4. EPMO Open Source Coordination Office Redaction File Detail Report

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4.1 Files compared

#	Location	File	Last Modified
1	BPS_1.0_21_Build_8.zip	bps_1_um_r0517.doc	Wed May 10 16:25:30 2017 UTC
2	BPS_1.0_21_Build_8.zip	bps_1_um_r0517.doc	Fri Aug 4 21:09:54 2017 UTC

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	1	ELECTRONIC CLAIMS MA NAGEMENT E NGINE (ECM E)
	2	Version 1. 0
	3	USER MANUA L
	4	August 201 6
	5	Department of Vetera ns Affairs
	6	Office of Informatio n and Tech nology (OI T)
	7	Product De velopment
	8	Revision H istoryDate Descriptio n (Patch # if applic able)Proje ct Manager Technical Writer0452 017Updated for BPS1 21Stephan ie KutsonD eAnn Kelly 10/2015Upd ated for B PS120Sha ron Tauben feldJohn R ogers06/20 16Updated Title Page to curren t OI&T sta ndards.
	9	Updated fo r BPS119 to reflec t customer requested revisions throughou t screensh ots includ ing numero us changes throughou t to updat e for incl usion of t he Close C laim funct ionality a nd the new Non-Billa ble Status Report (N BS)Therese TarletonV ida Dunie1 0/2015Upda ted for BP S118Shar on Taubenf eldJohn Ro gers11/201 3Updated f or BPS11 5 (made nu merous min or changes throughou t; fixed d efective p age breaks )Sharon Ta ubenfeldFi rstView Te am02/2012U pdated for BPS111S ookie Spen ceChristy Smith10/20 11Updated for BPS1 10Sookie S penceChris ty Smith06 /2011Updat ed for BPS 110 and consistenc ySookie Sp enceLori T orrance12/ 2010Review ed and upd ated revis ions; inse rted TRICA RE disclai merSookie SpenceChri sty Smith1 0/2010Upda ted for ac curacy cha nges per C BOSookie S penceLori Torrance08 /2010Updat ed for BPS 18 and A ddendumSoo kie Spence Jeanne Dod ge-Allen10 /2009Updat ed for pat ch BPS1.0 8 ePharma cy COB Sup portMary A nthony/Tim othy Holme sMary Elle n Gray04/2 009Updated for patch BPS1.07 Mary Antho nyMary Ell en Gray02/ 2007Update d for patc h BPS1.0 2Sookie Sp enceChrist y Smith08/ 2006Update d for inte rim patch BPS1.03S ookie Spen ceNancy Sm ith/
	10	Mary Ellen Gray04/20 06Initial release of the ECME User Manua l.Sookie S penceNancy Smith(Thi s page inc luded for two-sided copying.)
	11	Contents
	12	11
	13	Introducti on
	14
	15
	16	32
	17	Orientatio n
	18
	19
	20	32.1 Worki ng with th e ECME Use r Manual
	21
	22
	23	42.2 Obtai ning Onlin e Help
	24
	25
	26	52.3 Findi ng Related Manuals
	27
	28
	29	73
	30	ECME Menu Structures
	31
	32
	33	83.1 The C omplete EC ME Menu St ructure
	34
	35
	36	103.2 ECME User Scre en
	37
	38
	39	103.3 ECME Pharmacy COB Menu S tructure
	40
	41
	42	103.4 Phar macy ECME Manager Me nu Structu re
	43
	44
	45	103.5 Phar macy Elect ronic Clai ms Reports Menu Stru cture
	46
	47
	48	124
	49	Accessing the ECME M ain Menu
	50
	51
	52	145
	53	Accessing the ECME U ser Screen
	54
	55
	56	195.1 Chan ge View
	57
	58
	59	275.2 Sort List
	60
	61
	62	295.3 Reve rse Payabl e Claim
	63
	64
	65	325.4 Resu bmit Claim
	66
	67
	68	355.5 Clos e Claim
	69
	70
	71	385.5.1 Va riations t o the Clos e claim pr ocess.
	72
	73
	74	405.5.2 Sp ecial Note s regardin g secondar y claims
	75
	76
	77	405.6 Add/ View Comme nts
	78
	79
	80	425.7 Furt her Resear ch Screen
	81
	82
	83	435.7.1 In surance De tails
	84
	85
	86	445.7.2 Vi ew Eligibi lity
	87
	88
	89	455.7.3 Vi ew Prescri ption
	90
	91
	92	475.7.4 Ad d/View Com ments
	93
	94
	95	475.7.5 Cl aims Track ing
	96
	97
	98	495.7.6 Th ird Party Inquiry
	99
	100
	101	505.7.7 On Hold Copa y Listing
	102
	103
	104	515.7.8 Re lease Copa y
	105
	106
	107	535.7.9 IB (Integrat ed Billing ) Events R eport
	108
	109
	110	575.7.10 G roup Plan Menu
	111
	112
	113	585.7.11 E ligibility Inquiry O ption
	114
	115
	116	605.8 Prin t Claim Lo g (hidden action)
	117
	118
	119	635.09 Sen d to Workl ist
	120
	121
	122	665.10 Reo pen Closed Claims (h idden acti on)
	123
	124
	125	685.11 Res ubmit with Edits (hi dden actio n)
	126
	127
	128	725.12 OP ECC Reject Informati on (hidden action)
	129
	130
	131	735.13 Re submit Cla im Without Reversal (hidden ac tion)
	132
	133
	134	755.14 Op en/Close N on Billabl e Entry (h idden acti on)
	135
	136
	137	765.15 Dis play Updat e (hidden action)
	138
	139
	140	785.16 Exi t (from EC ME User Sc reen)
	141
	142
	143	796.
	144	Accessing the ECME P harmacy CO B Menu
	145
	146
	147	796.1 Pote ntial Seco ndary Rx C laims Repo rt
	148
	149
	150	816.2 Pote ntial Clai ms Report for Dual E ligible
	151
	152
	153	836.3 Proc ess Second ary/TRICAR E Rx to EC ME
	154
	155
	156	846.3.1
	157	Submitting Secondary Claims
	158
	159
	160	856.3.2
	161	Submitting Primary C laims for TRICARE an d Dual Eli gibility P atients
	162
	163
	164	877
	165	Accessing the Pharma cy ECME Ma nager Menu
	166
	167
	168	877.1 ECME Transacti on Mainten ance Optio ns
	169
	170
	171	887.1.1 Vi ew/Unstran d Submissi ons Not Co mpleted
	172
	173
	174	907.1.2 RE OPEN a CLO SED ECME C laim
	175
	176
	177	917.2 Phar macy ECME Setup Menu
	178
	179
	180	927.2.1 Ed it Basic E CME Parame ters
	181
	182
	183	947.2.2 Ed it ECME Ph armacy Dat a
	184
	185
	186	977.2.3 Re gister Pha rmacy with Austin In formation Technology Center
	187
	188
	189	1007.3 Sta tistics Sc reen
	190
	191
	192	1027.3.1 U pdate Cont inuously
	193
	194
	195	1037.3.2 D isplay Upd ate
	196
	197
	198	1037.3.3 Z ero (clear ) Statisti cs
	199
	200
	201	1057.3.4 E xiting the Statistic s Screen
	202
	203
	204	1078
	205	Accessing the Pharma cy Electro nic Claims Reports
	206
	207
	208	1088.1 Cla im Results and Statu s
	209
	210
	211	1108.1.1 P ayable Cla ims Report
	212
	213
	214	1168.1.2 R ejected Cl aims Repor t
	215
	216
	217	1228.1.3 C MOP/ECME A ctivity Re port
	218
	219
	220	1248.1.4 R eversal Cl aims Repor t
	221
	222
	223	1288.1.5 C laims Subm itted, Not Yet Relea sed
	224
	225
	226	1298.1.6 R ecent Tran sactions
	227
	228
	229	1348.1.7 T otals by D ate
	230
	231
	232	1358.1.8 C losed Clai ms Report
	233
	234
	235	1388.1.9 N on-Billabl e Status R eport
	236
	237
	238	1468.1.10 Spending A ccount Rep ort
	239
	240
	241	1528.2 Oth er Reports
	242
	243
	244	1528.2.1 E CME Claims -Response Inquiry Op tion
	245
	246
	247	1558.2.2 P ayer Sheet Detail Re port Optio n
	248
	249
	250	1608.2.3 E CME Setup – Pharmaci es Report
	251
	252
	253	1628.2.4 T urn-around time stat istics
	254
	255
	256	1638.2.5 V iew ePharm acy Rx
	257
	258
	259	1748.2.6 O PECC Produ ctivity Re port
	260
	261
	262	1819
	263	BPS Nightl y Backgrou nd Job
	264
	265
	266	18310
	267	Glossary
	268
	269
	270	19911
	271	Acronyms
	272
	273
	274	20112
	275	Index
	276
	277
	278
	279
	280	1
	281	Introducti on XE "In troduction "
	282	The Electr onic Claim s Manageme nt Engine (ECME) gen erates ele ctronic cl aims in Na tional Cou ncil for P rescriptio n Drug Pro grams (NCP DP) V. D.0 formats, based on t he Outpati ent Pharma cy V. 7.0 workflow. ECME:
	283	Allows pha rmacy clai ms process ing staff to submit, resubmit, and rever se electro nic claims ;
	284	Provides r eports for end users and manag ement on c laims stat us, transa ction hist ory, and s ystem conf iguration standings;
	285	Allows Aut omated Dat a Processi ng Applica tion Coord inator (AD PAC) and I nformation Resources Managemen t Service (IRMS) sta ff to conf igure ECME to pharma cy site sp ecificatio ns.
	286	Allows Eli gibility I nquiry and Verificat ion transa ctions for verificat ion of val id patient pharmacy insurance.
	287	ECME claim s processi ng begins when event s within O utpatient Pharmacy V . 7.0 meet specific criteria, based on I ntegrated Billing (I B) V. 2.0 determinat ion, that indicate t he system should gen erate an e lectronic claim. To build a cl aim throug h ECME, se veral cond itions mus t be met. First, the patient m ust be reg istered an d have pha rmacy pres cription i nsurance c overage. S econd, the patient m ust be a n on-service connected patient o r, if serv ice connec ted; the p rescriptio n must not be for th e service- connected condition. The patie nt must no t have an environmen tal indica tors condi tion, unle ss the pat ient is Ac tive Duty. (If the p atient is Active Dut y, all pre scriptions are billa ble). Fina lly, the d rug must b e billable . Logic em bedded wit hin ECME m anages the creation of the ele ctronic cl aim, which requires integratio n with IB V. 2.0, Ph armacy Dat a Manageme nt, and Na tional Dru g File (ND F) V. 4.0. ECME also generates claims du ring Conso lidated Ma il Outpati ent Pharma cy (CMOP) V. 2.0 pro cessing fo r prescrip tions that meet bill ing requir ements.
	288	The Vetera ns Health Administra tion (VHA) developed ECME soft ware in or der to com ply with t he Health Insurance Portabilit y and Acco untability Act (HIPA A) of 1996 and updat ed it to c omply with the HIPAA rule of 2 009, which requires health car e provider s to trans mit outpat ient pharm acy prescr iption cla ims to pay ers electr onically i n the NCPD P format a nd to rece ive respon ses on a r eal-time b asis. ECME is derive d from the Point of Sale (POS) Applicati on develop ed by the Indian Hea lth Servic e (IHS) an d is assig ned to the BPS names pace.
	289	The ECME U ser Manual helps use rs submit electronic claims, a ids ADPAC and IRMS s taff in co nfiguring ECME to ph armacy sit e specific ations, an d is a ref erence man ual for al l screens and option s within E CME. While the ECME User Manua l does exp lain how t o use the Electronic Managemen t Claims E ngine, it is not int ended to s how how EC ME interac ts with Ou tpatient P harmacy V. 7.0, IB V . 2.0, the Austin In formation Technology Center, a nd other s oftware pa ckages to build, sub mit, recei ve, and pr ocess an e lectronic claim.
	290	The ECME U ser Manual assumes t hat you ar e familiar with the VistA comp uting envi ronment, i ncluding t he Outpati ent Pharma cy V. 7.0 workflow a nd the Dep artment of Veterans Affairs (D VA) FileMa n data str uctures an d terminol ogy.
	291	The ECME U ser Manual consists of the fol lowing sec tions.
	292	ECME Intro duction: Outlines t he history , use, and intent of the ECME software.
	293	ECME Orien tation: S hows how t o use the menus and options to generate an electro nic claim, obtain on line help, and find related ma nuals.
	294	ECME Menu Structures : Lists t he complet e ECME men u structur e. It also lists the ECME User , Manager, and Repor ts menus.
	295	Accessing the ECME M enu: Desc ribes how to gain ac cess to th e ECME mai n Menu.
	296	Accessing the ECME U ser Screen : Describ es the ele ments of s ubmitting pharmacy c laims to i nsurers th rough the ECME syste m.
	297	Accessing the ECME P HARMACY CO B menu: D escribes t he element s of submi tting phar macy claim s to secon dary insur ers and su bmitting T RICARE cla ims.
	298	Accessing the Pharma cy ECME Ma nager Menu : Describ es electro nic claims managemen t features that requ ire manage ment level decisions .
	299	Accessing the Pharma cy Electro nic Claims Reports: Describes the repor ts generat ed by ECME .
	300	ECME Backg round Jobs : Describ es the tas ks perform ed by the Nightly Ba ckground J ob.
	301	Glossary: Defines c ommon ECME -related t erms.
	302	Acronyms: Lists ECM E-related acronyms.
	303	Index: Li sts subjec ts, option s, and men us alphabe tically.
	304	2
	305	Orientatio n XE "Orie ntation"
	306	2.1 Workin g with the ECME User Manual
	307	The Electr onic Claim s Manageme nt Engine (ECME) Use r Manual i s a menu- and option -oriented manual. In most case s, the man ual descri bes a menu or option , shows ho w to acces s it, and uses table s and scre en shots t o describe its field s.
	308	The ECME U ser Manual uses the following methods to enhance r eadability .
	309	Menu optio ns and scr een action s are ital icized.
	310	Example: The Add Ph armacy/OPE CC Comment action tr iggers the system to display t he Pharmac y/OPECC Co mment on t he ECME Us er Screen.
	311	Screen pro mpts are d enoted wit h quotatio n marks ar ound them.
	312	Example: The “Selec t Action:” prompt wi ll display next.
	313	Variable n ames, form al name of options, field and file names , and secu rity keys are comple tely upper case.
	314	Example: The BPS US ER key.
	315	Screen cap tures/dial ogues are shaded and shown in a non-prop ortional f ont.
	316	User respo nses to on line promp ts are in boldface t ype.
	317	Example:
	318	Select Pha rmacy ECME User Menu Option: R PT
	319	<Enter> in dicates yo u must pre ss the Ent er key (or Return ke y) on the keyboard t o proceed to the nex t prompt. Other keys are repre sented wit hin < > an gle bracke ts.
	320	Example:
	321	Select Pha rmacy ECME Manager M enu Option : ?<Enter>
	322	The follow ing symbol s alert yo u to speci al informa tion.
	323	SymbolDesc riptionCau tions you to notice critical i nformation .Indicates especiall y importan t or helpf ul informa tion.Indic ates that you must h old a part icular sec urity key to perform a specifi c task.
	324	Example: You must hold the BPS MANAGE R and BPS MENU keys to access the Pharma cy ECME Ma nager Menu options. 2.2 Obtain ing Online Help XE "Online He lp"
	325	The ECME s oftware pr ovides onl ine help a nd commonl y used sys tem defaul t prompts. You can e nter quest ion marks at any res ponse prom pt. At the end of th e help dis play, Vist A (Veteran s Health I nformation Systems a nd Technol ogy Archit ecture) im mediately returns yo u to the p oint from which you started.
	326	To retriev e Online H elp in any VistA cha racter-bas ed product :
	327	Enter a si ngle quest ion mark ( ?) at a fi eld/prompt to obtain a brief d escription :
	328	If a field is a poin ter, enter ing one qu estion mar k (?) disp lays the H ELP PROMPT field con tents and a list of choices, i f the list is short.
	329	If the lis t is long, the syste m will ask you if th e entire l ist should be displa yed. A Y(E S) respons e will inv oke the di splay. By prefacing the starti ng point w ith an up- arrow (^) as a respo nse, you c an give th e display a starting point. Fo r example, ^M starts an alphab etic listi ng at the letter M i nstead of the letter A while ^ 127 starts any listi ng at the 127th entr y.
	330	Enter two question m arks (??) at a field /prompt fo r a more d etailed de scription. If a fiel d is a poi nter, ente ring two q uestion ma rks displa ys the HEL P PROMPT f ield conte nts and th e list of choices.
	331	Enter thre e question marks (?? ?) at a fi eld/prompt to invoke any addit ional Help text stor ed in Help Frames.
	332	2.3 Findin g Related Manuals XE "Related Manuals"
	333	To learn m ore about the ECME V . 1.0 soft ware, plea se consult the follo wing:
	334	Electronic Claims Ma nagement E ngine (ECM E) V. 1.0 Technical Manual/Sec urity Guid e
	335	All ECME V . 1.0 docu mentation can be fou nd at the VistA Docu mentation Library at http:// DNS/pm/h a pe/ipt_501 0/EDI_Port foli o / TAS%20Inte rim%20Repo sitory/MCC F%20TAS%20 Sche d u l e.zip .
	336	VHA-orient ed HIPAA ( Health Ins urance Por tability a nd Account ability Ac t) informa tion can b e found at
	337	(This page included for two-si ded copyin g.)
	338	3
	339	ECME Menu Structures XE "ECME Menu Struc tures"
	340	This secti on provide s a map of the Elect ronic Clai ms Managem ent Engine (ECME) me nu structu re includi ng a list of all opt ions. ECME is a menu -driven sy stem that allows acc ess based on the sec urity keys that you hold.
	341	Currently, ECME has the follow ing securi ty keys: BPSMENU, B PS USER, B PS MANAGER , BPS MAST ER, BPS SU PERVISOR, and BPS RE PORTS. All users mus t have the BPSMENU k ey in addi tion to th e specific keys list ed below.
	342	The follow ing table lists the type of us ers who wo uld need a ccess to a specific menu and t he ECME Se curity Key s you must hold in o rder to ac cess a par ticular EC ME menu. F or example , the OPEC C (Outpati ent Pharma cy Electro nic Claims Coordinat or) would need acces s to all E CME menus, while a P harmacy Te chnician m ight only need acces s to the M ain Menu, ECME User Screen, an d Reports menus.
	343	Table 3-1: List of U sers with Suggested ECME Menus and Secur ity Keys
	344	Type of Us er*ECME Me nuECME Sec urity Keys OPECCAll E CME Menus
	345	ECME Ma in Menu
	346	ECME Us er Screen
	347	ECME Ph armacy COB
	348	Pharmac y ECME Man ager Menu
	349	Pharmac y Electron ic Claims Reports B PSMENU
	350	BPS USER
	351	BPS MANA GER
	352	BPS REPO RTSPharmac ist, Pharm acy Techni cian ECM E Main Men u
	353	ECME Us er Screen
	354	Pharmac y Electron ic Claims Reports B PSMENU
	355	BPS USER
	356	BPS REPO RTSePharma cy Site Ma nager and back-up ECME Main Menu
	357	ECME Us er Screen
	358	Pharmac y ECME Man ager Menu
	359	Pharmac y Electron ic Claims Reports B PSMENU
	360	BPS USER
	361	BPS MANA GER
	362	BPS MAST ER
	363	BPS REPO RTSADPAC
	364	(Autom ated Data
	365	Proce ssing Appl ication
	366	Coord inator) ECME Main Menu
	367	ECME Ph armacy COB
	368	Pharmac y ECME Man ager Menu
	369	Pharmac y Electron ic Claims Reports B PSMENU
	370	BPS MANA GER
	371	(BPS MA STER is al so
	372	requir ed to acce ss certain
	373	MGR me nu options )
	374	BPS REPO RTSIRMS
	375	(Inform ation Reso urces
	376	Manage ment Servi ce)ECME Ma in Menu
	377	Pharmac y ECME Man ager Menu
	378	Pharmac y Electron ic Claims ReportsBPS MENU
	379	BPS MANA GER
	380	(BPS MA STER is al so
	381	requir ed to acce ss certain
	382	MGR me nu options )
	383	BPS REPO RTSOPECC S upervisorP harmacy El ectronic C laims Repo rtsBPS SUP ERVISOR
	384	BPS REPORT S3.1 The C omplete EC ME Menu St ructure XE "ECME Men u Options"
	385	The comple te list of ECME menu options i s shown be low. The O PECC needs to access all ECME options.
	386	You must h old the BP SMENU and BPS MANAGE R keys to view the P harmacy EC ME Manager Menu opti on. The BP S MASTER k ey is also required to view th e Edit ECM E Pharmacy Data (PHA R), Pharma cy ECME Se tup Menu ( SET), Edit Basic ECM E Paramete rs (BAS), and Regist er Pharmac y with Aus tin Inform ation Tech nology Cen ter (REG) options.U
	387	ECME User Screen
	388	COB
	389	ECME Pharm acy COB .. .
	390	SEC
	391	Potential Secondary Rx Claims Report
	392	TRI
	393	Potential Claims Rep ort for Du al Eligibl e
	394	PRO
	395	Process Se condary/TR ICARE Rx t o ECME
	396	MGR
	397	Pharmacy E CME Manage r Menu . .
	398	MNT
	399	ECME trans action mai ntenance o ptions …
	400
	401	UNS
	402	View/Unstr and Submis sions Not Completed
	403
	404	ROC
	405	Re Open CL OSED Claim
	406	SET
	407	Pharmacy E CME Setup Menu ...
	408
	409	BAS
	410	Edit Basic ECME Para meters
	411
	412	PHAR
	413	Edit ECME Pharmacy D ata
	414
	415	REG
	416	Register P harmacy wi th Austin Informatio n Technolog y Center
	417	STAT
	418	Statistics Screen
	419	RPT
	420	Pharmacy E lectronic Claims Rep orts . .
	421
	422	CLA
	423	Claim Resu lts and St atus . .
	424
	425
	426	PAY
	427	Payable Cl aims Repor t
	428
	429
	430	REJ
	431	Rejected C laims Repo rt
	432
	433
	434	ECMP
	435	CMOP/ECME Activity R eport
	436
	437
	438	REV
	439	Reversal C laims Repo rt
	440
	441
	442	NYR
	443	Claims Sub mitted, No t Yet Rele ased
	444
	445
	446	REC
	447	Recent Tra nsactions
	448
	449
	450	DAY
	451	Totals by Date
	452
	453
	454	CLO
	455	Closed Cla ims Report
	456
	457
	458	NBS
	459	Non-Billab le Status Report
	460
	461
	462	SPA
	463	Spending A ccount Rep ort
	464
	465	OTH
	466	Other Repo rts . .
	467
	468
	469	CRI
	470	ECME Claim s-Response Inquiry
	471
	472
	473	PAY
	474	Payer Shee t Detail R eport
	475
	476
	477	PHAR
	478	ECME Setup - Pharmac ies Report
	479
	480
	481	TAT
	482	Turn-aroun d time sta tistics
	483
	484
	485	VER
	486	View ePhar macy Rx
	487
	488
	489	OPR
	490	OPECC Prod uctivity R eport
	491	3.2 ECME U ser Screen XE "Pharm acy ECME U ser Screen "
	492	The ECME U ser Screen structure is listed below. Th e ECME Use r Screen i s a List M anager scr een that h as multipl e actions contained within the option. O PECCs must have acce ss to this option. I t may be h elpful for Pharmacis ts and the ePharmacy Site Mana ger to hav e access a lso.
	493	You must h old the BP S MENU and BPS USER keys to vi ew the ECM E User Scr een option .U
	494	ECME User Screen
	495	3.3 ECME P harmacy CO B Menu Str ucture
	496	The ECME P harmacy CO B Menu opt ion struct ure is lis ted below. OPECCs mu st be able to access this menu .
	497	You must h old the BP SMENU keys to view t he ECME Ph armacy COB option. C OB
	498	ECME Pharm acy COB . .
	499	SEC Pot ential Sec ondary Rx Claims Rep ort
	500
	501	TRI Po tential Cl aims Repor t for Dual Eligible
	502
	503	PRO Pro cess Secon dary/TRICA RE Rx to E CME
	504	3.4 Pharma cy ECME Ma nager Menu Structure " Pharmacy ECME Mana ger Menu O ptions"
	505	The Pharma cy ECME Ma nager Menu option st ructure is listed be low. ADPAC , IRMS (In formation Resources Management Service) and OPECC staff must be able t o use this menu.
