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Rebill Prescriptions

The Rebill Prescriptions feature attempts to capture a higher reimbursement for claims that have recently had their drugs change in price. In order to use this feature, the pharmacy must first fax in a signed waiver to BestRx Pharmacy Software. This can be found here. This waiver is necessary before the feature is enabled because the process of rebilling can result in rejected prescriptions. When these prescriptions are rejected, they have to be rebilled in a standard manual fashion by the pharmacy. BestRx Pharmacy Software is not liable for money lost on these prescriptions. The BestRx program also needs to be updated if the version you are currently using is older than (06-02-2012). Perform an automatic update by going to Misc -> A. Check for Program Updates.

Options

The From and To dates indicate the range of Fill Dates to search when determining what prescriptions to rebill. At this time you cannot auto-rebill prescriptions older than 30 days. This is because some insurance companies require you to submit paper forms if you attempt to bill a prescription older than 30 days, and submitting paper forms is a difficult and tedious process.

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The “Drug Price Changed Within Days of Fill Date” field is used to indicate how long of a period from the fill date to consider if the drug price has changed within that period. Let’s say a prescription was filled on April 1, 2012 and the price of that drug changed on April 20, 2012. If you had a value of 30 for this field, then that prescription would be chosen to be rebilled as the drug price was changed within 19 days of the fill date. But if you had a value of 15 in this field, then that prescription would not be chosen since it falls out of the specified date range.

If you wish to narrow down the report and only rebill for Brands, or both Brand & Generic, choose so in the dropdown list. The same goes for Rx and OTC drugs. RXs with DURs will generate all prescriptions with DUR codes attached. Usually DUR codes do not change on prescriptions, and these scripts should be fine to rebill. This is not the same for Rxs w/ Prior Authorization. These prescriptions often require new and separate PA numbers, and the process of rebilling would be no different therefore we recommend this option to be kept as 'No'. Lastly the user can filter the report by Drug or Insurance Plan / drug or insurance plan group, by selecting them in their corresponding fields. By clicking the binoculars next to the plan field, the software will display a search result of all plans that are Rebill (B3) compatible.

Rebilling Process

Once the proper search criteria has been entered, the user can click the "Generate" button to retrieve the prescriptions that need to be rebilled. Those prescriptions will show up in the grid as shown below. The grid will show the Patient and Rx Info, including the Originally Billed cost as well as the Originally Paid amount.

Next the user should select which prescriptions they want to rebill. They can choose to select all by checking the box on the bottom left. Once they have selected all the prescription they would like to rebill, they can click on the "Start Transmitting" button.

As the prescriptions are transmitted, some new values will start to display in the blank columns in the grid. You will see the New Billed cost and once the claim is received you will also see the New Paid amount as well as the status of the rebill (whether is was Paid, Rejected, etc.).

NOTE: If there are prescriptions that are Rejected, the pharmacy must rebill this prescriptions from the main RxProcessing screen, otherwise they will lose the original amount for the prescriptions. IT IS VERY IMPORTANT THAT ALL THE REJECTED PRESCRIPITONS ARE REBILLED FROM THE MAIN SCREEN. BestRx Pharmacy Software will not be liable for any loss due to these rejected prescriptions.In order to rebill a prescription from the main screen after it has been rejected through the auto rebill feature, make sure that the Rebill Adjustment flag is changed from "A" to BLANK in the field indicated below. After it has been cleared, send the prescription as normal with the "Save & Transmit Now" button.

At the bottom of screen you will be able to see what prescription is currently being processed. Once all the prescriptions are finished rebilling, this status will say Finished Rebilling Prescriptions.

Once all the prescriptions are finished rebilling, the user can view the results and responses by going to the Results tab. This will display one sub-tab with the Paid claims and another with the Rejected claims. Clicking on a specific prescription will display the response for that claim. This will be especially helpful when dealing with rejected claims.

The Rebill function should be performed every week to two weeks in order to make sure that you are never leaving the window of opportunity to capture a higher reimbursement for these claims.