal record number assigned to the plan within the BestRx system.

• Address/State/City/ZIP - Insurance company mailing address information.

• E-Mail Address - Insurance company email contact information.

• Pharmacy ID Qualifier - Defaults to 01 (NPI); update only if the insurance requires a different provider identifier.

• Pharmacy # - Your pharmacy’s identifier, defaulted to NPI; override if a different number is required by the insurance.

• Default Group Number - Common group number used for the plan, automatically applied when adding it to a patient profile.

• Cash Plan - Indicates whether the plan is a cash plan.

• NCPDP Version - Specifies the claim transmission version; D.0 is the default, 5.1 is obsolete, and TP is used for third-party billing when claims are not transmitted electronically.

• Transmit Multiple Claims - Determines whether multiple claims are sent at once; when set to Yes, up to four claims may be transmitted simultaneously.

• Warn if reversing Rx older than - Use the value from the Pharmacy Setup screen or enter a custom number of days.

• Rx Brand Price Code - Price code for brand medications; default '0' means no price code.

• Rx Generic Price Code - Price code for generic medications; default '0' means no price code.

• OTC Price Code - Price code for over-the-counter medications; default '0' means no price code.

• Minimum Copay Amount (Brand) - Sets a minimum copay amount for brand drugs.

• Minimum Copay Amount (Generic) - Sets a minimum copay amount for generic drugs.

• Minimum Copay Pct (Brand) - Sets a minimum copay percentage for brand drugs.

• Minimum Copay Pct (Generic) - Sets a minimum copay percentage for generic drugs.

• Dispensing Fee (Brand) - Indicates if a dispensing fee is applied to brand medications.

• Dispensing Fee (Generic) - Indicates if a dispensing fee is applied to generic medications.

• Tax Percentage - Minimum tax percentage to apply.

• Flat Tax Amount - Flat tax amount to apply, if required.

• Discount Percentage - Indicates if prescriptions under this plan receive a discount.

• Brand Clawback Type - Select clawback method: Processor Clawback (default), None, DIR fee, or BER (Brand Effective Rate).

• Generic Clawback Type - Select clawback method: Processor Clawback (default), None, DIR fee, or GER (Generic Effective Rate).

• Calculate U&C Charges by - Determines calculation method: Use Pharmacy Setup (default), Cash Price, Percent Markup, or Acquisition Cost.

• Calculate 340B U&C Charges by - Determines 340B calculation method: Use Pharmacy Setup (default), Cash Price, Percent Markup, or Acquisition Cost.

• Transmit Internal Claims - Enables or disables internal claim transmission (Yes/No).

• Internal Claim Total Calculation - Determines total calculation method: Total Billed Amount (default) or Patient Pay Amount.

• Internal Claim Pat Pay Calculation - Determines patient pay calculation: Total Billed Amount (default), Price Code, or Zero Patient Pay.

• Auto-Learn COB Settings - Indicate if the system should attempt to automatically populate COB settings during split billing. This setting is located in the COB/Dual Billing tab of the insurance plan. If duplicate OPPRA lines are populating or COB information is not filling in as expected, try turning this setting off and manually adjusting the OPAP/OPPRA settings below.

• 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 information 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 information to be sent on claim reversals.

• Send Compound Segment - Indicate whether or not to send the compound segment to the insurance company when transmitting a compounded claim.

• Product ID Qualifier to Send - Indicate which Product ID qualifier to send with the compound. Typically this will be 00 - Not Specified. Other options include 03 - NDC, Value from Drug File, or 0 - Not Specified, depending on payer requirements.

• Product ID to Send - Indicate the Product ID to send for the compound. Typically this will be a single zero (0). Other options include eleven zeros (00000000000) or the NDC of the main ingredient, depending on how the insurance requires the compound to be submitted.

• Calculate Cost Using - Indicate how the compound cost should be calculated. Options include using the cost from the drug file or using the sum of all ingredient costs.

• Compounding Fee - Indicate whether a flat compounding fee should be submitted during transmission of compounded claims.

• Provider ID Qualifier
  Specifies the qualifier for the additional provider ID requested by the insurance (e.g., 01 – DEA, 02 – State License, 03 – SSN).

• Provider ID
  Enter the additional provider ID required by the insurance.

• Worker’s Compensation Plan
  Indicates if the plan is Workers’ Compensation (Yes or No). Enables the corresponding segment from the Patient File.

• Prompt to Enter DURs
  Determines whether users are prompted to enter DUR information during prescription entry (Yes or No).

• Pharmacy Service Type
  Defines how the pharmacy service type code is transmitted (e.g. Send 2 character code (default), Send 1 character code, or Don’t Send.)

• Accepts B3 Transactions
  Indicates whether the insurance accepts B3 transactions (Yes or No, default = No).

• Send Rx Serial #
  Specifies whether to send the Rx serial number (Yes or No).

• Send 12-Character Rx Serial #
  Sends a 12-digit serial number. If No, an 8-digit number is sent.

• Prescriber ID to Transmit
  Default is NPI. Can be changed if the insurance requires a different identifier.

• Refills Expire In
  Default is 12 months. Options include 6, 12, 18, 24 months, Do Not Expire, or Custom.

• Controlled Refills Expire In
  Default is 6 months. Options include 6, 12, 18, 24 months, Do Not Expire, or Custom.

• Price Formulary
  Select a formulary configured in BestRx to apply to this insurance plan.

• Drugs Allowed for Plan
  Default is All Drugs.

• Send Patient Residence Code
  Sends the residence code from the Patient File or overrides it with a fixed value.

• Send Patient ID
  Indicates whether to include the patient ID on claims (Yes or No).

• Send Patient Email
  Indicates whether to include the patient email on claims (Yes or No).

• Diagnosis Code Type
  Select the ICD version:

  • ICD-10 if filled after transition date (default)

  • ICD-10 for all Rx

  • ICD-9 for all Rx

• Send Decimal Point in Diagnosis Codes
  Indicates whether to include a decimal in diagnosis codes (Yes or No).

• Pharmacy Service Type
  Defines how the pharmacy service type is transmitted (e.g., Use Value from Provider File, 01 – Retail, 02 – Compounding, etc).

• Block LTC ID’s for Billing
  Prevents LTC IDs from being used in billing (Yes or No).

• Send Quantity Prescriber
  Specifies when to send prescriber quantity:

  • C2’s Only (default)

  • Do Not Send

  • Controls Only

  • All Rx

• Allow as Secondary to Govt Plans
  Indicates if the plan can be used as secondary to government plans (Yes or No).

• 340B Plan Type
  Identifies participation in a 340B program (Yes or No) and specifies type.

• Apply “08” for 340B Basis of Cost
  Uses default value from Pharmacy Setup.

• Apply “20” for 340B Sub Clar Code
  Uses default value from Pharmacy Setup.

• Auto Add to Refill Queue
  When enabled, prevents prescriptions from being automatically added to the refill queue (applies to Primary Insurance only).

• Auto-Process with Night Tech
  Allows automatic processing of prescriptions for this insurance plan when enabled.