	506	You must h old the BP SMENU and BPS MANAGE R keys to view the P harmacy EC ME Manager Menu opti on.MGR
	507	Pharmacy E CME Manage r Menu . .
	508	MNT
	509	ECME trans action mai ntenance o ptions …
	510
	511	UNS
	512	View/Unstr and Submis sions Not Completed
	513
	514	ROC
	515	Re Open CL OSED Claim
	516	SET
	517	Pharmacy E CME Setup Menu ...
	518
	519	BAS
	520	Edit Basic ECME Para meters
	521
	522	PHAR
	523	Edit ECME Pharmacy D ata
	524
	525	REG
	526	Register P harmacy wi th Austin Automation Center
	527	STAT
	528	Statistics Screen
	529	3.5 Pharma cy Electro nic Claims Reports M enu Struct ure XE " P harmacy El ectronic C laims Repo rts Menu S tructure"
	530	The Pharma cy Electro nic Claims Reports m enu option structure is listed below. OP ECCs and P harmacy st aff involv ed with th e ePharmac y process must be ab le to acce ss this me nu.
	531	You must h old the BP SMENU and BPS REPORT keys to v iew the Ph armacy Ele ctronic Cl aims Repor ts option. The OPECC Productiv ity Report will only display i f the user holds the BPS SUPER VISOR KEY. RPT
	532	Pharmacy E lectronic Claims Rep orts . .
	533
	534	CLA
	535	Claim Resu lts and St atus . .
	536
	537
	538	PAY
	539	Payable Cl aims Repor t
	540
	541
	542	REJ
	543	Rejected C laims Repo rt
	544
	545
	546	ECMP
	547	CMOP/ECME Activity R eport
	548
	549
	550	REV
	551	Reversal C lams Repor t
	552
	553
	554	NYR
	555	Claims Sub mitted, No t Yet Rele ased
	556
	557
	558	REC
	559	Recent Tra nsactions
	560
	561
	562	DAY
	563	Totals by Date
	564
	565
	566	CLO
	567	Closed Cla ims Report
	568
	569
	570	NBS
	571	Non-Billab le Status Report
	572	SPA Spe nding Acco unt Report
	573
	574	OTH
	575	Other Repo rts . .
	576
	577
	578	CRI
	579	ECME Claim s-Response Inquiry
	580
	581
	582	PAY
	583	Payer Shee t Detail R eport
	584
	585
	586	PHAR
	587	ECME Setup - Pharmac ies Report
	588
	589
	590	TAT
	591	Turn-aroun d time sta tistics
	592
	593
	594	VER
	595	View ePhar macy Rx
	596
	597
	598	OPR
	599	OPECC Prod uctivity R eport
	600	4
	601	Accessing the ECME M ain Menu XE "ECME M ain Menu"
	602	The Electr onic Claim s Manageme nt Engine Main Menu option is usually ac cessed thr ough the C ore Applic ations Men u.
	603	You must h old the BP SMENU key to view th e Electron ic Claims Management Engine (E CME) Main Menu.Examp le 4-1: A ccessing t he Electro nic Claims Managemen t Engine M ain Menu
	604	Select Cor e Applicat ions Optio n: ?
	605	Laboratory ...
	606	PIMS MAS MANAGE R ...
	607	Mental Hea lth ...
	608	Military R etirees .. .
	609	Patient Da ta Log
	610	Informatio n Manageme nt Systems (SWIMS) . ..
	611	Voluntary Services' Menu ...
	612	AR Finance AR Manager M enu ...
	613	BPS ECME ...
	614	EN Engineerin g Main Men u ...
	615	FEE Fee Basis Main Menu ...
	616	HL7 HL7 Main M enu ...
	617	IB Integrated Billing M aster Menu ...
	618	NS Nursing Sy stem Manag er's Menu ...
	619	PSO Outpatient Pharmacy Manager .. .
	620	VOL Voluntary Service Ma ster Menu ...
	621	Select Cor e Applicat ions Optio n: BPS EC ME
	622	(This page included for two-si ded copyin g.)
	623	5
	624	Accessing the ECME U ser Screen XE "ECME User Scre en"
	625	The ECME U ser Screen provides access to pharmacy c laims that have been submitted electroni cally to t hird party payers/Ph armacy Ben efit Manag ers (PBM). This opti on allows you to rev iew, close , reverse, or resubm it electro nic claims .
	626	From the E CME User S creen you can access additiona l actions needed to process el ectronic p harmacy cl aims, incl uding the Further Re search act ion, which allows yo u to resea rch insura nce, eligi bility and prescript ion inform ation.
	627	You must h old the BP SMENU AND BPS USER k ey to view the ECME User Scree n option.T his screen is access ed by sele cting the U (ECME Us er Screen) option on the ECME Main Menu screen.
	628	The screen will disp lay nothin g the firs t time you enter thi s menu opt ion. Selec t the Chan ge View op tion, CV, as in sect ion 5.1, a nd specify preferenc es to be d isplayed o n the scre en. The sy stem will then defau lt to thes e settings and displ ay current informati on about a ctive pati ents and p rescriptio ns for the timeframe requested .Example 5 -1: Acces sing the E CME User S creen Opti on
	629	*** ****** ****** ****** ****** **
	630	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	631	* XXXXX V AMC *
	632	* Main M enu *
	633	*** ****** ****** ****** ****** **
	634	U ECME User Screen
	635	COB ECME Pharm acy COB .. .
	636	MGR Pharmacy E CME Manage r Menu ...
	637	RPT Pharmacy E lectronic Claims Rep orts ...
	638	Select ECM E Option: U ECME Us er Screen
	639	Please wai t...
	640	Example 5- 2: Displa ying the E CME User S creen Opti on
	641	PHARMACY E CME Jul 03, 20 10@14:55:0 1 Page : 1 of 30
	642	SELECTED D IVISION(S) : ALL
	643	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	644	Sorted b y: Transac tion date by default
	645	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# STATUS /LOC/TYP/R XINF
	646	1 ECMEPa tient,FIVE (XXXX) I BINSUR1/ VET Pb: 0 Rj:1 AcR v:3 RjRv:0
	647	1.1 CO LCHICINE 0 .6MG 0007 4-3781-01 06/24 1012 97$ 1/ 0000000016 53 M RT DS/N
	648	10/1 9/10 - Cla rification Code 8 su bmitted.
	649	(OPP USER,TWO)
	650	p-Re versal acc epted
	651	Enter ?? f or more ac tions
	652	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	653	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	654	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	655	Select Act ion: Next Screen//
	656	This secti on diagram s and desc ribes the different elements o f your ECM E User Scr een.
	657	Dia gram 5-1: ECME User Screen Ar eas
	658
	659
	660
	661
	662
	663
	664	The table below desc ribes the four areas of the EC ME User Sc reen.
	665	Table 5-1: Descript ion of ECM E User Scr een Areas
	666	Screen Are aDescripti onHeader A reaDisplay s the date /time the screen was built, pa ge status, selected division(s ), user an d activity date rang e. Patient /
	667	Rx AreaDis plays info rmation ab out the pa tient and prescripti on:#Line N umber. Seq uential li ne number for each p atient and associate d prescrip tion line( s).Patient Lines # PATIENT (Patient ID) INSURA NCE/ EligI ndicator SummarySta tus
	668	ECMEPatien t,FIVE (X XXX) IBINS UR1/ VET Pb:0 Rj:1 AcRv:3 Rj Rv:0
	669	The first line is th e Patient Summary In formation line, whic h displays the patie nt’s name, (patient ID), insur ance compa ny and pho ne; eligib ility indi cator for the patien t and insu rance: VET = Veteran s, TRI = T RICARE; CV A = CHAMPV A; claim p rogress st atus and a summary s tatus of a ll claims submitted for this p atient wit hin the ti me frame r equested i n the ECME User Scre en paramet ers. The c odes for t he summary status ar e as follo ws:
	670	Pb = Payab le
	671	Rj = Rejec ted
	672	AcRv = Rev ersal Acce pted
	673	RjRv = R eversal Re jected
	674	Exam ple: VET Pb :17 Rj:4 A cRv:0 RjRv :0.Claim/ Prescripti on Informa tion LineT he Prescri ption line (s) follow the patie nt informa tion lines sequentia lly. For e ach fill, an ECME cl aim is sen t to the p ayer and e ach of the se claims is display ed as a se parate lin e on the U ser Screen (ECME Use r Screen).
	675	Drug Nam e ND C DOS RX# Copay Refill/E CME# COLCHIC INE 0.6MG 00074-378 1-01 06/24 101297 $ 1 /00000 0001653
	676	LOC /BillT YPE /RXSta tus /Rele ase Status
	677	M/ RT/ DS /N
	678	These show for each claim:
	679	Drug Name
	680	NDC (Natio nal Drug C ode)
	681	Date of Se rvice
	682	Rx#
	683	$ Patient Copay (if applicable )
	684	Refill#
	685	ECME#
	686	Fill Locat ion
	687	C = Consol idated Mai l Outpatie nt Pharmac y (CMOP)
	688	M = LO CAL MAIL
	689	W = WI NDOW FILL
	690	Bill Type
	691	BB = B ackbill
	692	P2 = PRO option
	693	RS = Res ubmission
	694	RT = Rea l Time Fil l
	695	RX Status
	696	AC = Acti ve
	697	NV = Non-v erified
	698	HL = Hold
	699	SU = Suspe nd
	700	EX = Expir ed
	701	DS = Disco ntinued
	702	DL = Delet ed
	703	?? = Unkno wn
	704	Release St atus
	705	N = Rx NOT Released
	706	R = Rx Rel eased
	707	Coordinati on of Bene fits Indic ator
	708	p- primary claim
	709	s- seconda ry claim
	710	s-Payable (p-Payable )
	711	The status is displa yed only f or those f ill lines (claims) t hat repres ent the mo st recent fill. If t here is mo re than on e fill for the same prescripti on within the time f rame reque sted in th e ECME Use r Screen p arameters, the previ ous fill/c laim is in dicated wi th "*" i nstead of Rx status, and the m ost curren t fill wil l display the RX sta tus. If a fill has b een create d and put on suspens e, the scr een displa ys "*". User-Input Comments The system allows th e ECME use r to enter comments for any cl aim displa yed on the ECME User Screen. T he most re cent comme nt is disp layed unde r the Pres cription I nformation line.
	712	If a claim has been resubmitte d since th e most rec ent commen t, a messa ge display s in place of the mo st recent comment: “Prior com ments supp ressed – u se CMT act ion for al l comments ”.Payer Re turned Res ponsesThe Payer Retu rned Respo nse inform ation is d isplayed b eneath the user-inpu t comments or beneat h the pati ent inform ation line , if no co mments wer e entered. Each resp onse will begin on a separate line.
	713	Valid paye r-returned responses include R ejected (w ith a Nati onal Counc il for Pre scription Drug Progr ams (NCPDP ) rejectio n code des cribed in the ePharm acy Reject s & Resolu tions Guid e on the DNS , with add itional li nes of des criptive e rror messa ges), Paya ble, Rever sal Accept ed, Revers al Rejecte d, Strande d, Strande d reversal , Captured , Duplicat e, Other, Cancelled, Corrupt, Unknown st atus and I n Progress . If a cla im is clos ed, “Close d” is adde d to the s tatus, e.g ., “Revers al accepte d/Closed”. Message Wi ndowThis s ection dis plays a pl us (+) sig n, minus ( -) sign or informati onal text (i.e., Ent er ?? for more actio ns). The p lus and mi nus signs, entered a t the acti on prompt, are used to jump fo rward or b ack a scre en.Action AreaA list of Claims Data Entr y options is availab le to you as describ ed in Sect ion 5 of t his manual . A double question mark (??) may be ent ered at th e "Select Action" pr ompt for a list of a ll List Ma nager opti ons availa ble.An opt ion chosen at the pa tient info rmation le vel is per formed on all claim items for that patie nt.The ECM E User Scr een also d isplays no n-billable entries i n addition to billab le claims. TRICARE an d CHAMPVA prescripti ons with p seudo-reje ction code s of eT an d eC displ ay with a few differ ences. The display f or non-bil lable entr ies does n ot include date of s ervice or an ECME nu mber. Also , an open/ closed ind icator dis plays for each pseud o-rejectio n entry an d the open /closed st atus is on ly for dis play purpo ses. The u ser is abl e to filte r based on the statu s by using the Chang e View act ion.
	714	The ECME U ser Screen has sever al actions that help you navig ate it, as shown bel ow. Action s are ente red at the "Select A ction" pro mpt by typ ing the sy nonym for the action (e.g., CV for Chang e View), t he first u nique lett er(s) of t he action name (e.g. , CL for C lose) or t he full na me of the action (e. g., Sort L ist for So rt List).
	715	Example 5- 2: List of all ECME User Scree n Actions
	716	+ Enter ?? f or more ac tions
	717	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	718	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	719	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	720	List Manag er provide s generic actions ap plicable t o List Man ager Scree ns. A doub le questio n mark (?? ) may be e ntered at the "Selec t Action" prompt for a list of other act ions avail able. Ente ring the s ynonym is the quicke st way to select an action.
	721	Example 5- 3: Display ing List M anager Act ions by En tering “?? ”
	722	Select Act ion: Next Screen// ? ?
	723	The follow ing action s are also available :
	724	+ Next Screen
	725	- Previ ous Screen
	726	UP Up a Line
	727	DN Down a Line
	728	> Shift View to R ight
	729	< Shift View to L eft
	730	FS First Screen
	731	LS Last Screen
	732	GO Go to Page
	733	RD Re Di splay Scre en
	734	PS Print Screen
	735	PL Print List
	736	SL Searc h List
	737	ADPL Auto Display(On /Off)
	738	Q
	739	Quit
	740	Press RETU RN to cont inue or '^ ' to exit:
	741	ROC Reope n Closed C laims
	742	OCN Open/ Close Non Billable E ntry
	743	DV Print Developer Claim Log
	744	REJ OPECC Reject In formation
	745	RER Resub mit Claim w/o Revers al
	746	EX Exit
	747	LOG Print Claim Log
	748	RED Resub mit Claim w/EDITS
	749	UD Displ ay Update
	750	Enter RETU RN to cont inue or '^ ' to exit:
	751	The follow ing action s are not available for non-bi llable ent ries: REV Reverse P ayable Cla im, CLO Cl ose Claim, LOG Prin t Claim Lo g, WRK Sen d to Workl ist, ROC R eopen Clos ed Claims, RED Resu bmit Claim w/EDITS, RER Resubm it Claim w /o Reversa l, and RH Release Co pay (On FR Further R esearch).
	752	After sele cting an a ction, a p rompt may display fo r the user to select an item f rom the EC ME User sc reen. If the action requires the user t o select a patient l ine, the s ystem will default a value of 1 for the item promp t if there is only o ne patient displayed . If the action req uires the user to se lect a cla im line, t he system will defau lt a value of 1.1 fo r the prom pt if ther e is only one claim displayed.
	753	5.1 Change View XE " Change Vi ew"
	754	The Change View acti on allows you to cus tomize inf ormation y ou want to see displ ayed on th e ECME Use r Screen.
	755	The action is access ed by ente ring CV at the “Sele ct Action: ” prompt o n the ECME User Scre en. The sy stem gives you the o ption to “ SAVE” thes e selectio ns as your “preferre d view”.
	756	(This page included for two-si ded copyin g.)
	757	Example 5. 1-1: Acce ssing the Change Vie w Action
	758	PHARMACY E CME Apr 26, 20 06@11:44:4 5 Page : 1 of 2
	759	SELECTED D IVISION(S) : ALL
	760	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	761	Sor ted by: Pa tient Name
	762	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	763	6 ECMEpa tient,Two (XXXX) W EBMD TE/ VET Pb:1 Rj:0 AcRv:0 RjR v:1
	764	6.1 FU ROSEMIDE 1 0MG/M 006 41-2312-25 04/18 100 004065$ 0 /000000504 691 W RT A C/R
	765	p-Pa yable
	766	6.2 CH OLESTYRAMI NE 4G 000 87-0580-01 04/19 100 004066$ 0 /000000504 692 W RT A C/R
	767	p-Re versal rej ected
	768	NN:T ransaction Rejected At Switch Or Interme diary
	769	NC16 -The clear inghouse d id not rep ly in time .
	770	7 ECMEpa tient,One (XXXX) W EBMD TE/ VET ALL payabl e
	771	7.1 AL BUTEROL IN HALER 555 55-4444-22 04/26 100 003744$ 0 /000000504 304 W RT A C/R
	772	p-Pa yable
	773	7.2 AC ETYLCYSTEI NE 20 000 87-0570-09 04/21 100 004054$ 0 /000000504 677 W RT A C/N
	774	p-Pa yable
	775	8 ECMEpa tient,Thre e (XXXX) W EBMD TE/ VET ALL payabl e
	776	+ Enter ?? f or more ac tions
	777	The screen has been updated on APR 26,20 06@14:50:4 7. Press " Q" to quit .
	778	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	779	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	780	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	781	Select Act ion: Next Screen//CV Change Vi ew
	782	(This page included for two-si ded copyin g.)
	783	View data by divisio n(s) or al l division s.
	784	Example 5. 1-2: Sele cting View s by Divis ion
	785	Selec t one of t he followi ng:
	786	D DIVISION
	787	A ALL
	788	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: A// DIVISION
	789	Selected :
	790	Select ECM E Pharmacy Division( s): BAY PI NES
	791	BAY PINES
	792	View data by Eligibi lity Type of the cla im.
	793	Example 5. 1-3: Sele cting View s by Eligi bility Typ e
	794	Selec t one of t he followi ng:
	795	V VETERAN
	796	T TRICARE
	797	C CHAMPVA
	798	A ALL
	799	Select Cer tain Eligi bility Typ e or (A)ll : A// LL
	800	View data for one EC ME user or all users . The ECME user is d efined as the person who last processed/ finished/r esubmitted , etc., th e prescrip tion fill.
	801	Example 5. 1-4: Sele cting View s from Ent ries by On e User
	802	Selec t one of t he followi ng:
	803	U ONE USER
	804	A ALL Disp lay One EC ME (U)ser or (A)LL: A// U ONE USER
	805	Select Use r: USER
	806	1 E CMEuser,On e UO PHARMA CIST
	807	2 E CMEuser,Tw o UTW PHARMA CIST
	808	3 E CMEuser,Th ree UTH PHARMA CIST
	809	CHOOSE 1-3 : 1 ECMEu ser,One UO PHARMA CIST
	810	View data from one p atient or all patien ts.
	811	Example 5. 1-5: Sele cting View s from Ent ries for O ne Patient
	812	Se lect one o f the foll owing:
	813	P ONE PATIEN T
	814	A ALL
	815	Display On e (P)atien t or (A)LL : A// P O NE PATIENT
	816	Select Pat ient: ECME patient,ON E// ECME
	817	1 ECM Epatient,O ne 1-1-65 666443333 NO NSC VET ERAN
	818	2 ECM Epatient,T wo 1-1-65 666443444 NO NSC VET ERAN
	819	3 ECM Epatient,T hree 1-1-68 666773333 YES SC VET ERAN
	820	ENTER '^' TO STOP, O R
	821	CHOOSE 1-3 : 2 ECMEp atient,Two 1- 1-65 66 6443444 NO NSC VETER AN
	822	Enrollmen t Priority : GROUP 8g Categor y: NOT ENR OLLED End Date: 08/ 01/2005
	823	View data about one prescripti on or all prescripti ons.
	824	Example 5. 1-6: Sele cting View s from Ent ries for O ne Prescri ption
	825	Se lect one o f the foll owing:
	826	R ONE RX
	827	A ALL
	828	Display On e (R)x or (A)LL: A// R ONE RX
	829	Select RX: 123456
	830	Choose dat a for a pe riod of da ys or hour s.
	831	Example 5. 1-7: Sele cting View s by Timef rame of th e Default of Days
	832	Selec t one of t he followi ng:
	833	D DAYS
	834	H HOURS
	835	Activity T imeframe ( H)ours or (D)ays: D/ / <Enter> AYS
	836	Enter a nu mber for t he timefra me value f or the num ber of day s, or numb er of hour s, to view .
	837	Example 5. 1-8: Sele cting View s by Timef rame Numbe r of Days or Hours
	838	Activity T imeframe V alue: (1-9 99): 40// 10
	839	Choose whi ch types o f claims w ill displa y on the U ser Screen .
	840	Example 5. 1-9: Sele cting Type s of Claim s
	841	Selec t one of t he followi ng:
	842	O OPEN CLAIM S
	843	C CLOSED CLA IMS
	844	A ALL
	845	Select Ope n/Closed o r All Clai ms: A// <E nter> LL
	846	Choose whi ch types o f non-bill able entri es will di splay on t he User Sc reen.
	847	Example 5. 1-10: Sel ecting Typ es of Entr ies
	848	Selec t one of t he followi ng:
	849	O Open Non-B illable En tries
	850	C Closed Non -Billable Entries
	851	A ALL
	852	Please note this question only appli es to
	853	TRICAR E or CHAMP VA Non-Bil lable Entr ies.
	854	Display (O )pen or (C )losed or (A)ll Non- Billable E ntries: A/ /
	855	Choose whi ch types o f payer re quests wil l display on the Use r Screen.
	856	Example 5. 1-11: Sel ecting Typ es of Requ ests
	857	Selec t one of t he followi ng:
	858	B BILLING RE QUESTS
	859	R REVERSALS
	860	A ALL
	861	Select Sub mission Ty pe: A// <E nter> LL
	862	View rejec ted claims , payable claims or all claims .
	863	Example 5. 1-12: Sel ecting Vie ws of Clai m Status
	864	Selec t one of t he followi ng:
	865	R REJECTS
	866	P PAYABLES
	867	U UNSTRANDED
	868	A ALL
	869	Display (R )ejects or (P)ayable s or (U)ns tranded or (A)LL: R/ / R REJE CTS
	870	View relea sed claims , non-rele ased claim s or all c laims.
	871	Example 5. 1-13: Sel ecting Vie ws of Rele ased Claim s
	872	Selec t one of t he followi ng:
	873	R RELEASED
	874	N NON-RELEAS ED
	875	A ALL
	876	Display (R )eleased R xs or (N)o n-Released Rxs or (A )LL: A// R ELEASED
	877	View CMOP, Mail, Win dow or all claims.
	878	Example 5. 1-14: Sel ecting Vie ws of CMOP Claims
	879	Selec t one of t he followi ng:
	880	C CMOP
	881	M MAIL
	882	W WINDOW
	883	A ALL
	884	Display (C )MOP or (M )ail or (W )indow or (A)LL: A// CMOP
	885	View real time, back bills, bi lls proces sed with t he PRO opt ion, resub missions ( please see Section 6 .3), or al l claims.
	886	Example 5. 1-15: Sel ecting Vie ws of Bill Types
	887	Select one of the fo llowing:
	888	R REALTIME
	889	B BACKBILLS
	890	P PRO OPTION
	891	S RESUBMISSI ON
	892	A ALL
	893	Display (R )ealTime F ills or (B )ackbills or (P)RO O ption or ( A)LL: A// REALTIME
	894	View one r eject code or all re ject codes if the op tion “REJE CTS” was c hosen for types of c laims to v iew in (G) Rejected Claims, ab ove.
	895	Example 5. 1-16: Sel ecting Vie ws of One Reject Cod e
	896	Selec t one of t he followi ng:
	897	R REJECT COD E
	898	A ALL
	899	Display Sp ecific (R) eject Code or (A)LL: A// REJEC T CODE
	900	Select Rej ect Code: 29 M /I Number Refills Au thorized
	901	View data for a spec ific insur ance compa ny or all insurance companies.
	902	Example 5. 1-17: Sel ecting Vie ws by a Sp ecific Ins urance Com pany
	903	Selec t one of t he followi ng:
	904	I SPECIFIC I NSURANCES( S)
	905	A ALL
	906	Select Cer tain (I)NS URANCE or (A)LL): I/ / <Enter> SPECIFIC INSURANCES (S)
	907	Selected : OPINSUR2
	908	Select INS URANCE: DE VELOPMENT INS 123 HERE S TREET SAN FR ANCISCO
	909	CALIFORN IA Y
	910	Selected : DEVELOPM ENT INS
	911	OPINSUR2
	912	Select INS URANCE: OP INSUR2 25 INS WAY BIRM ALABAMA Y
	913	Selec t one of t he followi ng:
	914	Y YES
	915	N NO
	916	Delete OPI NSUR2 from your list ?: NO// y YES
	917	Selected : DEVELOPM ENT INS
	918	Select INS URANCE:
	919	You must a nswer Y or N to keep the Chang e View act ion select ions as yo ur preferr ed view. I f you ente r Y, the p referred v iew is sto red in ECM E for use when you e nter the E CME User S creen. If you enter N, the dis play will only show the select ed views u ntil you q uit ECME U ser Screen or use th e Change V iew action again.
