9. Insurance Plan File

Owned by Anthony Campana
Last updated: Nov 22, 2022
10 min read

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

 

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

 

Miscellaneous

 

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.

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