	920	Example 5. 1-18: Ent ering “Y” to Save Se lections a s User’s P referred V iew
	921	DO YOU WAN T TO SAVE THIS VIEW AS YOUR PR EFERRED VI EW (Y/N)?: YES
	922	Updating s creen...
	923	5.2 Sort L ist XE " S ort List"
	924	The Sort L ist screen action al lows you t o customiz e the sort order of data displ ayed on th e ECME Use r Screen.
	925	Sort Order (Defaults );
	926	T
	927	Transactio n Date/Tim e
	928
	929
	930	(descendin g)
	931	D
	932	Division
	933
	934
	935
	936	(ascending )
	937	I
	938	Insurance Company
	939
	940
	941	(ascending )
	942	C
	943	Reject Cod e
	944
	945
	946
	947	(ascending )
	948	P
	949	Patient Na me
	950
	951
	952
	953	(ascending )
	954	N
	955	Drug Name
	956
	957
	958
	959	(ascending )
	960
	961	B
	962	Bill Type [BB/P2/RT]
	963
	964
	965	(ascending )
	966	L
	967	Fill Locat ion
	968
	969
	970
	971	(ascending )
	972	R
	973	Released/N on-Release
	974
	975
	976	(ascending )
	977	A
	978	Active/Dis continued Rx
	979
	980	(ascending )
	981	Transactio n Date/Tim e (descend ing) is th e secondar y sort for ALL prima ry sort se lections. Sorting is by PATIEN TS (not cl aims), bas ed on the date/time of their m ost recent transacti on.
	982	Active/Dis continued Rx option sorts clai ms by the Rx status. Access thi s action b y entering SO at the “Select A ction:” pr ompt on th e ECME Use r Screen. The system will give you the o ption to “ SAVE” thes e selectio ns as the User’s “Pr eferred Vi ew”.
	983	Example 5. 2-1: Acce ssing the Sort List Option
	984	PHARMACY E CME Apr 30, 20 05@09:10:1 8 Page: 1 of 2
	985	SELECTED D IVISION(S) : ALL
	986	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	987	Sor ted by: Pa tient Name
	988	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	989	6 ECMEpa tient,Two (XXXX) WEB MD / 89% Pb: 5 Rj:0 AcR v:0 RjRv:0
	990	6.1 FU ROSEMIDE 1 0MG/M 006 41-2312-25 04/21 100 004065$ 0 /000000504 691 W RT A C/R
	991	p-Pa yable
	992	6.2 CH OLESTYRAMI NE 4G 000 87-0580-01 04/21 100 004066$ 0 /000000504 692 W RT A C/R
	993	p-Re versal rej ected
	994	NN:T ransaction Rejected At Switch Or Interme diary
	995	NC16 -The clear inghouse d id not rep ly in time .
	996	7 ECMEpa tient,One (XXXX) WEBMD TE/ VET ALL payab le
	997	+ Enter ?? f or more ac tions
	998	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	999	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1000	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1001	Select Act ion: Next Screen//SO Sort Li st
	1002	Example 5. 2-2: Choo sing Patie nt as the User’s Sor t Preferen ce
	1003	Selec t one of t he followi ng:
	1004	T TRANSACTIO N DATE
	1005	D DIVISION
	1006	I INSURANCE
	1007	C REJECT COD E
	1008	P PATIENT NA ME
	1009	N DRUG NAME
	1010	B BILL TYPE (BB/P2/RT)
	1011	L FILL LOCAT ION
	1012	R RELEASED/N ON-RELEASE D
	1013	A ACTIVE/DIS CONTINUED
	1014	ENTER SORT TYPE: P// PATIENT N AME
	1015	Example 5. 2-3: Choo sing User’ s Sort Pre ference as the Prefe rred View
	1016	Selec t one of t he followi ng:
	1017	Y YES
	1018	N NO
	1019	DO YOU WAN T TO SAVE THIS VIEW AS YOUR PR EFERRED VI EW (Y/N)?: YES
	1020	Updating s creen...
	1021	5.3 Revers e Payable Claim XE " Reverse P ayable Cla im"
	1022	The Revers e Payable Claim acti on allows a user to submit a c laim rever sal reques t to the i nsurer for a claim t hat was re turned as “Payable” or “Revers al Rejecte d”. A prim ary claim cannot be reversed i f there is a payable secondary claim. Th e secondar y claim mu st be reve rsed befor e the prim ary claim can be rev ersed.
	1023	Claims tha t have bee n closed w ill be dis played wit h “/Closed ” after th e status. Closed cla ims cannot be revers ed until t hey are fi rst reopen ed. If you attempt t o reverse a claim th at is clos ed, a mess age is dis played tel ling you t hat the cl aim “is Cl osed and c annot be R eversed. R eopen the claim and try again. ”
	1024	Access the action by entering REV at the “Select A ction:” pr ompt on th e ECME Use r Screen.
	1025	Example 5. 3-1: Acce ssing and Executing the Revers e Payable Claim Acti on
	1026	PHARMACY E CME Aug 10, 20 05@10:31:2 2 Page: 1 8 of 42
	1027	SELECTED D IVISION(S) : ALL
	1028	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1029	Sor ted by: Pa tient Name
	1030	+# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	1031	7 ECMEpa tient,One (XXXX) WE BMD TE/ VET A LL payable
	1032	7.1 AL BUTEROL IN HALER 555 55-4444-22 08/08 100 003744$ 0 /000000504 304 W RT A C/R
	1033	p-Pa yable
	1034	7.2 AC ETYLCYSTEI NE 20 000 87-0570-09 08/01 100 004054$ 0 /000000504 677 W RT A C/N
	1035	p-Pa yable
	1036	+ Enter ?? f or more ac tions
	1037	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1038	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1039	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1040	Select Act ion: Next Screen// R EV Rever se Payable Claim
	1041	You will s ee the fol lowing mes sage, if y ou attempt to revers e a primar y claim wh en there i s a payabl e secondar y claim.
	1042	Example 5. 3-2: Ente ring the L ine Item f or a Claim with a Pa yable Seco ndary Clai m
	1043	1.12 FLU RAZEPAM 15 MG C 00140 -0065-14 0 3/04 10232 2$ 2/00000 0113596 W RT AC/R
	1044	cannot be Reversed i f the seco ndary clai m is payab le.
	1045	Please rev erse the s econdary c laim first .
	1046	You are p rompted fo r the line item of t he payable claim to be reverse d. Remembe r, if you enter the patient li ne number, a claim r everse req uest will be created for all o f the paya ble claims for that patient.
	1047	Example 5. 3-3: Ente ring the L ine Item f or the Cla im Reversa l Request
	1048	Enter the line numb ers for th e Payable claim(s) t o be Rever sed.
	1049	Select: 7 .1
	1050	The select ed line it em is redi splayed an d you are required t o enter te xt to expl ain the re versal rea son.
	1051	Example 5. 3-4: Typi ng Text fo r Required Reversal Reason
	1052	You've cho sen to REV ERSE the f ollowing p rescriptio n for ECME patient,Si x
	1053	7.1 AL BUTEROL IN HALER 555 55-4444-22 02/28 100 003744$ 0 /000000504 304 W RT A C/R
	1054	Enter REQU IRED REVER SAL REASON : RX IS FO R SC CONDI TION
	1055	This respo nse must h ave at lea st 0 chara cters and no more
	1056	than 60 ch aracters a nd must no t contain embedded u parrow
	1057	The system asks if y ou are sur e you want to contin ue with th e transact ion. You c an answer Y or N. If you type in Y, the claim reve rsal reque st is subm itted.
	1058	Example 5. 3-5: Ente ring “Y” t o Continue Claim Rev ersal Requ est
	1059	Enter REQU IRED REVER SAL REASON : Drug is only billa ble throug h CMOP
	1060	Are you su re?(Y/N)? YES
	1061	The system asks if y ou want to mark the claim as n on-billabl e in Claim s Tracking , and ther efore rele ase the pa tient copa y (if any) . Enter Y or N. If y ou enter Y , you will be prompt ed for a C laims Trac king Non-B illable Re ason and a Comment. If the rev ersal is a ccepted by the payer , the ECME claim wil l be close d and a cl ose event will then be sent to IB with t he non-bil lable reas on and com ment provi ded by the user. IB should mar k the epis ode as non -billable and releas e the firs t-party co pay.
	1062	Example 5. 3-6: Ente ring “Y” t o Mark the Claim as Non-billab le
	1063	Do you wan t to mark the claim as non-bil lable in C laims Trac king and r elease the Patient C opay (if a ny) (Yes/N o)? No//Ye s
	1064	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: ??
	1065	Choose from:
	1066	1 NOT INSURED
	1067	2 SC T REATMENT
	1068	3 AGEN T ORANGE
	1069	4 IONI ZING RADIA TION
	1070	5 SOUT HWEST ASIA
	1071	7 COVE RAGE CANCE LED
	1072	10 INVA LID PRESCR IPTION ENT RY
	1073	12 PRES CRIPTION D ELETED
	1074	13 PRES CRIPTION N OT RELEASE D
	1075	14 DRUG NOT BILLA BLE
	1076	21 MILI TARY SEXUA L TRAUMA
	1077	29 HEAD /NECK CANC ER
	1078	30 COMB AT VETERAN
	1079	33 90 D AY RX FILL NOT COVER ED
	1080	34 NOT A CONTRACT ED PROVIDE R
	1081	35 INVAL ID MULTIPL ES PER DAY SUPP
	1082	36 REFI LL TOO SOO N
	1083	37 INVA LID NDC FR OM CMOP
	1084	38 PRO JECT 112/S HAD
	1085	39 NON COVERED D RUG PER PL AN
	1086	40 FIL ING TIMEFR AME NOT ME T
	1087	61 NO PHARMACY C OVERAGE
	1088	85 NPI /TAXONOMY ISSUES
	1089	86 RX DUR REJECT
	1090	87 RX PRIOR AUTH NOT OBTAI NED
	1091	88 RX MEDICARE P ART D
	1092	89 RX DISCOUNT C ARD
	1093	91 DAT E OF BIRTH MISMATCH
	1094	999 OTH ER
	1095	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: 2 SC TREA TMENT
	1096	Comment : RX IS FOR SC CONDIT ION
	1097	Are you su re (Y/N)? YES
	1098	If the rev ersal is a pproved by the third -party pay er, the cl aim will b e marked a s non-bill able.
	1099	The system submits a claim rev ersal requ est to the payer for each sele cted claim .
	1100	Example 5. 3-7: Clai m Reversal Request i s Submitte d
	1101	Processing Primary c laim...
	1102	Claim Stat us:
	1103	Reversing. ..
	1104	IN PROGRES S-Building the trans action
	1105	IN PROGRES S-Transmit ting
	1106	IN PROGRES S-Parsing response
	1107	E REVERSAL ACCEPTED
	1108	Reversal A ccepted
	1109	1 claim re versal sub mitted.
	1110	Enter RETU RN to cont inue or '^ ' to exit:
	1111	The payer will eithe r “Accept” or “Rejec t” the cla im reversa l request. The payer return st atus is di splayed on the Payer Returned Response l ine.
	1112	Example 5. 3-8: Acce pted Payab le Claim R eversal Re quest
	1113	PHARMACY E CME Aug 10, 20 05@10:31:2 2 Page: 1 8 of 42
	1114	SELECTED D IVISION(S) : ALL
	1115	Transmitte d by ALL u sers Activity Date Rang e: within the past X X day(s)
	1116	Sor ted by: Pa tient Name
	1117	+# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	1118	7 ECMEPa tient,Six (XXXX) WE BMD TE/ VET A LL payable
	1119	7.1 AL BUTEROL IN HALER 555 55-4444-22 02/28 100 003744$ 0 /000000504 304 W RT D S/R
	1120	p-Re versal Acc epted
	1121	5.4 Resubm it Claim X E " Resubm it Claim"
	1122	The Resubm it Claim a ction send s a claim reversal r equest to the insure r, followe d by a new claim for the same prescripti on, with t he new or updated da ta for the se conditi ons:
	1123	If the cla im was ini tially ret urned as “ Payable”, the system sends a c laim rever sal reques t. If the payer “Acc epts” the reversal r equest, th e claim re submission is sent. If the pay er “Reject s” the rev ersal requ est, the c laim is NO T resubmit ted.
	1124	If the cla im was ini tially ret urned as “ Rejected” or non-bil lable, the system im mediately sends the claim subm ission to the payer and the re versal req uest is NO T sent.
	1125	The Resubm it action is accesse d by enter ing RES at the “Sele ct Action: ” prompt o n the ECME User Scre en.
	1126	Example 5. 6-1: Acces sing and E xecuting t he Resubmi t Claim Ac tion
	1127	PHARMACY E CME Jul 22, 20 08@14:41:5 5 Page : 1 of 29
	1128	SELECTED D IVISION(S) : ALL
	1129	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1130	Sorted by: Transa ction Date
	1131	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/TYP R XINF
	1132	1 ECMEpa tient,One (XXXX) OP INSUR1/ VE T Pb:2 Rj: 4 AcRv:4 R jRv:0
	1133	1.1 RE SERPINE 0. 1MG S 000 83-0035-40 07/19 100 598$ 1 /000000000 520 W RT A C/N
	1134	p-In progress- Waiting t o start
	1135	1.2 LI DOCAINE 0. 5% W/ 001 86-0140-01 07/19 100 704$ 1 /000000000 623 W RT A C/N
	1136	p-In progress- Transmitt ing
	1137	1.3 IM IPRAMINE 2 5MG T 007 79-0588-30 07/19 100 820$ 1 /000000000 740 W RT * */N
	1138	p-Re jected
	1139	07:M /I Cardhol der ID
	1140	1.4 FL URAZEPAM 1 5MG C 007 81-2806-05 07/18 100 948$ 0 /000000000 870 W RT * */N
	1141	p-Re jected
	1142	07:M /I Cardhol der ID
	1143	1.5 DA CARBAZINE 100MG 000 26-8151-10 07/21 100 958$ 2 /000000000 880 W RT * */N
	1144	p-Re versal acc epted
	1145	+ Enter ?? f or more ac tions
	1146	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1147	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1148	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1149	Select Act ion: Next Screen// r es Resub mit Claim
	1150	You are pr ompted for the line item(s) of the claim to be res ubmitted.
	1151	You may al so submit multiple l ine items separated by commas (e.g. “1.1 ,1.2”), or a range o f line ite ms separat ed by a hy phen (e.g. “1.1-1.3” ).Example 5.4-2: Ent ering the Line Item for the Cl aim Resubm ission Req uest
	1152	Enter the line numbe rs for the claim(s) to be resu bmitted.
	1153	Select ite m(s): 1.5
	1154	Claims tha t have bee n closed w ill be dis played wit h “/Closed ” after th e status. Closed cla ims cannot be resubm itted unti l they are reopened. If you at tempt to r esubmit a claim that is closed , a messag e is displ ayed telli ng you tha t you cann ot resubmi t.
	1155	Example 5. 4-3: Resu bmitting a Closed Cl aim
	1156	You've cho sen to RES UBMIT the following prescripti on
	1157	1.2 AM ITRIPTYLIN E HCL 006 03-2212-32 10/11 205 6098 0 /000001616 051 M RT D S/N
	1158	Are you su re?(Y/N)? y YES
	1159	>> Cannot Resubmit
	1160	1.2 AM ITRIPTYLIN E HCL 006 03-2212-32 10/11 205 6098 0 /000001616 051 M RT D S/N
	1161	because t he claim i s Closed. Reopen the claim and try again .
	1162	0 claims h ave been r esubmitted .
	1163	The primar y claim ca nnot be re submitted if there i s a payabl e secondar y claim. I n these ca ses, you m ust revers e the seco ndary clai m.
	1164	If you att empt to re submit a p rimary cla im when th ere is a p ayable sec ondary cla im, you wi ll see the following message, which will discontin ue the cla ims resubm ission pro cess.
	1165	Example 5. 4-4: Enter ing the Li ne Item fo r a Claim that has a Payable S econdary C laim
	1166	The claim:
	1167	1.12 FLU RAZEPAM 15 MG C 00140 -0065-14 0 3/04 10232 2$ 2/00000 0113596 W RT AC/R
	1168	cannot be Resubmitte d if the s econdary c laim is pa yable.
	1169	Please rev erse the s econdary c laim first .
	1170	Otherwise, the syste m redispla ys the lin e item for resubmiss ion, then asks if yo u are sure you want to continu e with the transacti on. You ca n enter Y or N. If y ou answer Y, the cla im resubmi ssion proc ess contin ues.
	1171	Example 5. 4-5: Enter ing “Y” to Continue Claim Resu bmission R equest
	1172	You've cho sen to RES UBMIT the following prescripti on for ECM Epatient,O ne
	1173	100MG 000 26-8151-10 06/26 100 958$ 2 /000000000 880 W RT * */N
	1174	Are you su re?(Y/N)? y YES
	1175	ECME will allow mult iple submi ssions of the same p rescriptio n and fill to be pla ced on the request q ueue at th e same tim e. The ECM E engine w ill proces s all requ ests in th e order th at they ar e received . Note tha t even tho ugh a requ est may be placed on the queue , whether or not it is process ed will de pend on th e outcome of the pre vious requ est. For i nstance, i f there ar e two entr ies on the queue and the secon d is reque sting a re versal, it may not b e processe d if the p revious re quest come s back wit h an E REV ERSAL ACCE PTED statu s. If ther e is alrea dy a submi ssion in t he queue f or this pr escription and fill, a message is displa yed and yo u are aske d if you w ant to pro ceed.
	1176	Example 5. 4-6: Ente ring “Y” t o Place Mu ltiple Sub missions i n the Queu e
	1177	The claim is in prog ress. The request wi ll be sche duled and processed after
	1178	the previo us request (s) are co mpleted. P lease be a ware that the result of
	1179	the resubm it depends on the pa yer's resp onse to th e prior in complete r equests.
	1180	Do you wan t to proce ed?(Y/N)? y YES
	1181	The claim resubmissi on request is submit ted and th e progress is displa yed.
	1182	Example 5. 4-7: Disp laying a S uccessfull y Resubmit ted Claim
	1183	Claim Stat us:
	1184	IN PROGRES S-Waiting to start
	1185	IN PROGRES S-Building the claim
	1186	IN PROGRES S-Transmit ting
	1187	E PAYABLE
	1188	Veteran Pr escription 100958 su ccessfully submitted to ECME f or claim g eneration.
	1189	1 claim ha s been res ubmitted.
	1190	Enter RETU RN to cont inue or '^ ' to exit: <ENTER>
	1191	Updating s creen for resubmitte d claims.. .
	1192	The line i tem will d isplay the status of a claim t hat was re submitted and the Bi ll Type in dicator of “RS”. The “RS” indi cates a re submitted claim. The resubmit indicator will also display fo r a non-bi llable pre scription that has b een resubm itted, eve n if there is no cla im because the presc ription re mained non -billable.
	1193	Example 5. 4-8: Displ aying the Claim Stat us after a Resubmiss ion
	1194	PHARMACY E CME Jul 12, 20 08@14:42:4 6 Page : 1 of 29
	1195	SELECTED D IVISION(S) : ALL
	1196	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1197	Sorted by: Transa ction Date
	1198	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/TYP R XINF
	1199	1 ECMEpa tient,One (XXXX) OP INSUR1/ VE T Pb:2 Rj: 4 AcRv:4 R jRv:0
	1200	1.1 RE SERPINE 0. 1MG S 000 83-0035-40 07/09 100 598$ 1 /000000000 520 W RT A C/N
	1201	p-In progress- Waiting t o start
	1202	1.2 LI DOCAINE 0. 5% W/ 001 86-0140-01 07/09 100 704$ 1 /000000000 623 W RT A C/N
	1203	p-In progress- Waiting t o start
	1204	1.3 IM IPRAMINE 2 5MG T 007 79-0588-30 07/09 100 820$ 1 /000000000 740 W RT * */N
	1205	p-Re jected
	1206	07:M /I Cardhol der ID
	1207	1.4 FL URAZEPAM 1 5MG C 007 81-2806-05 07/08 100 948$ 0 /000000000 870 W RT * */N
	1208	p-Re jected
	1209	07:M /I Cardhol der ID
	1210	1.5 DA CARBAZINE 100MG 000 26-8151-10 07/06 100 958$ 2 /000000000 880 W RS * */N
	1211	p-Pa yable
	1212	+ Enter ?? f or more ac tions
	1213	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1214	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1215	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1216	Select Act ion: Next Screen//
	1217	5.5 Close Claim XE " Close Cla im"
	1218	This actio n allows y ou to clos e claims t hat were i nitially r eturned as “Rejected ”, and rev ersals tha t were “Re leased and Accepted” .
	1219	Claims tha t have alr eady been closed are displayed with “/Cl osed” afte r the stat us. If you attempt t o close a claim that is alread y closed, the follow ing messag e is displ ayed, “Thi s claim is already c losed.”
	1220	The Close Claim acti on will pr event a cl aim from b eing close d if it is currently open on t he Pharmac y Worklist . If you a ttempt to close a cl aim that i s open in the Pharma cy Worklis t, a messa ge will be displayed that the claim cann ot be clos ed because it is ope n in the P harmacy Wo rklist.
	1221	PHARMACY E CME Jul 15, 20 14@18:43:0 2 Page: 1 of 1
	1222	SELECTED D IVISION(S) : GENERIC CITY
	1223	Transmitte d by Trans mitter, Pe rson Ac tivity Dat e Range: w ithin the past 365 d ay(s)
	1224	Sorted b y: Transac tion date by default
	1225	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# STATUS/LOC /TYP/RXINF
	1226	1
	1227	1.1 AB ACAVIR SUL FATE 0017 3066101 07 /15 ###### #0/00000## #7412 M RT SU/N
	1228	07/1 5/14 - IGN ORED - tes t of cmop
	1229	p-Re jected
	1230	NN:T ransaction Rejected At Switch Or Interme diary
	1231	NC16 -The clear inghouse d id not rep ly in time .
	1232	Enter ?? f or more ac tions
	1233	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1234	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1235	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1236	Select Act ion: Quit/ /CLO
	1237	Enter the line numbe rs for the claim(s) to be clos ed.
	1238	Select ite m(s): 1.1/ /1.1
	1239	You've cho sen to clo se the fol lowing pre scription( s) for
	1240	Oppatient, ONE :
	1241	1.1 AB ACAVIR SUL FATE 0017 3066101 07 /15 ###### #0/00000## #7412 M RT SU/N
	1242	NN:T ransaction Rejected At Switch Or Interme diary
	1243	NC16 -The clear inghouse d id not rep ly in time .
	1244	ALL Select ed Rxs wil l be CLOSE D using th e same inf ormation g athered in the
	1245	following prompts.
	1246	Are you su re?(Y/N)? y YES
	1247	The Prescr iption is currently open in th e pharmaci st’s Third Party Pay er Reject Worklist. The claim cannot be closed unt il action is taken b y the phar macist.
	1248	PHARMACY E CME Jul 15, 20 14@18:43:0 2 Page: 1 of 1
	1249	SELECTED D IVISION(S) : GENERIC CITY
	1250	Transmitte d by Trans mitter, Pe rson Ac tivity Dat e Range: w ithin the past 365 d ay(s)
	1251	Sorted b y: Transac tion date by default
	1252	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# STATUS/LOC /TYP/RXINF
	1253	1
	1254	1.1 AB ACAVIR SUL FATE 0017 3066101 07 /15 ###### #0/00000## #7412 M RT SU/N
	1255	07/1 5/14 - IGN ORED - tes t of cmop
	1256	p-Re jected
	1257	NN:T ransaction Rejected At Switch Or Interme diary
	1258	NC16 -The clear inghouse d id not rep ly in time .
	1259	Enter ?? f or more ac tions
	1260	CU Contin uous Updat e REV Reverse Pa yable Clai m FR Furt her Resear ch
	1261	UD Displa y Update RES Resubmit C laim LOG Prin t Claim Lo g
	1262	CV Change View CLO Close Clai m WRK Send to Workli st
	1263	SO Sort L ist CMT Add/View C omments EX Exit
	1264	Select Act ion: Quit/ /
	1265	The CLOSE action can not be app lied to th e secondar y claim if the prima ry claim h as already been clos ed. The se condary cl aim is con sidered cl osed when the primar y claim is closed.
	1266	This actio n is acces sed by ent ering CLO at the “Se lect Actio n:” prompt on the EC ME User Sc reen. The system pro mpts you f or the lin e number(s ) for the claim(s) y ou are clo sing.
	1267	Example 5. 5-1: Enter ing a Pres cription L ine Item t o Close On e Rejected Claim
	1268	PHARMACY E CME Aug 02, 20 05@12:19 Page: 1 of 7 0
	1269	SELECTED D IVISION(S) : ALL
	1270	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1271	Sor ted by: Pa tient Name
	1272	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	1273	7 ECMEpa tient,Two (XXXX) WEB MD / VET Pb :3 Rj:1 Ac Rv:0 RjRv: 0
	1274	7.1 DE SIPRAMINE 25MG T 000 68-0011-10 08/02 100 003962$ 0 /000000504 559 W RT * */N
	1275	p-Re jected
	1276	07:M /I Cardhol der ID Num ber
	1277	22:M /I Dispens e As Writt en(DAW)/Pr oduct Sele ction Code
	1278	34:M /I Submiss ion Clarif ication Co de
	1279	7.2 CO DEINE SULF ATE 30 000 02-1010-02 08/02 100 82$ 0 /000000504 561 W RT E X/N
	1280	p-Re jected
	1281	07:M /I Cardhol der ID Num ber
	1282	23:M /I Ingredi ent Cost S ubmitted
	1283	8 ECMEpat ient,Two (XXXX) WEB MD / VET AL L payable
	1284	8.1 TE STOSTERONE ENTH. 000 03-0328-40 07/30 90 9238$ 0/00000110 5472 M RT AC/N
	1285	p-Pa yable
	1286	+ Enter ?? f or more ac tions
	1287	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1288	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1289	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1290	Select Lin e Item(s): Next Scre en// CLO Close Cla im
	1291	Enter the line numbe rs for the claim(s) to be clos ed.
	1292	Select Lin e Item(s): 7.1
	1293	The system redisplay s the sele cted line item(s), t hen notes that all p rescriptio n line ite ms for pat ient line items will be closed using the same info rmation en tered into the non-b illable re asons name prompt. Y ou are the n asked if you want to continu e.
	1294	Example 5. 5-2: Ente ring “Y” t o Continue Close Cla im Request
	1295	You've cho sen to clo se the fol lowing pre scription( s) for
	1296	ECMEpatien t,Two:
	1297	7.1 DE SIPRAMINE 25MG T 000 68-0011-10 03/20 100 003962$ 0 /000000504 559 W RT * */N
	1298	07:M /I Cardhol der ID Num ber
	1299	22:M /I Dispens e As Writt en(DAW)/Pr oduct Sele ction Code
	1300	34:M /I Submiss ion Clarif ication Co de
	1301	ALL Select ed Rxs wil l be CLOSE D using th e same inf ormation g athered in the follo wing promp ts.
	1302	Are you su re?(Y/N)? YES
	1303	You are pr ompted for a non-bil lable reas on code.
	1304	Example 5. 5-3: List ing Non-Bi llable Rea son Codes
	1305	PHARMACY E CME Aug 12, 20 05@12:19 Pa ge: 1 o f 70
	1306	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: ??
	1307	Choose from:
	1308	1 NOT INSURED
	1309	2 SC T REATMENT
	1310	3 AGEN T ORANGE
	1311	4 IONI ZING RADIA TION
	1312	5 SOUT HWEST ASIA
	1313	7 COVE RAGE CANCE LED
	1314	10 INVA LID PRESCR IPTION ENT RY
	1315	12 PRES CRIPTION D ELETED
	1316	13 PRES CRIPTION N OT RELEASE D
	1317	14 DRUG NOT BILLA BLE
	1318	21 MILI TARY SEXUA L TRAUMA
	1319	29 HEAD /NECK CANC ER
	1320	30 COMB AT VETERAN
	1321	33 90 D AY RX FILL NOT COVER ED
	1322	34 NOT A CONTRACT ED PROVIDE R
	1323	35 INVA LID MULTIP LES PER DA Y SUPP
	1324	36 REFI LL TOO SOO N
	1325	37 INVA LID NDC FR OM CMOP
	1326	38 PROJ ECT 112/SH AD
	1327	39 NON COVERED DR UG PER PLA N
	1328	40 FILI NG TIMEFRA ME NOT MET
	1329	61 NO P HARMACY CO VERAGE
	1330	85 NPI/ TAXONOMY I SSUES
	1331	86 RX D UR REJECT
	1332	87 RX P RIOR AUTH NOT OBTAIN ED
	1333	88 RX M EDICARE PA RT D
	1334	89 RX D ISCOUNT CA RD
	1335	91 DATE OF BIRTH MISMATCH
	1336	999 OTHE R
	1337	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: 61 NO PHA RMACY COVE RAGE
	1338	You are p rompted fo r a commen t (explana tion), and again whe ther you w ant to con tinue.
	1339	Example 5. 5-4: Ente ring a Com ment and A nswering ‘ Are You Su re?’ Quest ion
	1340	Comment : ECME Rejec t: Insuran ce does no t cover Rx s
	1341	Are you su re?(Y/N)? YES
	1342	Closing Cl aim VA2006 =1712884=0 00010=0006 693...OK
	1343	1 claim ha s been clo sed.
	1344	Enter RETU RN to cont inue or '^ ' to exit: <Enter>
	1345	Updating s creen for closed cla ims...
	1346	5.5.1 Vari ations to the Close claim proc ess. XE " Variation s to the C lose claim process"
	1347	If the Non -Billable Reason sel ected is “ OTHER”, th e system p rompts you with two choices: ” NON-BILLAB LE” or “DR OP TO PAPE R”.
	1348	If you sel ect (N)ON- BILLABLE E PISODE, th e Claims T racking en try displa ys the Bil lable Epis ode flag = “N” with the Non-Bi llable Rea son that y ou selecte d. Note th at Billabl e Episode flag will be changed back to " Y" if a se condary cl aim is lat er generat ed and is returned a s payable.
	1349	If you sel ect (D)ROP TO PAPER, the syste m stores t he selecte d Non-Bill able Reaso n in the C lose Claim Comments, updates t he Claims Tracking e ntry to di splay the Billable E pisode fla g = “Y”, c reates the next bill date as T +1 and sto res Claims Tracking comments i ncluding t he initial Non-billa ble Reason . The next scheduled billing r un will pi ck up this bill as l ong as the prescript ion has be en release d.
	1350	Example 5. 5.1-1: Cl osing a Pr escription
	1351	You've cho sen to clo se the fol lowing pre scription( s) for
	1352	ECMEPatien t,FIVE :
	1353	4.1 CO LCHICINE 0 .6MG 0007 4378101 06 /24 101297 $ 1/00 0000001653 M RT DS/N
	1354	ALL Select ed Rxs wil l be CLOSE D using th e same inf ormation g athered in the
	1355	following prompts.
	1356	Are you su re?(Y/N)? YES
	1357	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: OTHER
	1358	Selec t one of t he followi ng:
	1359	N NON-BILLAB LE
	1360	D DROP TO PA PER
	1361	Treat as ( N)on-Billa ble Episod e or (D)ro p Bill to Paper?: NO N-BILLABLE
	1362	Comment : Insurance does not cover Rxs
	1363	Release Pa tient CoPa y(Y/N)? YE S
	1364	Are you su re?(Y/N)? NO
	1365	Example 5. 5.1-2: En tering Non -Billable Episode fo r Reason C ode 31
	1366	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: 31 90 DAY RX FILL N OT COVERED
	1367	Selec t one of t he followi ng:
	1368	N NON-BILLA BLE
	1369	D DROP TO P APER
	1370	Treat as ( N)on-Billa ble Episod e or (D)ro p Bill to Paper?: Se lect: N No n-billable
	1371	The appli cation wil l prompt y ou for a c omment. Th e text can be up to 40 charact ers and mu st not con tain any e mbedded up -arrows (^ ).
	1372	Example 5. 5.1-3: En tering a C omment
	1373	Comment : ECME Rejec t: Plan do es not cov er 90-day fills
	1374	You can e nter Y or N to choos e to conti nue the cl ose claim request or not.
	1375	Example 5. 5.1-4: Ent ering “Y” to Continu e Close Cl aim Reques t
	1376	Are you su re?(Y/N)? Y YES
	1377	If the Rx# display i s followed by a “$”, the ECME user is gi ven the fo llowing pr ompt to an swer wheth er the pat ient copay can be re leased als o or not. If you sel ect Y, the patient c opay bill will be au tomaticall y removed from hold status for ALL selec ted claims .
	1378	Example 5. 5.1-5: Rel easing Pat ient Copay
	1379	Release Pa tient CoPa y(Y/N)? Y YES
	1380	When the c laim is su ccessfully closed, t he display shows tha t the tran saction we nt through “OK” and states tha t the clai m was clos ed.
	1381	Example 5. 5.1-6: Di splaying S ystem Clos ing the Cl aim
	1382	Closing Cl aim VA2005 -1111111-1 23456-0000 501...OK
	1383	1 claim ha s been clo sed.
	1384	Enter RET URN to con tinue or ' ^' to exit :/ <Enter>
	1385	Updating s creen for closed cla ims...
	1386	The closed claim tra nsaction m ay no long er be disp layed with the patie nt’s other prescript ion line i tems depen ding on th e filters set in Cha nge View. The system will noti fy Integra ted Billin g of the c losed clai m so that Claims Tra cking can be updated .
	1387	Example 5. 5.1-7: Clo sed Item i s No Longe r Displaye d
	1388	PHARMACY E CME Aug 12, 20 05@13:13:1 5 Page : 1 of 69
	1389	SELECTED D IVISION(S) : ALL
	1390	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1391	Sor ted by: Pa tient Name
	1392	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	1393	7 ECMEpa tient,Two (XXXX) WEB MD / VET P b:3 Rj:1 A cRv:0 RjRv :0
	1394	7.1 CO DEINE SULF ATE 30 000 02-1010-02 08/03 100 82$ 0 /000000504 561 W RT E X/N
	1395	p-Re jected
	1396	07:M /I Cardhol der ID Num ber
	1397	23:M /I Ingredi ent Cost S ubmitted
	1398	8 ECMEpat ient, Thre e (XXXX ) WEBMD / VET A LL payable
	1399	8.1 TE STOSTERONE ENTH. 000 03-0328-40 08/03 90 9238$ 0/00000110 5472 M RT AC/N
	1400	p-Pa yable
	1401	9 ECMEpat ient,22 (XXXX) WE BMD / VET A LL payable
	1402	9.1 HY DROCODONE 5/ACET 557 78-8998-88 08/12 909 254$ 1 /000001105 496 C RT A C/N
	1403	+ Enter ?? f or more ac tions
	1404	5.5.2 Spec ial Notes regarding secondary claims XE " Variati ons to the Close cla im process "
	1405	If a prima ry claim i s successf ully close d and ther e is secon dary insur ance for t hat claim, a seconda ry insuran ce notific ation is d isplayed s o that the user will know to b ill the se condary pa yer.
	1406	Example 5. 5.2-1: Sec ondary Ins urance Not ification
	1407	This patie nt has ADD ITIONAL in surance wi th Rx Cove rage that may be use d to bill this claim . The syst em will ch ange the C T entry to a NON-BIL LABLE Epis ode. If ap propriate, please go to the EC ME Pharmac y COB menu and use t he PRO - P rocess Sec ondary/TRI CARE Rx to ECME opti on to crea te an ePha rmacy seco ndary clai m.
	1408	Patient: EC MEpatient, One
	1409	Date of se rvice: JU N 29, 2010
	1410	Insurance: EC MEInsuranc e,One
	1411	Group numb er: 10 001
	1412	BISOPROL OL 2.5MG/ 51285-004 7-02 06/29 2055810$ 0/00000 1615758 W RT AC/R
	1413	Do you wan t to print the infor mation (ab ove) conce rning addi tional ins urance?
	1414	(Y/N)? n NO
	1415	5.6 Add/Vi ew Comment s XE " Add /View Comm ents"
	1416	The system allows th e ECME use r to enter comments for any cl aim displa yed on the ECME User Screen. T here are t wo types o f comments that can be added: OPECC Com ments and Pharmacy/O PECC Comme nts. More details ar e in parag raph B. be low. The m ost recent comment w ill be dis played und er the Pre scription Informatio n line. If a claim h as been re submitted, a message displays in place o f the most recent co mment: “P rior comme nts suppre ssed – use CMT actio n for all comments”. The mess age indica ting the p rior comme nts were s uppressed is not cap tured in C MT Add/Vie w Comments .
	1417	Access thi s action b y entering CMT at th e “Select Action:” p rompt on t he ECME Us er Screen. The syste m prompts you for a line selec tion to id entify the line item (s) to con tain a com ment. You are allowe d to selec t more tha n one clai m to add t he same co mment to o r can sele ct the pat ient summa ry line to add the s ame commen t to all c laims that are liste d under th is patient .
	1418	Example 5. 6-1: Enter ing a Pres cription L ine Item t o Add a Co mment
	1419	PHARMACY E CME Jul 02, 20 05@22:19 Page: 1 of 7 0
	1420	SELECTED D IVISION(S) : ALL
	1421	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1422	Sor ted by: Pa tient Name
	1423	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	1424	1 ECMEpa tient,Two (XXXX) WEB MD / VET Pb :3 Rj:1 Ac Rv:0 RjRv: 0
	1425	1.1 TA MOXIFEN CI TRATE 000 93-0784-86 07/01 909 392$ 0 /000001105 634 W ** D S/R
	1426	p-Re jected
	1427	NN:T ransaction Rejected At Switch Or Interme diary
	1428	NC40 -Request f rom an unk nown site. Registrat ion is req uired
	1429	1.2 DE SIPRAMINE HCL 25 000 68-0011-10 07/01 909 393$ 0 /000001105 635 W ** A C/R
	1430	p-Pa yable
	1431	1.3 DI AZEPAM 5MG /ML IN 001 40-1933-06 07/01 909 394$ 0 /000001105 636 W ** A C/N
	1432	p-Pa yable
	1433	+ Enter ?? f or more ac tions
	1434	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1435	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1436	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1437	Select Act ion: Next Screen// C MT Add/V iew Commen ts
	1438	Enter the line numbe r for whic h you wish to Add/Vi ew comment s.
	1439	Select: 1. 2
	1440	The Add/Vi ew Comment s list man ager scree n displays with mult iple actio ns. Both c omment act ions allow the user to enter a comment f or display on the EC ME User Sc reen; howe ver, the a ction to A dd Pharmac y/OPECC Co mment also displays the commen t on the O utpatient Pharmacy T hird Party Payer Rej ects Workl ist. Afte r selectin g a commen t action, the system displays the select ed line it em and pro mpts you t o enter a comment
	1441	Example 5. 6-2: Displ aying the Prescripti on Line It em to Add a Comment or Quit
	1442	O Add OP ECC Commen t EX Exit
	1443	P Add Ph armacy/OPE CC Comment
	1444	Select act ion: Next Screen// O Add OPE CC Comment
	1445	Enter the line numbe r for whic h you wish to Add co mments.
	1446	Select ite m: 12.1//
	1447	The system prompts f or the com ment and a llows you to enter 7 0 characte rs of free form text. The syste m will tra ck the use r who ente red the co mment.
	1448	Example 5. 6-3: Addin g a commen t to a Pre scription Line Item
	1449	Enter Comm ent: This shows a te st comment line for a prescrip tion line item.
	1450	The commen t that has been adde d is displ ayed with the date o f the entr y, and a P harmacy/OP ECC Commen t is indic ated by “( Pharm)”. T he system then promp ts you for a comment action, t o Quit (th e default) or Exit.
	1451	Example 5. 6-4: Displ aying the Added Comm ent and Pr ompting fo r Another
	1452	ADD/VIEW C OMMENTS Jul 02, 20 05@22:19 Page: 1 of 1
	1453	PHARMACY E CME
	1454	SELECTED D IVISION(S) : ALL
	1455	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1456	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	1457	1.1 DE SIPRAMINE HCL 25 000 68-0011-10 07/01 909 393$ 0 /000001105 635 W ** A C/R
	1458	08/1 5/05 - Thi s shows a test comme nt line fo r a prescr iption lin e item.
	1459	(LAS T,FIRST NA ME)
	1460	p-Payable
	1461	07/ 11/15 (Pha rm) - TEST COMMENT F OR PHARMAC Y/OPECC CO MMENT
	1462	(LAS T,FIRST NA ME)
	1463	p-P ayable
	1464	Enter ?? f or more ac tions
	1465	O Add OP ECC Commen t EX Exit
	1466	P Add Ph armacy/OPE CC Comment
	1467
	1468	Select act ion: Next Screen//
	1469	Comments c an also be generated automatic ally by th e system. The Outpat ient Pharm acy system allows pr escription s with spe cified cla im rejecti ons to be sent to th e Pharmacy Worklist automatica lly. There are two t ypes of us er-defined rejection s for Vete ran prescr iptions: ( 1) Transfe r Rejects, and (2) R eject Reso lution Req uired Reje cts. The T ransfer Re ject comme nt is “Aut o Send to Pharmacy W orklist du e to Trans fer Reject Code” and the Rejec t Resoluti on Require d Reject c omment is “Auto Send to Pharma cy Worklis t due to R eject Reso lution Req uired”. I n addition , TRICARE and CHAMPV A prescrip tions are sent to th e Pharmacy Worklist if the cla im is reje cted for a ny reason. The TRICA RE and CHA MPVA comme nt is “Aut o Send to Pharmacy W orklist & OPECC – CV A/TRI”.
	1470	5.7 Furthe r Research Screen XE " Further Research Screen"
	1471	The Furthe r Research Screen al lows you t o access d ifferent s ets of dat a within V istA for q uick probl em resolut ion. The F urther Res earch Scre en allows you to acc ess (or ju mp to) opt ions in ot her VistA applicatio ns.
	1472	Enter FR a t the “Sel ect Action :” prompt on the ECM E User Scr een.
	1473	Example 5. 7-1: Acces sing the F urther Res earch Acti on
	1474	PHARMACY E CME July 26, 2 005@11:31: 22 Page: 18 of 42
	1475	SELECTED D IVISION(S) : ALL
	1476	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1477	Sor ted by: Pa tient Name
	1478	+# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	1479	16 ECMEpa tient,One (XXXX ) WEBMD / VE T ALL pay able
	1480	16.1 ET ANERCEPT 2 5MG/VI 584 06-0425-34 07/22 909 504$ 0 /000001105 747 M RT A C/N
	1481	p-Pa yable
	1482	16.2 ET ANERCEPT 2 5MG/VI 584 06-0425-34 07/22 909 504$ 1 /000001105 747 M RT A C/N
	1483	p-Pa yable
	1484	16.3 DI VALPROEX 1 25MG T 000 74-6212-13 07/22 909 505$ 0 /000001105 748 M RT A C/N
	1485	p-Pa yable
	1486	16.4 CO LLAGENASE OINT 504 84-0527-30 07/22 909 506$ 0 /000001105 749 M RT A C/N
	1487	p-Pa yable
	1488	16.5 NA FCILLIN 1 GM. IN 002 09-6950-22 07/22 909 507$ 0 /000001105 750 M RT A C/N
	1489	p-Pa yable
	1490	+ Enter ?? for more actions
	1491	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1492	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1493	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1494	Select Act ion: Next Screen// F R Further Research
	1495	The system re-displa ys the ECM E User Scr een with m ultiple ne w “Researc h” options .
	1496	Example 5. 7-2: Displ aying Mult iple Furth er Researc h Menu Opt ions
	1497	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1498	SELECTED D IVISION(S) : ALL
	1499	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1500	Sorted b y: Transac tion date by default
	1501	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1502	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1503	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1504	p-Re jected
	1505	85:C laim Not P rocessed
	1506	NN:T ransaction Rejected At Switch Or Interme diary
	1507	02:M /I Version /Release N umber
	1508	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1509	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1510	p-Re versal Oth er
	1511	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1512	p-Re versal Oth er
	1513	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1514	p-Pa yable
	1515	+ Enter ?? f or more ac tions
	1516	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1517	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1518	VP View Prescripti on OH On Hold C opay List EX Exi t
	1519	CMT Add/V iew Commen ts RH Release C opay
	1520	Select act ion:Next S creen//
	1521	5.7.1 Insu rance Deta ils XE "In surance De tails"
	1522	This actio n allows y ou to view insurance details f or a singl e patient line item. The Insur ance Detai ls action allows you to access the Patie nt Insuran ce Info Vi ew/Edit op tion, loca ted on the Patient I nsurance M enu in the Integrate d Billing software.
	1523	Enter INS at the “Se lect Actio n” prompt, and a sin gle line i tem to vie w the Insu rance Deta ils inform ation for a patient.
	1524	Example 5. 7.1-1: Acc essing Ins urance Det ails Optio n
	1525	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1526	SELECTED D IVISION(S) : ALL
	1527	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1528	Sorted b y: Transac tion date by default
	1529	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1530	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1531	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1532	p-Re jected
	1533	85:C laim Not P rocessed
	1534	NN:T ransaction Rejected At Switch Or Interme diary
	1535	02:M /I Version /Release N umber
	1536	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1537	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1538	p-Re versal Oth er
	1539	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1540	p-Re versal Oth er
	1541	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1542	p-Pa yable
	1543	+ Enter ?? f or more ac tions
	1544	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1545	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1546	VP View Prescripti on OH On Hold C opay List EX Exi t
	1547	CMT Add/V iew Commen ts RH Release C opay
	1548	Select act ion:Next S creen// IN S Insuran ce details
	1549	Please sel ect a SING LE Patient Line item for viewi ng Insuran ce
	1550	Select ite m: 1.4
	1551	While in P atient Ins urance Inf o View/Edi t, you wil l have acc ess to all of the ac tions at t he bottom of the Ins urance Scr een. When you enter QUIT, the system wil l return t o the Furt her Resear ch Screen.
	1552	Example 5. 7.1-2: Di splaying I nsurance D etails Act ions
	1553	Patient In surance In formation Aug 09, 20 06@12:56:4 9 Page: 1 of 1
	1554	Insurance Management for Patie nt: ECMEpa tient,One 0000
	1555	Insura nce Co. Ty pe of Poli cy Group Ho lder Eff ect. Expir es
	1556	1 WEBMD PRESCRIPT ION 10 000 SELF 01/01/00
	1557	Enter ?? f or more ac tions >>>
	1558	VP View P olicy Info BU Benefits U sed EX Exit
	1559	AB Annual Benefits INS View Insur ance Co.
	1560	Select Act ion:Quit// QUIT
	1561	5.7.2 View Eligibili ty XE " Vi ew Eligibi lity"
	1562	The View E ligibility action al lows you t o view the Patient E ligibility Screen.
	1563	The full s et of menu options i s availabl e only for users wit h IB INSUR ANCE SUPER VISOR and IB INSURAN CE COMPANY ADD secur ity keys.E nter VE to view elig ibility in formation for a sing le patient .
	1564	Example 5. 7.2-1: Acc essing Vie w Eligibil ity Option
	1565	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1566	SELECTED D IVISION(S) : ALL
	1567	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1568	Sorted b y: Transac tion date by default
	1569	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1570	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1571	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1572	p-Re jected
	1573	85:C laim Not P rocessed
	1574	NN:T ransaction Rejected At Switch Or Interme diary
	1575	02:M /I Version /Release N umber
	1576	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1577	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1578	p-Re versal Oth er
	1579	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1580	p-Re versal Oth er
	1581	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1582	p-Pa yable
	1583	+ Enter ?? f or more ac tions
	1584	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1585	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1586	VP View Prescripti on OH On Hold C opay List EX Exi t
	1587	CMT Add/V iew Commen ts RH Release C opay
	1588	Select act ion:Next S creen// VE View El igibility
	1589	Please sel ect a SING LE Patient Line item for viewi ng Eligibi lity
	1590	Select ite m: 1.4
	1591	While in t he View El igibility action, yo u will hav e access t o only the EXIT/QUIT action at the botto m of the P atient Eli gibility S creen. Whe n you ente r QUIT, th e system w ill return to the Fu rther Rese arch Scree n.
	1592	Example 5. 7.2-2: Di splaying V iew Eligib ility Opti ons.
	1593	Patient El igibility Aug 15, 20 05@11:14:1 2 Page: 1 of 1
	1594	ECMEPat ient,Six 5959 DOB: 01/02/66
	1595	Means T est: YES Ins ured: Yes
	1596	Date of T est: 07/29 /05 A/O Expo sure:
	1597	Co-pay E xemption T est: Rad. Expo sure:
	1598	Date of T est:
	1599	Patient ha s agreed t o pay dedu ctible
	1600	Prima ry Elig. C ode: NSC
	1601	Serv ice Connec ted: No
	1602	Rated Disabilit ies: None
	1603	Enter ?? f or more ac tions
	1604	EX Exit
	1605	Select Act ion: Quit/ /
	1606	5.7.3 View Prescript ion XE " V iew Prescr iption"
	1607	This actio n allows y ou to view details f or a singl e prescrip tion. It a ccesses th e View Pre scription option, lo cated on t he Rx Pres criptions Menu in th e Outpatie nt Pharmac y Manager software.
	1608	When VP is entered a t the “Sel ect Action :” field, you will b e prompted for the l ine item o f the pres cription y ou wish to display.
	1609	Example 5. 7.3-1: Acc essing Vie w Prescrip tion Actio n
	1610	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1611	SELECTED D IVISION(S) : ALL
	1612	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1613	Sorted b y: Transac tion date by default
	1614	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1615	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1616	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1617	p-Re jected
	1618	85:C laim Not P rocessed
	1619	NN:T ransaction Rejected At Switch Or Interme diary
	1620	02:M /I Version /Release N umber
	1621	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1622	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1623	p-Re versal Oth er
	1624	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1625	p-Re versal Oth er
	1626	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1627	p-Pa yable
	1628	+ Enter ?? f or more ac tions
	1629	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1630	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1631	VP View Prescripti on OH On Hold C opay List EX Exi t
	1632	CMT Add/V iew Commen ts RH Release C opay
	1633	Select act ion:Next S creen// VP View Pr escription
	1634	Please sel ect a SING LE Rx Line item for viewing a Prescripti on
	1635	Select ite m: 1.4
	1636	Once a sin gle prescr iption lin e item is entered, t he system displays t he followi ng screens for the s elected pr escription . When you enter QUI T, the sys tem will r eturn you to the Fur ther Resea rch Screen .
	1637	Example 5. 7.3-2: Di splaying V iew Prescr iption Opt ions.
	1638	Rx Activit y Log Nov 03, 20 XX@15:27:5 4 Page: 1 of 5
	1639	ECMEPatie nt,Six
	1640	PID: XXX X Ht(cm): _______ ( ______)
	1641	DOB: MAY X,XXXX (X X) Wt(kg): _ ______ (__ ____)
	1642	Rx # : XXXXXX$
	1643	Orde rable Item : TRIAMTER ENE 50MG
	1644	CMOP Drug : TRIAMTER ENE 50MG T AB
	1645	*Dosage : 50MG
	1646	Verb : TAKE
	1647	Disp ense Units : 1
	1648	Noun : TABLET
	1649	*Route : ORAL
	1650	*Schedule : 2X
	1651	Patient In structions
	1652	SIG : TAKE ONE TABLET BY MOUTH 2X
	1653	Pati ent Status : OPT NSC
	1654	Issue Date : 10/07/XX Fil l Date: 10 /07/XX
	1655	Last Fill Date : 10/07/XX (Window)
	1656	Last Re lease Date : Lot #:
	1657	Expires : 10/08/XX MFG:
	1658	D ays Supply : 90 QTY (TAB) : 11
	1659	# of Refills : 3 Rem aining: 3
	1660	Provider : OPINSUR2
	1661	Routing: W indow
	1662	Copies : 1
	1663	Method of Pickup :
	1664	Clinic : Not on F ile
	1665	Division : XXXXXXXX XX
	1666	Pharmacist :
	1667	Patient Counseling : NO
	1668	Remarks :
	1669	F inished By : PSOuser, Two
	1670	Entry B y: PSOuser ,Two Entry Date: 10/ 6/XX 11:45 :57
	1671	Original F ill Releas ed: Routing: W indow
	1672	Refill Log :
	1673	# Log Dat e Refill Date Qty Routi ng Lot # Phar macist
	1674	========== ========== ========== ========== ========== ========== ========== =========
	1675	There are NO Refills For this Prescripti on
	1676	Partial Fi lls:
	1677	# Log Da te Date Qty Routing Lot # Pharm acist
	1678	========== ========== ========== ========== ========== ========== ========== =========
	1679	There are NO Partial s for this Prescript ion
	1680	Activity L og:
	1681	# Date Reas on Rx Ref Init iator Of A ctivity
	1682	========== ========== ========== ========== ========== ========== ========== =========
	1683	1 08/03/ XX EDIT ORIGINAL PSOu ser,Two
	1684	Comments: FILL DATE (3050801),
	1685	Copay Acti vity Log:
	1686	# Date Reas on Rx Ref Initiato r Of Activ ity
	1687	========== ========== ========== ========== ========== ========== ========== =========
	1688	There's NO Copay act ivity to r eport
	1689	Label Log:
	1690	# Date Rx R ef Printed By
	1691	========== ========== ========== ========== ========== ========== ========== =========
	1692	1 08/01/ XX ORIG INAL PSOuser, Three
	1693	Comments: From RX nu mber XXXXX X
	1694	2 08/03/ 05 ORIG INAL PSOuser, Three
	1695	Comments: From RX nu mber XXXXX X (Reprint )
	1696	Rx Activit y Log Nov 03, 20 10@15:27:5 4 Page: 5 of 5
	1697	ECMEPatie nt,Six
	1698	PID: XXX X Ht(cm) : _______ (______)
	1699	DOB: JAN X, XXXX ( XX) Wt(kg): _______ (_ _____)+
	1700	ECME Log:
	1701	# Date Rx R ef Initiator Of Activi ty
	1702	========== ========== ========== ========== ========== ========== ========== =========
	1703	1 5/22/0 6@19:00:24 ORIGIN AL PSOuser,Th ree
	1704	Comments: Submitted to ECME:CM OP TRANSMI SSION(NDC: 00049-3980 -60)
	1705	2 7/6/06 @19:01:04 REFILL 1 PSOuser,Th ree
	1706	Comments: Submitted to ECME:CM OP TRANSMI SSION(NDC: 00049-3980 -60)
	1707	3 7/7/06 @14:39:19 REFILL 1 PSOuser,Th ree
	1708	Comments: Submitted to ECME:RE JECT WORKL IST-DUR OV ERRIDE COD ES(DD/M0/1 B)-E
	1709	PAYABLE-p MEDCO
	1710	ECME REJEC T Log:
	1711	# Date/Ti me Rcvd Rx Ref Reject Ty pe STA TUS Da te/Time Re solved
	1712	========== ========== ========== ========== ========== ========== ========== =========
	1713	1 7/6/06@ 19:02:08 REFILL 1 DUR RES OLVED 7/ 7/06@14:39 :19
	1714	Comments: AUTOMATICA LLY CLOSED (CLAIM RE -SUBMITTED )
	1715	Enter ?? f or more ac tions
	1716	Selec t Action:Q uit//
	1717	5.7.4 Add/ View Comme nts XE " A dd/View Co mments"
	1718	When CMT i s entered at the “Se lect Actio n:” field, you will access the Add/View Comments a s describe d in Secti on 5.8. Th e only dif ference is that when you selec t QUIT, yo u will be returned t o the Furt her Resear ch Screen.
	1719	5.7.5 Clai ms Trackin g XE "Clai ms Trackin g"
	1720	This actio n accesses the Claim s Tracking Edit Scre en of the Claims Tra cking Edit for Billi ng option in the Int egrated Bi lling soft ware.
	1721	Enter the CT action and then e nter a sin gle prescr iption lin e item to track a cl aim.
	1722	Example 5. 7.5-1: Acc essing Cla ims Tracki ng Option
	1723	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1724	SELECTED D IVISION(S) : ALL
	1725	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 1 day(s)
	1726	Sorted b y: Transac tion date by default
	1727	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1728	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1729	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1730	p-Re jected
	1731	85:C laim Not P rocessed
	1732	NN:T ransaction Rejected At Switch Or Interme diary
	1733	02:M /I Version /Release N umber
	1734	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1735	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /06 110033 6$ 0/00 0000003120 W RT DS/R
	1736	p-Re versal Oth er
	1737	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /07 110033 7$ 0/00 0000003122 W RT DS/R
	1738	p-Re versal Oth er
	1739	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /07 110033 9$ 0/00 0000003124 W RT AC/R
	1740	p-Pa yable
	1741	+ Enter ?? f or more ac tions
	1742	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1743	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1744	VP View Prescripti on OH On Hold C opay List EX Exi t
	1745	CMT Add/V iew Commen ts RH Release C opay
	1746	Select act ion:Next S creen// C T Claims Tracking
	1747	Please sel ect a SING LE Rx Line item when accessing Claims Tr acking.
	1748	Select ite m: 1.1.... ...
	1749	While in t he Claims Tracking a ction, you will have menu acce ss to all Claims opt ions at th e bottom. Entering E XIT or QUI T will end the Claim s Tracking and retur n you to t he Further Research screen.
	1750	Example 5. 7.5-2: Di splaying C laims Trac king Optio ns
	1751	CLAIMS TRA CKING EDIT Nov 03, 20 10@15:27:5 4 Page: 1 of 3
	1752	Expanded C laims Trac king Info for: ECME Patient, T wo ROI:
	1753	For: PRESC RIPTION RE FILL on 11 /04/05
	1754	+
	1755	Visit Type: PRE SCRIPTION REFILL Author ization #:
	1756	Prescript ion #: XXX XXXX No . Days App roved: 0
	1757	Fill Date: Nov 04, 2005 Second Opinion R equired:
	1758	Drug: ALL OPURINOL 3 00MG, 30'S Second Opinion O btained:
	1759	Qua ntity: 1
	1760	Days S upply: 1 Review In formation
	1761	2 NDC#: 510 79-0206-20 Insuranc e Claim: Y ES
	1762	Phys ician: ECM EProvider, Two Follow- up Type:
	1763	Random Sample:
	1764	Special Co ndition:
	1765	Local A ddition:
	1766	Ins. R eviewer:
	1767	Hospital R eviewer:
	1768	Billing Informatio n
	1769	+ Enter ?? f or more ac tions
	1770	BI Billin g Info Edi t TA Treatment Auth. EX Exit
	1771	RI Review Info SE Submit Cla im to ECME
	1772	Select Act ion:Next S creen// <E nter>
	1773	CLAIMS TRA CKING EDIT Nov 03, 20 10@15:27:5 4 Page: 2 of 3
	1774	Expanded C laims Trac king Info for: ECMEp atient,Two ROI:
	1775	For: PRESC RIPTION RE FILL on 11 /04/05
	1776	+
	1777	Episo de Billabl e: NO Total Cha rges: $ 0
	1778	Non-Bill able Reaso n: PRESCRI PTION NOT REL Estima ted Recv ( Pri): $
	1779	Nex t Bill Dat e: Estima ted Recv ( Sec): $
	1780	Work. Com p/OWCP/Tor t: Estima ted Recv ( ter): $
	1781	I nitial Bil l: Mean s Test Cha rges: $
	1782	Bill Statu s: Amount Paid: $ 0
	1783	Hospital Reviews E ntered
	1784	Insuranc e Reviews Entered
	1785	Service Connected Conditions :
	1786	Service C onnected: NO
	1787	+ Enter ?? f or more ac tions
	1788	BI Billin g Info Edi t TA Treatment Auth. EX Exit
	1789	RI Review Info SE Submit Cla im to ECME
	1790	Select Act ion:Next S creen//<En ter>
	1791	CLAIMS TRA CKING EDIT Nov 03, 20 10@15:27:5 4 Page: 3 of 3
	1792	Expanded C laims Trac king Info for: ECMEp atient,Two ROI:
	1793	For: PRESC RIPTION RE FILL on 11 /04/05
	1794	+
	1795	NONE STAT ED
	1796	Enter ?? f or more ac tions
	1797	BI Billin g Info Edi t TA Treatment Auth. EX Exit
	1798	RI Review Info SE Submit Cla im to ECME
	1799	Select Act ion:Quit//
	1800	5.7.6 Thir d Party In quiry XE " Third Par ty Inquiry "
	1801	The “TPJI” action al lows you t o access t he Third P arty Joint Inquiry o ption in t he Integra ted Billin g software .
	1802	Enter the TPJI actio n and then enter a s ingle pres cription l ine item t o access t he Third P arty (Join t) Inquiry claim inf ormation.
	1803	Example 5. 7.6-1: Acc essing Thi rd Party ( Joint) Inq uiry Optio n
	1804	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1805	SELECTED D IVISION(S) : ALL
	1806	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1807	Sorted b y: Transac tion date by default
	1808	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1809	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1810	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1811	p-Re jected
	1812	85:C laim Not P rocessed
	1813	NN:T ransaction Rejected At Switch Or Interme diary
	1814	02:M /I Version /Release N umber
	1815	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1816	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1817	p-Re versal Oth er
	1818	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1819	p-Re versal Oth er
	1820	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1821	p-Pa yable
	1822	+ Enter ?? f or more ac tions
	1823	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1824	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1825	VP View Prescripti on OH On Hold C opay List EX Exi t
	1826	CMT Add/V iew Commen ts RH Release C opay
	1827	Select act ion:Next S creen// T PJI Thir d Party In quiry
	1828	Please sel ect a SING LE Patient Line item when acce ssing TPJI
	1829	Select ite m:
	1830	While in T hird Party (Joint) I nquiry, yo u have acc ess to all actions d isplayed a t the bott om of the screen. En ter QUIT t o return t o the main Further R esearch Sc reen.
	1831	Example 5. 7.6-2: Di splaying T hird Party (Joint) I nquiry Opt ions.
	1832	Third Part y Active B ills Nov 03, 20 10@15:27:5 4 Page: 1 of 1
	1833	ECMEPatien t,SIX (XXX X)NSC
	1834	Bill # From To MT? Type Stat Rate Insure r Orig Am t Curr Amt
	1835	1 K400K9C e 06/15/0 5 06/15/05 YES OP A REIM IN WEBMD 45.00 45.00
	1836	2 K400K9D e 06/15/0 5 06/15/05 YES OP A REIM IN WEBMD 45.00 45.00
	1837	…
	1838	\|r Referre d \|* MT on Hold \|+ M ulti Carri ers \|
	1839	CI Claim Informatio n IL Inactive B ills PI Pati ent Insura nce
	1840	CP Change Patient HS Health Sum mary EL Pati ent Eligib ility
	1841	Select Act ion: Quit/ /
	1842	5.7.7 On H old Copay Listing XE " On-Hold Copay Lis ting"
	1843	This optio n lists On Hold copa y informat ion for a single pat ient. The OH action allows you to access the List Current/Pa st Held Ch arges by P t option, located on the On Ho ld Menu (w hich is lo cated on t he Automat ed Means T est Billin g Menu) in Integrate d Billing software.
	1844	The On Hol d Copay Li sting requ ires that a device w ith 132 co lumn width be used. It will no t display correctly using 80 c olumn widt h devices. Enter the OH action and then e nter a sin gle patien t line ite m to acces s the On H old Copay Listing op tion.
	1845	Example 5. 7.7-1: Acc essing On Hold Copay Listing O ption
	1846	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1847	SELECTED D IVISION(S) : ALL
	1848	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1849	Sorted b y: Transac tion date by default
	1850	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1851	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1852	1.1 SI METHICONE 40MG 0258 7542934 10 /26 110033 5$ 0/00 0000003119 W RT AC/R
	1853	p-Re jected
	1854	85:C laim Not P rocessed
	1855	NN:T ransaction Rejected At Switch Or Interme diary
	1856	02:M /I Version /Release N umber
	1857	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1858	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1859	p-Re versal Oth er
	1860	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1861	p-Re versal Oth er
	1862	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1863	p-Pa yable
	1864	+ Enter ?? f or more ac tions
	1865	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1866	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1867	VP View Prescripti on OH On Hold C opay List EX Exi t
	1868	CMT Add/V iew Commen ts RH Release C opay
	1869	Select act ion:Next S creen// O H On Hol d Copay Li sting
	1870	Please sel ect a SING LE Patient Line item when acce ssing On H old Copay Listing
	1871	Select ite m: 1
	1872	You are pr ompted for a start a nd end dat e for the report.
	1873	Example 5. 7.7-2: Ent ering On H old Copay Report Sta rt and End Dates
	1874	Start with DATE: T-3 (AUG 14, 2005)
	1875	Go to DATE: T (AUG 17, 2 005)
	1876	You are pr ompted to choose whe ther to in clude Phar macy Co-pa y charges or not.
	1877	Example 5. 7.7-3: En tering “Y” to Includ e Pharmacy Co-pay Ch arges on R eport
	1878	Include Ph armacy Co- pay charge s on this report? NO // YES
	1879	*** Margin width of this outpu t is 132 * **
	1880	* This o utput shou ld be queu ed *
	1881	DEVICE: HO ME// 132 PRINTER
	1882	Print the report at 132 charac ters.
	1883	Example 5. 9.7-4: Pr inted On H old Copay Listing Re port
	1884	List of al l HELD bil ls for EC MEPatient, SIX (XXXX) AUG 8,200 6 PAGE 1
	1885	PATIENT CH ARGES C ORRESPONDI NG THIRD P ARTY BILLS
	1886	========== ========== ========== ========== ========== ========== ========== =======\|\|= ========== ========== ========== =========
	1887	From/ Date AR IB \|\| AR
	1888	Action ID Type Bill# Fill Dt to AR Charge Status Status\|\| Bill# Cla ssf($Typ) ST Charg e % Paid
	1889	========== ========== ========== ========== ========== ========== ========== =======\|\|= ========== ========== ========== =========
	1890	'* ' = outpt visit on s ame day as Rx fill d ate \|\|
	1891	========== ========== ========== ========== ========== ========== ========== =======\|\|= ========== ========== ========== =========
	1892	5002877 NSC R X Rx #: 100003994 ECME # 0 0000123457 9 \|\|
	1893	12/30/0 5 8.00 ON HOLD\|\|
	1894	Enter RETU RN to cont inue or '^ ' to exit:
	1895	5.7.8 Rele ase Copay XE " Relea se Copay"
	1896	This actio n accesses the Relea se Charges 'On Hold' option, l ocated on the On Hol d Menu (wh ich is loc ated on th e Automate d Means Te st Billing Menu) in the Integr ated Billi ng softwar e. If you select a s ingle Rx L ine item, the system defaults the to the REF# of t he selecte d Rx.
	1897	Enter RH t o access t he Release Copay opt ion. You m ay select a single P atient lin e item or a single R x line ite m.
	1898	Example 5. 7.8-1: Acc essing Rel ease Copay Option
	1899	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1900	SELECTED D IVISION(S) : ALL
	1901	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1902	Sorted b y: Transac tion date by default
	1903	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1904	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1905	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1906	p-Re jected
	1907	85:C laim Not P rocessed
	1908	NN:T ransaction Rejected At Switch Or Interme diary
	1909	02:M /I Version /Release N umber
	1910	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1911	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1912	p-Re versal Oth er
	1913	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1914	p-Re versal Oth er
	1915	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1916	p-Pa yable
	1917	+ Enter ?? f or more ac tions
	1918	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1919	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1920	VP View Prescripti on OH On Hold C opay List EX Exi t
	1921	CMT Add/V iew Commen ts RH Release C opay
	1922	Select act ion:Next S creen// RH Relea se Copay
	1923	Please sel ect a SING LE Patient Line item or a SING LE Rx Line item when accessing
	1924	Release C opay from Hold.
	1925	Select ite m: 9
	1926	All copay charges on hold for the select ed patient or prescr iption are listed. S elect the line numbe r (referen ce number) of the it em for the release o f that cop ay, then a nswer Y to okay the charge to Accounts R eceivable. The selec tion is re displayed and you ar e advised that the l isted char ge has bee n passed t o Accounts Receivabl e.
	1927	Example 5. 7.8-2: Lis ting On Ho ld Copay C harges for Release C opay Optio n
	1928	ECMEPatien t,,SIX Pt ID: 000-00 -0000
	1929	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	1930	The follow ing IB Act ions for t his patien t are ON H OLD:
	1931	========== ========== ========== ========== ========== ========== ========== ==========
	1932	REF Act ion ID Bi ll Type Bill # Fr/Fl Dt To/Rls Dt Charge
	1933	========== ========== ========== ========== ========== ========== ========== ==========
	1934	1 000 596570 Rx #: 909708 08/01/05 08/01/05 21.00
	1935	EC ME #: 0000 00000000
	1936	2 000 596574 Rx #: 909693 08/01/05 08/01/05 21.00
	1937	EC ME #: 0000 00000000
	1938	3 000 596575 Rx #: 909694 08/01/05 08/01/05 21.00
	1939	EC ME #: 0000 00000000
	1940	4 000 596580 Rx #: 909728 08/01/05 08/01/05 21.00
	1941	EC ME #: 0000 00000000
	1942	5 000 596581 Rx #: 909703 08/01/05 08/01/05 21.00
	1943	EC ME #: 0000 00000000
	1944	6 000 596601 Rx #: 909698 08/01/05 08/03/05 21.00
	1945	EC ME #: 0000 00000000
	1946	Select IB Actions (R EF #) to r elease (or '^' to ex it): 2
	1947	OK to pass this char ge to Acco unts Recei vable? YES
	1948	Passing ch arges to A ccounts Re ceivable.. .
	1949	========== ========== ========== ========== ========== ========== ========== ==========
	1950	REF Act ion ID Bi ll Type Bill # Fr/Fl Dt To/Rls Dt Charge
	1951	========== ========== ========== ========== ========== ========== ========== ==========
	1952	2 000 596574 Rx #: 909693 K400KDC 08/01/05 08/01/05 21.00
	1953	EC ME #: 0000 00000000
	1954	The charge listed ab ove has be en passed to Account s Receivab le.
	1955	Enter RETU RN to cont inue or '^ ' to exit:
	1956	5.7.9 IB ( Integrated Billing) Events Rep ort XE " I B (Integra ted Billin g) Events Report"
	1957	The “EVNT” action al lows you t o access t he IB e-Ph armacy Men u Option, ECME Billi ng Events Report.
	1958	Enter EVN T to acces s the IB E vents Repo rt option. You may s elect a si ngle Patie nt line it em or a si ngle Rx li ne item.
	1959	Example 5. 7.9-1: Acc essing IB Events Rep ort Option
	1960	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1961	SELECTED D IVISION(S) : ALL
	1962	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1963	Sorted b y: Transac tion date by default
	1964	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1965	1 ECMEPa tient,,SIX (XXXX) OP INSUR2/205 5557898 VET Pb:1 0 Rj:2 AcR v:0 RjRv:1
	1966	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1967	p-Re jected
	1968	85:C laim Not P rocessed
	1969	NN:T ransaction Rejected At Switch Or Interme diary
	1970	02:M /I Version /Release N umber
	1971	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1972	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1973	p-Re versal Oth er
	1974	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1975	p-Re versal Oth er
	1976	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1977	p-Pa yable
	1978	+ Enter ?? f or more ac tions
	1979	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1980	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1981	VP View Prescripti on OH On Hold C opay List EX Exi t
	1982	CMT Add/V iew Commen ts RH Release C opay
	1983	Select act ion:Next S creen// EVNT IB Ev ents Repor t
	1984	Please sel ect a SING LE Patient Line item or a SING LE Rx Line item when accessing
	1985	The IB Ev ents Repor t.
	1986	Select ite m: 2
	1987	You are p rompted fo r a start and end da te for thi s report.
	1988	Example 5. 7.9-2: Ent ering Date s to Inclu de in IB E vents Repo rt Listing
	1989	START WITH DATE: TOD AY//T-60 (JUN 23, 2 005)
	1990	GO TO DATE : TODAY//T (AUG 22, 2005)
	1991	You are pr ompted to select M ( Mail), W ( window), C (CMOP) or A (All) e vents for the select ed line it em report.
	1992	Example 5. 7.9-3: Cho osing Defa ult ‘All’ for Types of Events for IB Eve nts Report
	1993	Selec t one of t he followi ng:
	1994	M MAIL
	1995	W WINDOW
	1996	C CMOP
	1997	A ALL
	1998	(M)AIL, (W )INDOW, (C )CMOP, (A) LL: ALL// <Enter> ALL
	1999	You are pr ompted to select S ( SUMMARY RE PORT) or D (DETAILED REPORT) a nd a print device.
	2000	Example 5. 7.9-4: Sel ecting Sum mary Type for IB Eve nts Report
	2001	S SUMMARY RE PORT
	2002	D DETAILED R EPORT
	2003	(S)UMMARY REPORT, (D )ETAILED R EPORT: SUM MARY REPOR T// <Ente r> SUMMARY REPORT
	2004	DEVICE: HO ME//
	2005	PAGE 1
	2006	BILLI NG ECME EV ENTS ON 06 /23/05 TO 08/22/05 (SUMMARY)
	2007	RX# FILL DAT E PA TIENT NAME DRUG
	2008	========== ========== ========== ========== ========== ========== ========== ==========
	2009	1 909693 0 08/0 1/05 EC MEPatient, SIX EPOETI N ALFA,REC OMB 20,000 UNT/
	2010	FINI SH 08/0 1/05 11:32 a Status:E CME Billab le
	2011	SUBM IT 08/0 1/05 11:34 a Status:O K
	2012	REVE RSAL 08/0 1/05 3:19p Status:E CME Claim reversed, no Bill to cancel
	2013	FINI SH 08/0 1/05 3:20p Status:E CME Billab le
	2014	SUBM IT 08/0 1/05 3:20p Status:O K
	2015	RELE ASE 08/0 1/05 3:20p Status:O K
	2016	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	2017	2 909694 0 08/0 1/05 EC MEPatient, Seven CYCL OPHOSPHAMI DE 1000MG INJ
	2018	FINI SH 08/0 1/05 11:44 a Status:E CME Billab le
	2019	SUBM IT 08/0 1/05 11:45 a Status:O K
	2020	REVE RSAL 08/0 1/05 3:37p Status:E CME Claim reversed, no Bill to cancel
	2021	FINI SH 08/0 1/05 3:38p Status:E CME Billab le
	2022	SUBM IT 08/0 1/05 3:38p Status:O K
	2023	RELE ASE 08/0 1/05 3:38p Status:O K
	2024	BILL ING 08/0 1/05 3:38p Status:B ill# K400K BC created
	2025	REVE RSAL 08/0 5/05 3:09p Status:B ill# K400K BC cancell ed
	2026	Press RETU RN to cont inue, '^' to exit:
	2027	Example 5. 7.9-5: Sel ecting a D etailed Ty pe for IB Events Rep ort
	2028	S SUMMARY RE PORT
	2029	D DETAILED R EPORT
	2030	(S)UMMARY REPORT, (D )ETAILED R EPORT: SUM MARY REPOR T// DETAIL ED REPORT
	2031	DEVICE: HO ME//
	2032	PAGE 1
	2033	BILLING EC ME EVENTS ON 07/06/1 1 TO 09/04 /11 (DETAI LED) for X XXXXX VAMC DIVISIO
	2034	RX# FILL DAT E PA TIENT NAME DRUG
	2035	========== ========== ========== ========== ========== ========== ========== ==========
	2036	1 205478 9 0 06/0 8/11 EC MEPATIENT, SIX C LONAZEPAM 1MG TAB
	2037	FINI SH 08/1 0/11 6:35p Status:E CME Billab le
	2038	ELIGIBILIT Y:
	2039	DRUG:CLONA ZEPAM 1MG TAB
	2040	NDC:57664- 0274-08, B ILLED QTY: 30, COST:. 024, DEA:4 CPR
	2041	PLAN: INS URANCE: WE BMD COB: S
	2042	BIN:123456 , PCN:1123 456789, PA YER SHEET B1:WBTESTB 1
	2043	PAYER SHEE T B2:WBTES TB2, PAYER SHEET B3: WBTESTB1
	2044	DISPENSING FEE:11.40 , BASIS OF COST DETE RM:COST CA LCULATIONS
	2045	COST:12.12 , GROSS AM T DUE:12.1 2, ADMIN F EE:0.00
	2046	USER:ECMEu ser,Two
	2047	SUBM IT 08/1 0/11 6:35p Status:O K
	2048	ECME#:0000 01614656, FILL DATE :06/08/11, RELEASE DATE:06/08 /11
	2049	PAYER RESP ONSE: PAYA BLE
	2050	PLAN:, INS URANCE: WE BMD
	2051	USER:ECMEu ser,Three
	2052	BILL ING 08/1 0/11 6:35p Status:B ill K10004 V created with ERROR s
	2053	Press RETU RN to cont inue, '^' to exit:
	2054	PAGE 2
	2055	BILLING EC ME EVENTS ON 07/06/1 1 TO 09/04 /11 (DETAI LED) for X XXXXX VAMC DIVISIO
	2056	RX# FILL DAT E PA TIENT NAME DRUG
	2057	========== ========== ========== ========== ========== ========== ========== ==========
	2058	ERROR DESC RIPTION: C annot esta blish rece ivable in AR (second ary ins).
	2059	ECME#:0000 01614656, FILL DATE :06/08/11, RELEASE DATE:06/08 /11
	2060	DRUG:CLONA ZEPAM 1MG TAB
	2061	NDC:57664- 0274-08, B ILLED QTY: 30, DAYS S UPPLY:30
	2062	BILLED:12. 12, PAID:6 8.32
	2063	PLAN:, INS URANCE: WE BMD
	2064	USER:ECMEu ser,One
	2065	REVE RSAL 08/1 1/11 1:18p Status:
	2066	ECME#:0000 01614656, FILL DATE :06/08/11, RELEASE DATE:06/08 /11
	2067	PAYER RESP ONSE: ACCE PTED
	2068	PLAN:, INS URANCE: WE BMD
	2069	USER:ECMEu ser,Two
	2070	REVERSAL R EASON:TST
	2071	FINI SH 08/1 1/11 1:20p Status:E CME Billab le
	2072	ELIGIBILIT Y:
	2073	DRUG:CLONA ZEPAM 1MG TAB
	2074	NDC:57664- 0274-08, B ILLED QTY: 30, COST:. 024, DEA:4 CPR
	2075	Press RETU RN to cont inue, '^' to exit:
	2076	PAGE 3
	2077	BILLING EC ME EVENTS ON 07/06/1 1 TO 09/04 /11 (DETAI LED) for DNS ENNE VAMC DIVISIO
	2078	RX# FILL DAT E PA TIENT NAME DRUG
	2079	========== ========== ========== ========== ========== ========== ========== ==========
	2080	PLAN: INS URANCE: WE BMD COB: S
	2081	BIN:123456 , PCN:1123 456789, PA YER SHEET B1:WBTESTB 1
	2082	PAYER SHEE T B2:WBTES TB2, PAYER SHEET B3: WBTESTB1
	2083	DISPENSING FEE:11.40 , BASIS OF COST DETE RM:COST CA LCULATIONS
	2084	COST:12.12 , GROSS AM T DUE:12.1 2, ADMIN F EE:0.00
	2085	USER:ECMEu ser,Two
	2086	SUBM IT 08/1 1/11 1:20p Status:O K
	2087	ECME#:0000 01614656, FILL DATE :06/08/11, RELEASE DATE:06/08 /11
	2088	PAYER RESP ONSE: REJE CTED
	2089	PLAN:, INS URANCE: WE BMD
	2090	USER:ECMEu ser,One
	2091	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	2092	2 205480 3 0 05/0 6/11 EC MEPATIENT, SIX L IDOCAINE 0 .5% (5MG/M L) 50ML M
	2093	FINI SH 08/1 0/11 6:07p Status:E CME Billab le
	2094	ELIGIBILIT Y:
	2095	DRUG:LIDOC AINE 0.5% (5MG/ML) 5 0ML MDV
	2096	NDC:00409- 4278-01, B ILLED QTY: 30, COST:1 .486, DEA: 6P
	2097	Press RETU RN to cont inue, '^' to exit:
	2098	5.7.10 Gro up Plan Me nu XE "Gro up Plan Me nu"
	2099	The “GRPL” action al lows you t o access t he Group P lan Menu. This menu includes t hree selec tions - Ed it PLAN AP PLICATION Sub-file ( EPLA), Mat ch Group P lan to a P harmacy Pl an (MGP), and Match Multiple G roup Plans to a Phar macy Plan (MMGP).
	2100	Enter GRP L to acces s the Grou p Plan Men u option.
	2101	Example 5. 7.10-1: Ac cessing Gr oup Plan M enu
	2102	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	2103	SELECTED D IVISION(S) : ALL
	2104	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2105	Sorted b y: Transac tion date by default
	2106	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	2107	1 ECMEPa tient,,SIX (XXXX) OP INSUR2/205 5557898 VET Pb:1 0 Rj:2 AcR v:0 RjRv:1
	2108	1.1 SI METHICONE 40MG 0258 7542934 10 /26 110033 5$ 0/00 0000003119 W RT AC/R
	2109	p-Re jected
	2110	85:C laim Not P rocessed
	2111	NN:T ransaction Rejected At Switch Or Interme diary
	2112	02:M /I Version /Release N umber
	2113	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2114	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	2115	p-Re versal Oth er
	2116	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	2117	p-Re versal Oth er
	2118	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	2119	p-Pa yable
	2120	+ Enter ?? f or more ac tions
	2121	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	2122	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	2123	VP View Prescripti on OH On Hold C opay List EX Exi t
	2124	CMT Add/V iew Commen ts RH Release C opay
	2125	Select act ion:Next S creen// GRPL Gr oup Plan M enu
	2126	- -- Group P lan Menu - --
	2127	EPLA Edit PLAN APPLI CATION Sub file
	2128	MGP Match Group Pla n to a Pha rmacy Plan
	2129	MMGP Match Multiple Group Plan s to a Pha rmacy Plan
	2130	Select Ite m(s):
	2131	5.7.11 Eli gibility I nquiry Opt ion XE " V iew Prescr iption"
	2132	The hidden “ELIG” Op tion acces ses the El igibility Inquiry Op tion, whic h allows t he sites t o verify p harmacy in surance fo r patients by sendin g an eligi bility ver ification submission to the th ird party payer.
	2133	When ELIG is entered at the “S elect Acti on:” field , you will be prompt ed for the line item of the pr escription you wish to display .
	2134	You can ed it the Rel ationship Code, Pers on Code, a nd Insuran ce Effecti ve Date.
	2135	Example 5. 7.11-1: Ac cessing El igibility Inquiry Op tion
	2136	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	2137	SELECTED D IVISION(S) : ALL
	2138	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2139	Sorted b y: Transac tion date by default
	2140	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	2141	1 ECMEPa tient,,SIX (XXXX) OP INSUR2/205 5557898 VET Pb:1 0 Rj:2 AcR v:0 RjRv:1
	2142	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	2143	p-Re jected
	2144	85:C laim Not P rocessed
	2145	NN:T ransaction Rejected At Switch Or Interme diary
	2146	02:M /I Version /Release N umber
	2147	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2148	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	2149	p-Re versal Oth er
	2150	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	2151	p-Re versal Oth er
	2152	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	2153	p-Pa yable
	2154	+ Enter ?? f or more ac tions
	2155	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	2156	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	2157	VP View Prescripti on OH On Hold C opay List EX Exi t
	2158	CMT Add/V iew Commen ts RH Release C opay
	2159	Select act ion:Next S creen// EL IG ELIG
	2160	Enter the line numbe r for the claim to b e submitte d for Elig ibility Ve rification
	2161	Select ite m: 1.1
	2162
	2163
	2164	You've cho sen to VER IFY Eligib ility of t he followi ng prescri ption for ECMEPATIEN T,
	2165	SIX
	2166	1.1 SI METHICONE 40MG 0258 7542934 10 /26 110033 5$ 0/00 0000003119 W RT AC/R
	2167	Are you su re?(Y/N)? YES
	2168	Relationsh ip Code: 1 // CARDHOLDER
	2169	Person Cod e: 01//
	2170	Effective Date: 10/ 06/2010// 11/3/2010
	2171
	2172	Are you su re?(Y/N)? YES
	2173
	2174	Not submit table: Eli gibility P ayer Sheet Not Found .
	2175
	2176	Enter RETU RN to cont inue or '^ ' to exit:
	2177	When you e nter QUIT, the syste m will ret urn you to the Furth er Researc h Screen.
	2178	When EX is entered a t the “Sel ect Action :” prompt from the F urther Res earch Scre en, the sy stem will return to the ECME U ser Screen .
	2179	Example 5. 7.11-2: En tering the EXIT Acti on from Fu rther Rese arch Scree n
	2180	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	2181	SELECTED D IVISION(S) : ALL
	2182	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2183	Sorted b y: Transac tion date by default
	2184	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	2185	1 ECMEPa tient,,SIX (XXXX) OP INSUR2/205 5557898 VET Pb:1 0 Rj:2 AcR v:0 RjRv:1
	2186	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	2187	p-Re jected
	2188	85:C laim Not P rocessed
	2189	NN:T ransaction Rejected At Switch Or Interme diary
	2190	02:M /I Version /Release N umber
	2191	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2192	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	2193	p-Re versal Oth er
	2194	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	2195	p-Re versal Oth er
	2196	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	2197	p-Pa yable
	2198	+ Enter ?? f or more ac tions
	2199	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	2200	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	2201	VP View Prescripti on OH On Hold C opay List EX Exi t
	2202	CMT Add/V iew Commen ts RH Release C opay
	2203	Select act ion:Next S creen// E X Exit
	2204	5.8 Print Claim Log (hidden ac tion) XE " Print Cla im Log"
	2205	The Print Claim Log option all ows you to print a d etailed hi story in r everse chr onological order of the third party clai ms and res ponses.
	2206	Enter the LOG action and a sin gle prescr iption lin e item to view the c laim log i nformation for a pre scription.
	2207	Example 5. 10-1: Acc essing the Print Cla im Log Opt ion
	2208	PHARMACY E CME Aug 12, 20 05@02:40:3 4 Page: 1 of 81
	2209	SELECTED D IVISION(S) : ALL
	2210	Transmitte d by ALL u sers Activity Date Rang e: within the past 3 0 day(s)
	2211	Sor ted by: Pa tient Name
	2212	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	2213	1 ECMEPa tient,,SIX (XXXX) OP INSUR2/205 5557898 VET Pb:1 0 Rj:2 AcR v:0 RjRv:1
	2214	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	2215	p-Re jected
	2216	85:C laim Not P rocessed
	2217	NN:T ransaction Rejected At Switch Or Interme diary
	2218	02:M /I Version /Release N umber
	2219	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2220	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /06 110033 6$ 0/00 0000003120 W RT DS/R
	2221	p-Re versal Oth er
	2222	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /07 110033 7$ 0/00 0000003122 W RT DS/R
	2223	p-Re versal Oth er
	2224	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /07 110033 9$ 0/00 0000003124 W RT AC/R
	2225	p-Pa yable
	2226	+ Enter ?? f or more ac tions
	2227	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2228	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2229	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2230	Select Act ion: Next Screen// L OG Print Claim Log
	2231	Enter the line numbe r for whic h you wish to print claim logs .
	2232	Select ite m: 5.1
	2233	As the dat a pages pr int to you r screen, there are options to print the informati on to a de vice (type PRINT and the devic e name) or exit (typ e EXIT) or continue to display informati on, which is the def ault (pres s <Enter>) .
	2234	Example 5. 8-2: Disp laying Cla im Log Dat a for a Se lected Pre scription Line Item
	2235	PHARMACY E CME A ug 22, 200 5@13:58:50 Page: 1 of 7
	2236	Claim Log informatio n
	2237	Pharmacy E CME Log
	2238	Rx #: 9093 93/0 EC ME#: 00000 1105635
	2239	Drug: AMOX ICILLIN 25 0MG CAP
	2240	Pat ient: ECME patient,On e (0000) S ex: M DOB: J AN 1, 1954 (57)
	2241	Submi tted: JUN 15,2005@15 :19:11
	2242	By: ECME user,One
	2243	VA Cla im #: VA20 05=1234567 893=123456 =0000502
	2244	+ Enter ?? f or more ac tions
	2245	PR Print Data EX Exit
	2246	Select act ion:Next S creen// <E nter>
	2247	PHARMACY E CME Sep 11, 20 05@11:36:1 4 Page: 2 of 7
	2248	Claim Log informatio n
	2249	+
	2250	Transactio n Informat ion (#661) ---------- ---------- ---------- ---------- ---------
	2251	Created on : JUN 15,2 005@16:25: 48
	2252	Submitted By: ECMEUS ER,FOUR
	2253	Transactio n Type: RE QUEST
	2254	Date of Se rvice: 06/ 15/2005
	2255	NDC Code: 00068-0011 -10
	2256	NCPDP Qty: 60 ( )
	2257	Days Suppl y: 30
	2258	Division : ALBANY IS C
	2259	NPI#: 4000 000016
	2260	ECME Pharm acy: XXXXX XXXX
	2261	Billed Qty : 90 (EA) Unit Co st: .752 Gross A mt Due: 79 .08
	2262	Ingredient Cost: 67. 68 Dispe nsing Fee: 11.40
	2263	U&C Charge : 79.08 A dmin Fee: 0.00
	2264	Insurance Name: WEBM D
	2265	Rx Coordin ation of B enefits: P RIMARY
	2266	BIN: 12345 6
	2267	PCN: 11234 56789
	2268	Group ID: WEBMDTEST
	2269	Cardholder ID:
	2270	Patient Re lationship Code: CAR DHOLDER
	2271	Cardholder First Nam e: One
	2272	Cardholder Last Name : ECMEpati ent
	2273	+ Enter ?? f or more ac tions
	2274	PR Print Data EX Exit
	2275	Select act ion:Next S creen// <E nter>
	2276	PHARMACY E CME Sep 11, 20 05@11:39:0 7 Page: 3 of 7
	2277	Claim Log informatio n
	2278	+
	2279	Plan ID: 8 729
	2280	Payer Shee t IEN: WBT ESTB1
	2281	B2 Payer S heet IEN: WBTESTB2
	2282	B3 Rebill Payer Shee t: WBTESTB 1
	2283	Certify Mo de:
	2284	Cert IEN:
	2285	+ Enter ?? f or more ac tions
	2286	PR Print Data EX Exit
	2287	Select act ion:Next S creen// <E nter>
	2288	PHARMACY E CME Sep 11, 20 05@11:39:5 1 Page: 4 of 7
	2289	Claim Log informatio n
	2290	+
	2291	Response I nformation (#661)--- ---------- ---------- ---------- ---------- ---------
	2292	Response R eceived: J UN 15,2005 @16:25:49
	2293	Date of Se rvice: 06/ 15/2005
	2294	Transactio n Response Status: P aid
	2295	Total Amou nt Paid: $ 40.00
	2296	Ingredient Cost Paid : $48.00 Dispensin g Fee Paid : $1.00
	2297	Patient Re sp (INS): ($9.00)
	2298	Reject cod e(s):
	2299	Payer Mess age:
	2300	Payer Addi tional Mes sage:
	2301	Reason for Service C ode: AD
	2302	DUR Text: AMOXICILLI N 250MG CA P
	2303	DUR Additi onal Text: The text would disp lay here
	2304	+ Enter ?? f or more ac tions
	2305	PR Print Data EX Exit
	2306	Select act ion:Next S creen// <E nter>
	2307	PHARMACY E CME Sep 11, 20 05@11:39:5 1 Page: 5 of 7
	2308	Claim Log informatio n
	2309	+
	2310	Transactio n Informat ion (#659) ---------- ---------- ---------- ---------- ---------
	2311	Created on : JUN 15,2 005@15:07: 34
	2312	Transactio n Type: RE QUEST
	2313	Date of Se rvice: 06/ 15/2005
	2314	NDC Code: 00068-0011 -10
	2315	NCPDP Qty: 60 ( )
	2316	Days Suppl y: 30
	2317	Division : ALBANY IS C
	2318	NPI#: 4000 000016
	2319	ECME Pharm acy: BAY P INES
	2320	Billed Qty : 90 (EA) Unit C ost: .752 Gross Amt Due: 7 9.08
	2321	Ingredient Cost: 67. 68 Dispe nsing Fee: 11.40
	2322	U&C Charge : 79.08 A dmin Fee: 0.00
	2323	Insurance Name: WEBM D
	2324	Rx Coordin ation of B enefits: P RIMARY
	2325	BIN: 12345 6
	2326	PCN: 11234 56789
	2327	Group ID: WEBMDTEST
	2328	Cardholder ID:
	2329	Patient Re lationship Code: CAR DHOLDER
	2330	Cardholder First Nam e: One
	2331	Cardholder Last Name : ECMEpati ent
	2332	+ Enter ?? for more a ctions
	2333	PR Print Data EX Exit
	2334	Select act ion:Next S creen// <E nter>
	2335	PHARMACY E CME Sep 11, 20 05@11:42:4 1 Page: 6 of 7
	2336	Claim Log informatio n
	2337	+
	2338	Plan ID: 8 729
	2339	Payer Shee t IEN: WBT ESTB1
	2340	B2 Payer S heet IEN: WBTESTB2
	2341	B3 Rebill Payer Shee t: WBTESTB 1
	2342	Certify Mo de:
	2343	Cert IEN:
	2344	+ Enter ?? f or more ac tions
	2345	PR Print Data EX Exit
	2346	Select act ion:Next S creen// <E nter>
	2347	After the last data page has d isplayed o n your scr een, press ing <Enter > will def ault to “Q UIT” and t he system returns to the ECME User Scree n.
	2348	PHARMACY E CME Sep 11, 20 05@11:43:0 1 Page: 7 of 7
	2349	Claim Log informatio n
	2350	+
	2351	Response I nformation (#659)--- ---------- ---------- ---------- ---------- ---------
	2352	Response R eceived: J UN 15,2005 @15:18:30
	2353	Date of Se rvice: 06/ 15/2005
	2354	Transactio n Response Status: R ejected
	2355	Total Amou nt Paid: $ 0
	2356	Ingredient Cost Paid : Dispe nsing Fee Paid:
	2357	Patient Re sp (INS):
	2358	Reject cod e(s):
	2359	NN:Transa ction Reje cted At Sw itch Or In termediary
	2360	Payer Mess age: NC40- Request fr om an unkn own site. Registrat ion is req uired
	2361	Payer Addi tional Mes sage:
	2362	Reason for Service C ode: AD
	2363	DUR Text: AMOXICILLI N 250MG CA P
	2364	DUR Additi onal Text: The text would disp lay here
	2365	Enter ?? f or more ac tions
	2366	PR Print Data EX Exit
	2367	Select act ion:Quit// <Enter> QUIT
	2368	5.09 Send to Worklis t XE " Se nd to Work list"
	2369	The Send t o Worklist action al lows you t o send rej ected clai ms to the Pharmacy W orklist. D epending o n Pharmacy settings, all or on ly claims with certa in reject codes may be sent to the Pharm acy Workli st from th e ECME Use r Screen.
	2370	Claims tha t have bee n closed w ill be dis played wit h “/Closed ” after th e status. Closed cla ims cannot be sent t o the Phar macy Work List. If y ou attempt to resubm it a claim that is c losed, a m essage is displayed telling yo u that the claim “is closed an d cannot b e sent to the Pharma cy Work Li st”.
	2371	Enter WRK at the Sel ect Action prompt, a nd a singl e line ite m for the claim you wish to se nd.
	2372	Example 5. 09-1: Acc essing the Send to W orklist Op tion, and Entering a Line Item .
	2373	PHARMACY E CME Jul 03, 20 08@12:04:0 2 Page: 1 of 41
	2374	SELECTED D IVISION(S) : ALL
	2375	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2376	Sorted b y: Transac tion date by default
	2377	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/ TYP RXINF
	2378	1 ECMEpa tient,One (XXXX) NON TRIC/ V ET Pb:0 Rj :6 AcRv:3 RjRv:2
	2379	1.1 AL BUTEROL 0. 5% IN 503 83-0741-20 07/03 205 4905$ 1 /000001614 782 W RT * */R
	2380	p-Re jected
	2381	07:M /I Cardhol der ID
	2382	1.2 JA PANESE ENC EPHAL 492 81-0680-30 06/27 205 5040$ 0 /000001614 918 W RT * */N
	2383	p-In progress- Parsing r esponse
	2384	1.3 JA PANESE ENC EPHAL 492 81-0680-30 07/03 205 5040$ 1 /000001614 918 W RT D IS/N
	2385	p-In progress- Parsing r esponse
	2386	1.4 OL ANZAPINE 1 0MG T 000 02-4117-30 06/29 205 5048$ 0 /000001614 926 W RT D IS/N
	2387	p-In progress- Parsing r esponse
	2388	1.5 OL ANZAPINE 1 0MG T 000 02-4117-30 06/29 205 5049$ 0 /000001614 927 W RT * */N
	2389	p-Re versal acc epted/Clos ed
	2390	1.6 OL ANZAPINE 1 0MG T 000 02-4117-30 07/03 205 5049$ 1 /000001614 927 W RT A C/N
	2391	+ Enter ?? f or more ac tions
	2392	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2393	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2394	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2395	Select Act ion: Next Screen// w rk Send to Worklis t
	2396	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2397	Select ite m(s): 1.1
	2398	You've cho sen to sen d to Pharm acy Work L ist the fo llowing:
	2399	1.1 AL BUTEROL 0. 5% IN 503 83-0741-20 06/03 205 4905$ 1 /000001614 782 W RT * */R
	2400	Comment fo r Pharmacy : Needs t o be resol ved in Pha rmacy.
	2401	Eligible c laim(s) wi ll be sent to the Ph armacy Wor klist...
	2402	Are you su re?(Y/N)? y YES
	2403	1.1 AL BUTEROL 0. 5% IN 503 83-0741-20 07/03 205 4905$ 1 /000001614 782 W RT * */R
	2404	has been s ent to the Pharmacy Work List.
	2405	Enter RETU RN to cont inue or '^ ' to exit:
	2406	Updating s creen...
	2407	The system updates t he ECME Us er Screen with the d ate, the s tatus, any comments entered, a nd the nam e of the u ser who co mpleted th e action.
	2408	Example 5. 09-2: The Updated U ser Screen
	2409	PHARMACY E CME Jul 03, 20 08@12:04:4 8 Page: 1 of 41
	2410	SELECTED D IVISION(S) : ALL
	2411	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2412	Sorted b y: Transac tion date by default
	2413	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/ TYP RXINF
	2414	1 ECMEpa tient,One (XXXX) NON TRIC/ V ET Pb:0 Rj :6 AcRv:3 RjRv:2
	2415	1.1 AL BUTEROL 0. 5% IN 503 83-0741-20 06/03 205 4905$ 1 /000001614 782 W RT * */R
	2416	07/2 3/08 - Sen t to Pharm acy: Needs to be res olved in P harmacy.
	2417	(ECM EUSER,FOUR )
	2418	p-Re jected
	2419	07:M /I Cardhol der ID
	2420	1.2 JA PANESE ENC EPHAL 492 81-0680-30 06/27 205 5040$ 0 /000001614 918 W RT * */N
	2421	p-In progress- Parsing r esponse
	2422	1.3 JA PANESE ENC EPHAL 492 81-0680-30 07/03 205 5040$ 1 /000001614 918 W RT D S/N
	2423	p-In progress- Parsing r esponse
	2424	1.4 OL ANZAPINE 1 0MG T 000 02-4117-30 06/29 205 5048$ 0 /000001614 926 W RT D S/N
	2425	p-In progress- Parsing r esponse
	2426	1.5 OL ANZAPINE 1 0MG T 000 02-4117-30 06/29 205 5049$ 0 /000001614 927 W RT * */N
	2427	+ Enter ?? f or more ac tions
	2428	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2429	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2430	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2431	Select Act ion: Next Screen//
	2432	If an inva lid claim is selecte d, other m essages ma y appear.
	2433	Example 5. 09-3: Sel ected Clai m Already on the Pha rmacy Work list
	2434	1.15 TAZAROTENE 0.1% T 0 0023-0042- 03 07/15 2 055208$ 0/0000016 15107 W RT AC/N
	2435	07/1 5/08 - Sen t to Pharm acy:testin g
	2436	+ Enter ?? f or more ac tions
	2437	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2438	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2439	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2440	Select Act ion: Next Screen// w rk Send to Worklis t
	2441	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2442	Select ite m(s): 1.15
	2443	You've cho sen to sen d to Pharm acy Work L ist the fo llowing:
	2444	1.15 TA ZAROTENE 0 .1% T 000 23-0042-03 07/15 205 5208$ 0 /000001615 107 W RT A C/N
	2445	was ALREAD Y sent to the Pharma cy Work Li st.
	2446	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2447	Select ite m(s):
	2448	Example 5. 09-4: Sel ected Clai m Doesn’t Have an El igible Rej ect Code
	2449	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2450	Select ite m(s):
	2451	You've cho sen to sen d to Pharm acy Work L ist the fo llowing:
	2452	1.11 ALLOP URINOL 100 MG 00364- 0632-02 02 /18 788538 $ 0/00 0001459640 W RT AC/N
	2453	doesn't ha ve eligibl e reject c ode to be sent to th e Pharmacy Work List .
	2454	Example 5. 09-5: Sel ected Clai m Has Not Been Rejec ted
	2455	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2456	Select ite m(s):
	2457	You've cho sen to sen d to Pharm acy Work L ist the fo llowing:
	2458	1.11 ACARB OSE 25MG T AB 00026- 2863-51 03 /03 788628 $ 0/00 0001459751 W RT DS/N
	2459	was not re jected and cannot be sent to t he Pharmac y Work Lis t.
	2460	Example 5. 09-6: Sel ected Clai m is Close d
	2461	1.22 ERYT HRITYL TET RAN 00223 -0916-01 0 4/03 10202 8$ 3/0 0000000240 3 W RT DL/ N
	2462	04/0 6/09 - RX DELETED
	2463	(ECM Eemployee, One)
	2464	p-Re jected/Clo sed
	2465	88:D UR Reject Error
	2466	1.23 ME THANTHELIN E 50M 000 14-1501-31 03/13 102 029$ 0 /000000002 404 W RT A C/N
	2467	p-Re jected
	2468	79:R efill Too Soon
	2469	+--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ----------
	2470	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2471	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2472	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2473	Select Act ion: Next Screen// W RK Send to Worklis t
	2474	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2475	Select ite m(s): 1.22
	2476	You've cho sen to sen d to Pharm acy Work L ist the fo llowing:
	2477	1.22 ER YTHRITYL T ETRAN 002 23-0916-01 04/03 102 028$ 3 /000000002 403 W RT D E/N
	2478	is closed and cannot be sent t o the Phar macy Work List.
	2479	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2480	Select ite m(s):
	2481	5.10 Reope n Closed C laims (hid den action ) XE " Reo pen Closed Claims (h idden opti on)"
	2482	The Reopen Closed Cl aims hidde n action a llows you to reopen closed cla ims direct ly from th e User Scr een instea d of havin g to acces s this fun ctionality from the ECME Trans action Mai ntenance O ptions men u. The BPS MANAGER s ecurity ke y is requi red to use this opti on.
	2483	Enter ROC at the “Se lect Actio n:” prompt to access the optio n, and sel ect a line item.
	2484	Example 5. 10-1: Acc essing the Reopen Cl osed Claim s Option
	2485	PHARMACY E CME Mar 27, 20 09@16:26:5 0 Page: 1 of 41
	2486	SELECTED D IVISION(S) : ALL
	2487	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2488	Sorted b y: Transac tion date by default
	2489	-#--PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/ TYP RXINF
	2490	1 ECMEpa tient,One (XXXX) OP INSUR2/205 5557898 VET ALL pa yable
	2491	1.1 DO XEPIN 25MG CAP 008 39-7221-06 03/27 102 105$ 0 /000000002 484 W BB A C/R
	2492	p-Pa yable
	2493	1.2 ME THAZOLAMID E 50M 000 05-5470-23 03/27 102 106$ 0 /000000002 485 W BB A C/R
	2494	p-Pa yable
	2495	2 ECMEpa tient,Two (XXXX) OP INSUR1/ VET Pb:53 Rj:28 AcRv :21 RjRv:6
	2496	2.1 ME DROXYPROGE STRON 000 09-0050-02 06/20 101 171$ 0 /000000001 521 W RT D S/N
	2497	06/2 0/08 - Cla rification Code 99 s ubmitted.
	2498	(ECM Euser,One)
	2499	p-Re versal acc epted
	2500	2.2 RE SERPINE 0. 1MG S 985 21-4587-02 03/26 101 237A$ 0 /000000001 695 C RT D S/R
	2501	p- R ejected/Cl osed
	2502	2.3 FU ROSEMIDE 1 0MG/M 510 79-0935-20 03/21 101 646$ 0 /000000002 014 W RT D S/N
	2503	+--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ----------
	2504	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2505	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2506	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2507	Select Act ion: Next Screen// R OC ROC
	2508	Enter the line numbe r for the claim you want to re open.
	2509	Select ite m(s): 2.2
	2510	You've cho sen to reo pen the fo llowing pr escription s(s) for
	2511	ECMEpatien t,One:
	2512	2.2 RE SERPINE 0. 1MG S 985 21-4587-02 03/26 101 237A$ 0 /000000001 695 C RT DS/R
	2513	All Select ed Rxs wil l be reope ned using the same i nformation gathered in the
	2514	following prompts.
	2515	Are you su re?(Y/N)? YES
	2516	You are pr ompted to enter Reop en Comment s, after c laim infor mation is displayed. Once you enter a co mment, you are asked if you wa nt to reop en this cl aim.
	2517	Example 5. 10-2: Ente ring Text Comment fo r Reopened Closed Cl aim
	2518	REOPEN COM MENTS: Cla im reopene d for new refill
	2519	ARE YOU SU RE YOU WAN T TO RE-OP EN THIS CL AIM? (Y/N) ? No// YES
	2520	ReOpening Claim: VA2 009=400000 0016=10522 0=0005843 ... OK
	2521	1 claim ha s been reo pened.
	2522	Enter RETU RN to cont inue or '^ ' to exit: <Enter>
	2523	Once the c laim has b een succes sfully reo pened, the screen is updated a nd re-disp layed.
	2524	Example 5. 10-3: The User Scree n is Updat ed and Re- Displayed
	2525	Updating s creen for reopened c laims...
	2526	PHARMACY E CME Mar 27, 20 09@16:28:3 2 Page: 1 of 41
	2527	SELECTED D IVISION(S) : ALL
	2528	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2529	Sorted b y: Transac tion date by default
	2530	-#--PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/ TYP RXINF
	2531	1 ECMEpa tient,One (XXXX) OP INSUR2/205 5557898 VET ALL pa yable
	2532	1.1 DO XEPIN 25MG CAP 008 39-7221-06 03/27 102 105$ 0 /000000002 484 W BB A C/R
	2533	p-Pa yable
	2534	1.2 ME THAZOLAMID E 50M 000 05-5470-23 03/27 102 106$ 0 /000000002 485 W BB A C/R
	2535	p-Pa yable
	2536	2 ECMEpa tient,Two (XXXX) OP INSUR1/ VET Pb:53 Rj:28 AcRv :21 RjRv:6
	2537	2.1 ME DROXYPROGE STRON 000 09-0050-02 03/20 101 171$ 0 /000000001 521 W RT D S/N
	2538	06/2 0/08 - Cla rification Code 99 s ubmitted.
	2539	(ECM Euser,One)
	2540	p-Re versal acc epted
	2541	2.2 RE SERPINE 0. 1MG S 985 21-4587-02 03/26 101 237A$ 0 /000000001 695 C RT D S/R
	2542	p-Re jected
	2543	2.3 FU ROSEMIDE 1 0MG/M 510 79-0935-20 03/21 101 646$ 0 /000000002 014 W RT D S/N
	2544	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2545	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2546	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2547	Select Act ion: Next Screen//
	2548	5.11 Resub mit with E dits (hidd en action) XE " Resu bmit with Edits (hid den option )"
	2549	The Resubm it with Ed its hidden action al lows you t o edit pre viously re jected ele ctronic ph armacy cla ims and to resubmit them with the edited informati on. The da ta fields that can b e edited t o enable r esubmissio n are the Pharmacy R elationshi p Code, Ph armacy Per son Code, Prior Auth orization Number, Pr ior Author ization Ty pe Code, u p to three Submissio n Clarific ation Code s (if the conditions explained below do not exist) , Date of Service, P atient Res idence Cod e, Pharmac y Service Type Code and/or Del ay Reason Code. (The Date of S ervice pro mpt is onl y asked if the presc ription ha s been rel eased.) I f the clai m selected is for se condary in surance, t he Coordin ation of B enefits in formation can also b e edited.
	2550	The relati onship cod e describe s the rela tionship t his patien t has to t he holder of this in surance po licy. The standard N CPDP Patie nt Relatio nship Code list foll ows. Howev er, it is important to note th at some pa yers use t heir own s et of code s for this field, so the field should be populated based upo n the paye r's expect ations.
	2551
	2552	0 Not Sp ecified
	2553
	2554	1 Cardho lder
	2555
	2556	2 Spouse
	2557
	2558	3 Child
	2559
	2560	4 Other
	2561	The Person Code is t he specifi c person c ode assign ed to the patient by the payer . The Prio r Authoriz ation numb er is the number sub mitted by the provid er to iden tify the p rior autho rization. For more i nformation on the Co ordination of Benefi ts fields, see the P rocess Sec ondary/TRI CARE Rx to ECME sect ion of thi s document .
	2562	The Submis sion Clari fication C ode cannot be edited if eithe r of these condition s exists:
	2563	An unresol ved reject is on the pharmacis ts’ workli st
	2564	A resolved reject of RTS (79-R efill Too Soon) or D UR (88-Dru g Utilizat ion Review ) is from the last c laim respo nse.
	2565	If neither condition exists, t he Submiss ion Clarif ication Co de is edit able. If either con dition exi sts, the S ubmission Clarificat ion Code p rompt is b ypassed an d a messag e is displ ayed on th e screen i ndicating the field cannot be edited.
	2566	You've cho sen to RES UBMIT the following prescripti on for ECM Epatient,f our
	2567	1.2 AL BUTEROL 0. 5% IN 2420 8034720 02 /22 000000 0 0/00 0000000003 W RT DS/N
	2568	Are you su re?(Y/N)? YES
	2569	Pharmacy R elationshi p Code: 1/ / C ARDHOLDER
	2570	Pharmacy P erson Code : 125//
	2571	Prior Auth orization Number: 00 000000000/ /
	2572	Prior Auth orization Type Code: 0// NOT SPEC IFIED
	2573	Submission Clarifica tion Code 1: 1 NO OVE RRIDE
	2574	**OPECC c annot edit Sub. Clar . Code fie ld for thi s reject - refer to Pharmacist
	2575	Patient Re sidence Co de: 1//
	2576	Claims tha t have bee n closed w ill be dis played wit h “/Closed ” after th e status. Closed cla ims cannot be resubm itted with edits. If you attem pt to resu bmit a cla im that is closed, a message i s displaye d telling you that t he claim i s “Closed and cannot be Resubm itted w/Ed its.”
	2577	Enter RED at the “Se lect Actio n:” prompt to choose the presc ription li ne to resu bmit.
	2578	Example 5. 11-1: Acc essing the Resubmit with Edits Option
	2579	PHARMACY E CME Aug 12, 20 11@02:40:3 4 Page: 1 of 81
	2580	SELECTED D IVISION(S) : ALL
	2581	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2582	Sor ted by: Pa tient Name
	2583	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	2584	5 ECMEpa tient,Two (XXXX) WE BMD / VET AL L payable
	2585	5.1 LE UCOVORIN 5 MG/ML 007 03-5140-01 08/12 109 58860$ 0 /000009378 798 W RT A C/N
	2586	p-Re versal rej ected
	2587	6 ECMEpa tient,One (XXXX) WEB MD / VET Pb: 3 Rj:1 AcR v:1 RjRv:0
	2588	6.1 GR ANULEX SPR AY 4O 005 14-0001-01 08/12 109 58847 0 /000009378 705 W RT A C/R
	2589	p-Pa yable
	2590	6.2 AC ARBOSE 100 MG TA 000 26-2862-51 08/12 525 36284 1 /000009378 782 W RT D S/N
	2591	03/2 0/06 - RX DISCONTINU ED
	2592	p-Re jected
	2593	08:M /I Person Code
	2594	+ Enter ?? f or more ac tions
	2595	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2596	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2597	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2598	Select Act ion: Quit/ / RED RE D
	2599	Enter the line numbe r for the claim to b e submitte d.
	2600	Example 5. 11-2: Ent ering the Line Item for the Cl aim Resubm ission Req uest
	2601	Enter the line numbe r for the claim to b e resubmit ted:
	2602	Select ite m: 6.2
	2603	If you att empt to re submit a p rimary cla im when th ere is a p ayable sec ondary cla im, you wi ll see the following message, which will discontin ue the cla ims resubm ission pro cess.
	2604	Example 5. 11-3: Ente ring the L ine Item f or a Claim that has a Payable Secondary Claim
	2605	The claim:
	2606	1.12 FLU RAZEPAM 15 MG C 00140 -0065-14 0 3/04 10232 2$ 2/00000 0113596 W RT AC/R
	2607	cannot be Resubmitte d if the s econdary c laim is pa yable.
	2608	Please rev erse the s econdary c laim first .
	2609	You can en ter Y or N to the “A RE YOU SUR E?” prompt . If you a nswer Y, t he claim r esubmissio n process will conti nue.
	2610	Example 5. 11-4: Ente ring Yes t o “Are You Sure” Pro mpt
	2611	You've cho sen to RES UBMIT the following prescripti on for ECM Epatient, One
	2612	1.2 LI DOCAINE 0. 5% W/ 001 86-0140-01 07/09 100 704$ 1 /000000000 623 W RT A C/N
	2613	ARE YOU SU RE? (Y/N)? No// YES
	2614	You can ed it the Pha rmacy Rela tionship C ode, Pharm acy Person Code, Pri or Authori zation Num ber, Prior Authoriza tion Type Code, up t o three Su bmission C larificati on Codes ( if conditi ons explai ned above are not me t), Date o f Service, Patient R esidence C ode, Pharm acy Servic e Type Cod e and/or D elay Reaso n Code.
	2615	Example 5. 11-5: Edit ing Prompt s
	2616	Pharmacy R elationshi p Code: <E nter>
	2617	Pharmacy P erson Code : 23
	2618	Prior Auth orization Number: 00 000000000/ /
	2619	Prior Auth orization Type Code: 0// NOT SPEC IFIED
	2620	Submission Clarifica tion Code 1: 5// THERAP Y CHANGE
	2621	Submission Clarifica tion Code 2:
	2622
	2623	Select one of the fo llowing:
	2624	1. 01/19/2 010 Curre nt Date of Service
	2625	2. 01/19/2 010 Fill Date
	2626	3. 01/20/2 010 Relea se Date
	2627	Date of Se rvice: 1// 2 01/19/2 010 Fill D ate
	2628	Patient Re sidence Co de: 1// HOME
	2629	Pharmacy S ervice Typ e Code: 1/ / R ETAIL
	2630	Delay Reas on Code:
	2631	The Resubm it with Ed its (RED) option wil l display the inform ation that will be u sed to pop ulate the Coordinati on of Bene fit fields in the se condary cl aim. If an y of the i nformation is missin g, the use r will be required t o edit the secondary claim inf ormation. If all the informati on is pres ent, the u ser is giv en the opt ion to edi t the data that will be sent o n the seco ndary clai m. The use r will als o be able to enter t he rate ty pe for the secondary claim.
	2632	Example 5. 11-6: Ente ring the s econdary c laim infor mation wit h payment informatio n
	2633	Data for S econdary C laim
	2634	---------- ---------- ----
	2635	Insurance: ECME INS URANCE2 COB: SECON DARY
	2636	Rate Type: REIMBURS ABLE INS.
	2637	Other Cove rage Code: 02 (OTHE R COVERAGE EXISTS - PAYMENT CO LLECTED)
	2638	Other Paye r Coverage Type: 01 (PRIMARY)
	2639	Other Paye r ID Quali fier: 03 (BANK INFO RMATION NU MBER (BIN) )
	2640	Other Paye r ID: 123 456
	2641	Other Paye r Date: J un 28, 201 0
	2642	Other Paye r Paid Qua lifier: 0 8 (SUM OF ALL REIMBU RSEMENT)
	2643	Other Paye r Amount P aid: 40.0 0
	2644	Do you wan t to edit this Secon dary Claim Informati on (Y/N)? N// y YES
	2645	Insura nce CO B Subscri ber ID Gro up Ho lder Eff ective Ex pires
	2646	====== ======= == == ======= ====== === ======= == ====== === ======= == ========
	2647	1 ECME I NSURAN PRI 12340987 T-GR OUP1 PAT IENT 10/2 0/2006 06/ 00/2011
	2648	2 ECME I NSURAN SEC D-GR OUP1 PAT IENT 07/0 9/2006 06/ 00/2011
	2649	SECONDARY INSURANCE POLICY: 2/ / ECME I NSURANCE1 (SECONDARY ) - D-GROU P1
	2650	SELECT RAT E TYPE: RE IMBURSABLE INS.// Who's Re sponsible: INSURER
	2651	OTHER COVE RAGE CODE: 02// O THER COVER AGE EXISTS - PAYMENT COLLECTED
	2652	OTHER PAYE R ID: 1234 56//
	2653	OTHER PAYE R DATE: J un 28, 201 0//
	2654	Edit Paid Amounts or Reject Co des (PAID AMOUNTS/RE JECT CODES ): PAID A MOUNTS//
	2655	OTHER PAYE R AMOUNT P AID QUALIF IER: 08// SUM OF ALL REIMBU RSEMENT
	2656	OTHER PAYE R AMOUNT P AID: (0-9 99999): 40 .00//
	2657	Example 5. 11-7: Ente ring the s econdary c laim infor mation wit h reject i nformation
	2658	Data for S econdary C laim
	2659	---------- ---------- ----
	2660	Insurance: DAVE INS URANCE COB: SECON DARY
	2661	Rate Type: REIMBURS ABLE INS.
	2662	Other Cove rage Code: 03 (OTHE R COVERAGE EXISTS - THIS CLAIM NOT COVER ED)
	2663	Other Paye r Coverage Type: 01 (PRIMARY)
	2664	Other Paye r ID Quali fier: 03 (BANK INFO RMATION NU MBER (BIN) )
	2665	Other Paye r ID: 610 459
	2666	Other Paye r Date: A ug 16, 201 0
	2667	Other Paye r Reject C ode: 34:M /I Submiss ion Clarif ication Co de
	2668	Other Paye r Reject C ode: 07:M /I Cardhol der ID
	2669	Other Paye r Reject C ode: JE:M /I Percent age Sales Tax Basis Submitted
	2670	Do you wan t to edit this Secon dary Claim Informati on (Y/N)? N// y YES
	2671	Insura nce CO B Subscri ber ID Gro up Ho lder Eff ective Ex pires
	2672	====== ======= == == ======= ====== === ======= == ====== === ======= == ========
	2673	1 DAVE I NSURANC SE C SI32432 D-G ROUP1 PA TIENT 05/ 09/2007
	2674	SECONDARY INSURANCE POLICY: 1/ / DAVE I NSURANCE ( SECONDARY) - D-GROUP 1
	2675	SELECT RAT E TYPE: RE IMBURSABLE INS.// Who's Re sponsible: INSURER
	2676	OTHER COVE RAGE CODE: 03// O THER COVER AGE EXISTS - THIS CL AIM NOT CO VERED
	2677	OTHER PAYE R ID: 6104 59//
	2678	OTHER PAYE R DATE: A ug 16, 201 0//
	2679	Edit Paid Amounts or Reject Co des (PAID AMOUNTS/RE JECT CODES ): REJECT CODES//
	2680	OTHER PAYE R REJECT C ODE: 34// M/I Submissio n Clarific ation Code
	2681	OTHER PAYE R REJECT C ODE: 07// M/I Cardholde r ID
	2682	OTHER PAYE R REJECT C ODE: JE// M/I Percentag e Sales Ta x Basis Su bmitted
	2683	OTHER PAYE R REJECT C ODE:
	2684	The Resubm it with Ed its (RED) option wil l prompt i f the clai m is corre ct and if the claim should be submitted to the thi rd party i nsurance. If the use r answers 'Yes' to b oth of the se prompts , the clai m will be submitted. If the us er chooses “No”, the action wi ll be canc elled.
	2685	Example 5. 11-8: Answ ering “Is the Claim Correct?” Prompt
	2686	IS THIS CL AIM CORREC T?(Y/N)? Y // ES
	2687	SUBMIT CLA IM TO ECME INSURANCE 1 ?(Y/N)? Y// ES
	2688	Veteran Pr escription 103689 su ccessfully submitted to ECME f or claim g eneration.
	2689	Example 5. 11-9: Answ ering “Are you sure? ” Prompt
	2690	Are you su re?(Y/N)? YES
	2691	Veteran Pr escription 100003433 A successf ully submi tted to EC ME for cla im generat ion.
	2692	Claim Stat us:
	2693	IN PROGRES S-Waiting to start
	2694
	2695	IN PROGRES S-Waiting for packet build
	2696	IN PROGRES S-Packet b eing built
	2697	IN PROGRES S-Transmit ting
	2698	E PAYABLE
	2699	Veteran Pr escription 100003433 A successf ully submi tted to EC ME for cla im generat ion.
	2700	1 claim ha s been res ubmitted.
	2701	Enter RETU RN to cont inue or '^ ' to exit: <Enter>
	2702	Updating s creen for resubmitte d claim...
	2703	5.12 OPEC C Reject I nformation (hidden a ction)
	2704	The OPECC Reject Inf ormation h idden acti on allows the user t o view det ails assoc iated with a rejecte d claim. T his action is only a vailable f or claims with open rejections and non-b illable pr escription s with pse udo-reject ions of eC or eT.
	2705	Access the action by entering REJ at the “Select A ction:” pr ompt on th e ECME Use r Screen.
	2706	Example 5. 12-1: Acc essing and Executing the OPECC Reject In formation Action
	2707	PHARMACY E CME Aug 10, 20 05@10:31:2 2 Page: 1 8 of 42
	2708	SELECTED D IVISION(S) : ALL
	2709	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2710	Sor ted by: Pa tient Name
	2711	+# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	2712	7 ECMEpa tient,One (XXXX) WE BMD TE/ VET A LL payable
	2713	7.1 PR EDNISONE 1 MG TA 0024 2074475 09 /16 100803 0/00 0000111872 W RS AC/N
	2714	09/1 0/15 – The comment g oes here.
	2715	(USE R, ONE)
	2716	p-Re jected
	2717	79:R efill Too Soon
	2718	+ Enter ?? f or more ac tions
	2719	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2720	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2721	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2722	Select Act ion: Next Screen// R EJ REJ OPECC Reje ct Informa tion
	2723	You will s ee the fol lowing mes sage, if y ou attempt to select a claim w hen there is no reje ction.
	2724	Example 5. 12-2: Ent ering the Line Item for a Clai m with no rejection
	2725	This claim is not a valid sele ction for the OPECC Reject Inf ormation s creen.
	2726	This scree n is for e ither reje cted claim s or non-b illable cl aims.
	2727	Enter RETU RN to cont inue or '^ ' to exit:
	2728	You are p rompted fo r the line item of t he rejecte d claim or non-billa ble prescr iption ent ry.
	2729	Example 5. 12-3: Ent ering the Line Item for the OP ECC Reject Informati on Action
	2730	Select Act ion: Next Screen// R EJ REJ OPECC Reje ct Informa tion
	2731	Select ite m: 7.1
	2732	The OPECC Reject Inf ormation S creen disp lays.
	2733	Example 5. 12-4: OPE CC Reject Informatio n Screen D isplay
	2734	OPECC Reje ct Informa tion Oct 28, 20 15@14:45:4 2 Page: 1 of 3
	2735	Division : XXXXXX NPI: 111 0099999 NC PDP: 53100 00XX
	2736	Patient : PATIENT,O NE(XXXP) Sex: M DOB: JUL X X,19XX(XX)
	2737	Rx# : 100XXX/0 ECME #: 0000001 11872 Da te of Serv ice: Sep 1 6, 2015
	2738	Drug : PREDNISON E 1MG TAB NDC C ode: 00242 -0744-75
	2739	REJECT Inf ormation ( Veteran) RESUBMISSI ON
	2740	Current EC ME Status: E REJECTE D
	2741	Rejects re ceived fro m Payer on 09/16/201 5 5:26:39 pm.
	2742	Code De scription
	2743	79 - Re fill Too S oon
	2744	Next Avail Fill: 10/ 31/2015
	2745	Payer Mess age : EMD 1000: CLA IM PAID
	2746	Payer Addl Msg : EMD 1000: CLA IM PAID RX :00000010X XXFILL:201 5-09-16
	2747	BIN :610144 PC N:TEST
	2748	OPECC COMM ENTS
	2749	- 09/10/15 5:17 pm – First com ment for O PECC scree n (USER,ON E)
	2750	PHARMACIST COMMENTS
	2751	- 05/12/15 8:23 am – Second co mment for Pharmacist (USER,TWO )
	2752	INSURANCE Informatio n
	2753	Insurance : VET CNF
	2754	Contact : 333 -444-5555
	2755	BIN : 610 144
	2756	PCN : TES T
	2757	Group Numb er : 246
	2758	Cardholder ID : 123 4567890
	2759	Effective Date : 01/ 25/2015
	2760	There are four actio ns availab le from th e OPECC Re ject Infor mation scr een: VW V iew Rx, VE R View ECM E Rx, MP M ed Profile , and PI P at Info.
	2761	Example 5. 12-5: Act ions Avail able from the OPECC Reject Inf ormation S creen
	2762	+ Enter ?? f or more ac tions
	2763	VW View R x VER View E CME Rx MP Med Pr ofile PI Pat In fo
	2764	Select: Ne xt Screen/ /
	2765	5.13 Resu bmit Claim Without R eversal (h idden acti on) XE " R esubmit Cl aim"
	2766	The Resubm it Claim w /o Reversa l action r esubmits a claim to the insure r without submitting a reversa l first, r egardless of the Vis tA claim s tatus. Thi s action s hould be u sed in ins tances whe re the pay er shows t he claim w as reverse d and Vist A shows a payable cl aim. This action is not availa ble if any non-cance lled bill exists..
	2767	The action is access ed by ente ring RER a t the “Sel ect Action :” prompt on the ECM E User Scr een.
	2768	Example 5. 13-1: Acce ssing and Executing the Resubm it Claim W /O Reversa l Action
	2769	Select Act ion: Next Screen// R ER RER Resubmit C laim w/o R eversal
	2770	You are pr ompted for the line item(s) of the claim to be res ubmitted.
	2771	You may al so submit multiple l ine items separated by commas (e.g. “1.1 ,1.2”), or a range o f line ite ms separat ed by a hy phen (e.g. “1.1-1.3” ).Example 5.13-2: En tering the Line Item for the C laim Resub mission Re quest
	2772	Note: This actio n will res ubmit clai ms without performin g a revers al.
	2773	This actio n should b e used in instances where the payer show s the
	2774	claim was reversed a nd VistA s hows a pay able claim . This act ion will
	2775	NOT submit a reversa l regardle ss of the current Vi stA claim status.
	2776	Enter the line numbe rs for the claim(s) to be resu bmitted w/ o reversal .
	2777	Select ite m(s):
	2778	The system redisplay s the line item for resubmissi on, then a sks if you are sure you want t o continue with the transactio n. You can enter Y o r N. If yo u answer Y , the clai m resubmis sion proce ss continu es.
	2779	Example 5. 13-5: Ente ring “Y” t o Continue Claim Res ubmission Request
	2780	You've cho sen to RES UBMIT W/O REVERSAL t he followi ng Rx for PATIENT,TW O
	2781	1.4 PR EDNISONE 1 MG TA 0024 2074475 10 /28 100XXX 0/00 0000112XXX W RT AC/N
	2782	Are you su re?(Y/N)? YES
	2783	ECME will allow mult iple submi ssions of the same p rescriptio n and fill to be pla ced on the request q ueue at th e same tim e. The ECM E engine w ill proces s all requ ests in th e order th at they ar e received . If there is alread y a submis sion in th e queue fo r this pre scription and fill, a message is display ed and you are asked if you wa nt to proc eed.
	2784	Example 5. 13-6: Ent ering “Y” to Place M ultiple Su bmissions in the Que ue
	2785	The claim is in prog ress. The request wi ll be sche duled and processed after
	2786	the previo us request (s) are co mpleted. P lease be a ware that the result of
	2787	the resubm it depends on the pa yer's resp onse to th e prior in complete r equests.
	2788	Do you wan t to proce ed?(Y/N)? y YES
	2789	The claim resubmissi on request is submit ted and th e progress is displa yed.
	2790	Example 5. 13-7: Dis playing a Successful ly Resubmi tted Claim
	2791	Claim Stat us:
	2792	IN PROGRES S-Waiting to start
	2793	IN PROGRES S-Building the claim
	2794	IN PROGRES S-Transmit ting
	2795	E PAYABLE
	2796	Veteran Pr escription 100958 su ccessfully submitted to ECME f or claim g eneration.
	2797	1 claim ha s been res ubmitted.
	2798	Enter RETU RN to cont inue or '^ ' to exit: <ENTER>
	2799	Updating s creen for resubmitte d claims.. .
	2800	The line i tem will d isplay the status of a claim t hat was re submitted and the Bi ll Type in dicator of “RS” . Th e “RS” ind icates a r esubmitted claim. Th e resubmit indicator will also display f or a non-b illable pr escription that has been resub mitted, ev en if ther e is no cl aim becaus e the pres cription r emained no n-billable .
	2801	Example 5. 13-8: Disp laying the Claim Sta tus after a Resubmis sion
	2802	PHARMACY E CME Oct 28, 20 15@16:29:3 2 Page: 2 of 52
	2803	SELECTED D IVISION(S) : ALL
	2804	Transmitte d by ALL u sers Activity Date Rang e: within the past 9 99 day(s)
	2805	Sorted b y: Transac tion date by default
	2806	+# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# STATUS/LOC /TYP/RXINF
	2807	1.4 PR EDNISONE 1 MG TA 0024 2074475 10 /28 100XXX 0/00 0000112XXX W RS AC/N
	2808	p-Pa yable
	2809	5.14 Open /Close Non Billable Entry (hid den action )
	2810	The Open/C lose Non B illable En try action marks a n on-billabl e entry as open or c losed. The action on ly applies to non-bi llable ent ries, not claims tha t have bee n submitte d to a thi rd party p ayer.
	2811	The action behaves l ike a togg le. If the entry is currently Open and t he action is selecte d, the use r will Clo se the ent ry. If the entry is currently Closed and the actio n is selec ted, the u ser will O pen the en try.
	2812	The action is access ed by ente ring OCN a t the “Sel ect Action :” prompt on the ECM E User Scr een.
	2813	Example 5. 14-1: Acce ssing and Executing the Open/C lose Non B illable En try Action
	2814	Select Act ion: Next Screen// O CN OCN Open/Close Non-Billa ble Entry
	2815	You are pr ompted for the line item(s) of the claim to be ope ned or clo sed.
	2816	Example 5. 14-2: Ente ring the L ine Item f or the Ope n/Close No n Billable Entry
	2817	Enter the line numbe r for the entry to b e opened o r closed.
	2818	Select ite m:
	2819	The system redisplay s the line item for resubmissi on, then p rompts for a comment . Next the system as ks if the user is su re. You ca n enter Y or N. If y ou answer Y, the ent ry is mark ed as Open or Closed .
	2820	Example 5. 14-5: Answ er Prompts for Open/ Close Non Billable e ntry
	2821	You've cho sen to CLO SE the fol lowing ent ry for
	2822	PATIENT,ON E :
	2823	3.1 MI LK OF MAGN ESIA 0034 9821742 100SSS 0/ W RS EX/N
	2824	p-No n-Billable /Open
	2825	eT:T RICARE-RX NOT BILLAB LE (DRUG N OT BILLABL E)
	2826	The Select ed Entry w ill be CLO SED.
	2827	Comment : Enter a co mment now
	2828	Are you su re? (Y/N)? YES
	2829	Closing En try
	2830	Enter RETU RN to cont inue or '^ ' to exit:
	2831	5.15 Displ ay Update (hidden ac tion) XE " Display U pdate"
	2832	The Displa y Update a ction revi ses the EC ME User Sc reen with the latest informati on about t he status of patient s’ prescri ptions usi ng the cur rent filte r settings . This act ion update s the ECME User Scre en only on ce.
	2833	This hidde n action i s accessed by enteri ng UD at t he “Select Action:” prompt on the ECME User Scree n.
	2834	Example 5. 15-1: Acc essing the Display U pdate Acti on
	2835	PHARMACY E CME Apr 26, 20 06@11:44:4 5 Page : 1 of 2
	2836	SELECTED D IVISION(S) : ALL
	2837	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2838	Sor ted by: Pa tient Name
	2839	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	2840	6 ECMEpa tient,Two (XXXX) WEBMD TE/ VET Pb:1 Rj:0 AcRv:0 Rj Rv:1
	2841	6.1 FU ROSEMIDE 1 0MG/M 006 41-2312-25 04/22 100 004065$ 0 /000000504 691 W RT A C/R
	2842	p-Pa yable
	2843	6.2 CH OLESTYRAMI NE 4G 000 87-0580-01 04/22 100 004066$ 0 /000000504 692 W RT A C/R
	2844	p-Re versal rej ected
	2845	NN:T ransaction Rejected At Switch Or Interme diary
	2846	NC16 -The clear inghouse d id not rep ly in time .
	2847	7 ECMEpa tient,One (XXXX) WEBMD TE/ VET ALL payab le
	2848	7.1 AL BUTEROL IN HALER 555 55-4444-22 04/26 100 003744$ 0 /000000504 304 W RT A C/R
	2849	p-Pa yable
	2850	7.2 AC ETYLCYSTEI NE 20 000 87-0570-09 04/21 100 004054$ 0 /000000504 677 W RT A C/N
	2851	s-Pa yable (p-P ayable)
	2852	8 ECMEpa tient,Thre e (XXXX) WEBMD TE/ VET ALL payab le
	2853	+ Enter ?? f or more ac tions
	2854	The screen has been updated on APR 26,20 06@14:50:4 7. Press " Q" to quit .
	2855	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2856	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2857	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2858	Select Act ion: Next Screen// U D Displa y Update
	2859	Updating s creen...
	2860	5.16 Exit (from ECME User Scre en) XE " Exit from ECME User Screen"
	2861	When EXIT or QUIT is entered a t the “Sel ect Action :” prompt, the syste m will ret urn the us er to the ECME Main Menu.
	2862	6.
	2863	Accessing the ECME P harmacy CO B Menu XE "Accessing the ECME Pharmacy C OB Menu"
	2864	The ECME P harmacy CO B Menu opt ion allows users to manually s end claims to second ary insura nce compan ies; gener ate primar y claims f or patient s with dua l eligibil ity; and v iew report s that sup port secon dary billi ng and pri mary billi ng for TRI CARE patie nts.
	2865	Example 6- 1: Accessi ng the ECM E Pharmacy COB Menu
	2866	*** ****** ****** ****** ****** **
	2867	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	2868	* XXXXXX VAMC *
	2869	* Main M enu *
	2870	*** ****** ****** ****** ****** **
	2871	U ECME User Screen
	2872	COB ECME Pharm acy COB .. .
	2873	MGR Pharmacy E CME Manage r Menu ...
	2874	RPT Pharmacy E lectronic Claims Rep orts ...
	2875	Select ECM E Option: MGR Pharm acy ECME M anager Men u
	2876	Example 6- 2: Display ing the EC ME Pharmac y COB Menu
	2877	*** ****** ****** ****** ****** **
	2878	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	2879	* XXXXXXX VAMC *
	2880	* Phar macy ECME Manager Me nu *
	2881	*** ****** ****** ****** ****** **
	2882	SEC Potential Secondary Rx Claims Report
	2883	TRI Potential Claims Rep ort for Du al Eligibl e
	2884	PRO Process Se condary/TR ICARE Rx t o ECME
	2885	Select ECM E Pharmacy COB Optio n:
	2886	6.1 Potent ial Second ary Rx Cla ims Report XE " Pote ntial Seco ndary Rx C laims Repo rt"
	2887	The Potent ial Second ary Rx Cla ims Report is design ed to help the OPECC (Outpatie nt Pharmac y Electron ic Claims Coordinato r) to iden tify poten tial Rx cl aims for a secondary insurance payer wit h pharmacy coverage, including both elec tronic and paper. Th is report will inclu de prescri ption clai ms where t he primary claim is payable or the prima ry claims has been r ejected an d closed. Below are some scena rios where a claim w ill not ap pear on th e report:
	2888	A prescrip tion where the secon dary claim is closed in ECME.
	2889	A prescrip tion where the secon dary claim is payabl e in ECME.
	2890	A prescrip tion where the prima ry payer p aid the fu ll amount as there i s no more revenue to collect f rom any ot her payers .
	2891	If a claim is determ ined to be electroni cally bill able, the OPECC acco mplishes t his throug h the Proc ess Second ary/TRICAR E Rx to EC ME option. If the cl aim must b e billed i n paper fo rmat, the OPECC foll ows the cu rrent proc edures for initiatin g a second ary bill w ith the bi lling staf f.
	2892	Access the Potential Secondary Rx Claims Report by entering SEC at the “ECME Pha rmacy COB Option:” p rompt on t he ECME Ph armacy COB Menu.
	2893	Example 6. 1-1: Acces sing the P otential S econdary R x Claims R eport
	2894	*** ****** ****** ****** ****** **
	2895	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	2896	* XXXXXX VAMC *
	2897	* Pharmacy Electroni c Claims R eports *
	2898	*** ****** ****** ****** ****** **
	2899	SEC Potential Secondary Rx Claims Report
	2900	TRI Potential Claims Rep ort for Du al Eligibl e
	2901	PRO Process Se condary/TR ICARE Rx t o ECME
	2902	Select ECM E Pharmacy COB Optio n: SEC Po tential Se condary Rx Claims Re port
	2903	After you have selec ted one, m any, or al l division s and a da te range, choose you r primary (required) and secon dary (opti onal) sort criteria.
	2904	Example 6. 1-2: Gener ating the Potential Secondary Rx Claims Report
	2905	SELECTION CRITERIA
	2906	Selec t one of t he followi ng:
	2907	D DIVISION
	2908	A ALL
	2909	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: ALL
	2910	EARLIEST D ATE: t (A PR 14, 200 9)
	2911	LATEST D ATE: T// < ENTER> (A PR 14, 200 9)
	2912	SORT CRITE RIA
	2913	Primary So rt: (N/P/ S/D): Divi sion// ??
	2914	Enter a co de from th e list to indicate t he Primary sort orde r.
	2915	Selec t one of t he followi ng:
	2916	N Patient Na me
	2917	P Payer
	2918	S Date Of Se rvice
	2919	D Division
	2920	Primary So rt: (N/P/ S/D): Divi sion// <EN TER>
	2921	Secondary Sort: (N/ P/S): <ENT ER>
	2922	DEVICE: HO ME// <ENTE R> UCX/TE LNET Ri ght Margin : 80// <EN TER>
	2923	Collecting Potential Secondary data.
	2924	Enter RETU RN to cont inue or '^ ' to exit: <ENTER>
	2925	========== ========== ========== ========== ========== ========== ========== =========
	2926	Potential Secondary Rx Claims Report 4/14/09 - 4/14/09 Page: 1
	2927	Selected D ivisions: ALL
	2928	Sorted By: Division;
	2929	Bill# RX# Fill Pati ent PatID COB Date Payers
	2930	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	2931	Division: XXXXXX
	2932	K9000LG 102179 4 ECME patient,On e 0000 p 4/14/ 09 ECME I NSURANCE1
	2933	t ECME I NSURANCE2
	2934	K0000QD 2055862 0 ECME patient,On e 0000 p 7/13/ 10 ECME I NSURANCE1
	2935	s ECME I NSURANCE2
	2936	- ECME I NSURANCE3
	2937	(P) Rej 2055865 0 ECME patient,On e 0000 p 7/13/ 10 ECME I NSURANCE1
	2938	s ECME I NSURANCE2
	2939	t ECME I NSURANCE3
	2940	(P) Rej 2055866 0 ECME patient,Tw o 4444 p 7/14/1 0 ECME IN SURANCE1
	2941	s ECME I NSURANCE2
	2942	Bill# "(P) Rej" indi cates a re jected/clo sed primar y ECME cla im
	2943	COB "-" in dicates a blank COB field in t he pt. ins . policy
	2944	6.2 XE "Po tential Cl aims Repor t for Dual Eligible" Potentia l Claims R eport for Dual Eligi ble
	2945	The Potent ial Claims Report fo r Dual Eli gible atte mpts to id entify pot ential pha rmacy clai ms for TRI CARE and C HAMPVA pay ers. This report inc ludes pres criptions that have been relea sed, but h ave not ye t been bil led for an y patient with dual eligibilit y (e.g. Ve teran, CHA MPVA and T RICARE) wh o has an a ctive insu rance plan with phar macy cover age and a Type of Pl an of TRIC ARE or CHA MPVA. If t he Claims Tracking e ntry for t he specifi c prescrip tion/fill is identif ied as bei ng non-bil lable, the n it will not appear on this r eport.
	2946	If a claim is determ ined to be electroni cally bill able, the OPECC can submit the prescript ion throug h the Proc ess Second ary/TRICAR E Rx to EC ME option.
	2947	Access the Potential Claims Re port for D ual Eligib leby enter ing TRI at the “ECME Pharmacy COB Option :” prompt on the ECM E Pharmacy COB Menu.
	2948	Example 6. 2-1: Acces sing the P otential C laims Repo rt for Dua l Eligible
	2949	*** ****** ****** ****** ****** **
	2950	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	2951	* XXXXX V AMC *
	2952	* Pharmacy Electroni c Claims R eports *
	2953	*** ****** ****** ****** ****** **
	2954	SEC Potential Secondary Rx Claims Report
	2955	TRI Potential Claims Rep ort for Du al Eligibl e
	2956	PRO Process Se condary/TR ICARE Rx t o ECME
	2957	Select ECM E Pharmacy COB Optio n: TRI Po tential Cl aims Repor t for Dual Eligible
	2958	After you have selec ted one, m any, or al l division s, the pat ient eligi bility cri teria (TRI CARE, CHAM PVA or all ) and a da te range, choose you r primary (required) and secon dary (opti onal) sort criteria.
	2959	Example 6. 2-2: Gener ating the Potential TRICARE Cl aims Repor t
	2960	Selec t one of t he followi ng:
	2961	D DIVISION
	2962	A ALL
	2963	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: ALL
	2964	Selec t one of t he followi ng:
	2965	T TRICARE
	2966	C CHAMPVA
	2967	A ALL
	2968	Display (T )RICARE or (C)HAMPVA or (A)LL Entries: A // LL
	2969	EARLIEST D ATE: t-10 (APR 06, 2009)
	2970	LATEST D ATE: T// (APR 16, 2009)
	2971	SORT CRITE RIA
	2972	Primary So rt: (N/P/ S/D/E): Di vision//
	2973	Secondary Sort: (N/ P/S/E):
	2974	Tertiary S ort: (N/P /S/E):
	2975	DEVICE: HO ME// ;;999 9 TELNET TERMINAL
	2976	Collecting TRICARE d ata.
	2977	Enter RETU RN to cont inue or '^ ' to exit:
	2978	========== ========== ========== ========== ========== ========== ========== ==========
	2979	Potential TRICARE Rx Claims Re port 8 /1/80 - 7/ 28/14 Page: 1
	2980	Selected D ivisions: ALL
	2981	Selected P atient Eli gibility: ALL
	2982
	2983	Sorted By: Division;
	2984	'*' indica tes the HP ID/OEID fa iled valid ation chec ks
	2985	RX# F ill Date Patient Pat ID COB Eli g Payers H PID/OEID
	2986	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	2987	Division: XXXXX VAMC
	2988	100407 2 9/9/10 OPTRICAR E,ONE 16 0P p TRI C TRICARE- 23 TEST 6 999999999*
	2989	100408 1 9/9/10 OPTRICAR E,ONE 16 0P p TRI C TRICARE- 23 TEST 6 999999999*
	2990	6.3 Proces s Secondar y/TRICARE Rx to ECME XE "Proce ss Seconda ry/Tricare Rx to ECM E"
	2991	The Proces s Secondar y/TRICARE Rx to ECME option al lows the O PECC to su bmit claim s for pres criptions/ refills th at were en tered for Secondary claims, TR ICARE pati ents or pa tients wit h dual eli gibility ( e.g. Veter an and TRI CARE). The se claims are identi fied using the Poten tial Secon dary Rx Cl aims Repor t and Pote ntial Clai ms Report for Dual E ligible.
	2992	This optio n submits the claim to the thi rd party p ayer. Any further pr ocessing o n the clai m must the n be done through th e actions available on the ECM E User Scr een.
	2993	When proce ssing a cl aim for TR ICARE, CHA MPVA and d ual eligib ility pati ents, user s will be asked for the patien t’s name, the fill/r efill numb er from th e list pro vided, and an approp riate bill ing Rate T ype. If th e user sel ects a CHA MPVA Rate Type (CHAM PVA or CHA MPVA REIMB . INS.), t he claim w ill be pro cessed as a CHAMPVA claim. If the user s elects a T RICARE Rat e Type (TR ICARE or T RICARE REI MB. INS.), the claim will be p rocessed a s a TRICAR E claim. I f the user selects a Reimbursa ble Insura nce type, it will be processed as a regu lar non-TR ICARE and non-CHAMPV A claim. T he Date of Service i s determin ed based o n the date of servic e algorith m used in Outpatient Pharmacy.
	2994	Claims can also be r esubmitted using the Process S econdary/T RICARE RX to ECME op tion. Seco ndary Clai ms that ar e rejected by insura nce compan ies becaus e of missi ng or inco rrect data received, or Primar y Claims t hat have b een reject ed or reve rsed, may be resubmi tted. This option is not inten ded to use for Payab le claims. Payable c laims must be revers ed using t he Reverse Payable C laim Actio n on the E CME User S creen befo re they ca n be resub mitted via this opti on. Inform ation prev iously ent ered for t he claim w ill appear as the de faults.
	2995	You must h old the BP SUSER key to use the Process S econdary/T RICARE Rx to ECME op tion. Acce ss the Pro cess Secon dary/TRICA RE Rx to E CME option by enteri ng PRO at the “ECME Pharmacy C OB Option: ” prompt o n the ECME Pharmacy COB Menu.
	2996	Example 6. 3-1: Acces sing the P rocess Sec ondary/TRI CARE Rx to ECME opti on
	2997	*** ****** ****** ****** ****** **
	2998	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	2999	* XXXXXX V AMC *
	3000	* Pharmacy Electroni c Claims R eports *
	3001	*** ****** ****** ****** ****** **
	3002	SEC Potential Secondary Rx Claims Report
	3003	TRI Potential Claims Rep ort for Du al Eligibl e
	3004	PRO Process Se condary/TR ICARE Rx t o ECME
	3005	Select ECM E Pharmacy COB Optio n: PRO Pr ocess Seco ndary/TRIC ARE Rx to ECME
	3006	6.3.1
	3007	Submitting Secondary Claims XE "Submitti ng Seconda ry Claims"
	3008
	3009	XE "Submi tting Seco ndary Clai ms"
	3010	The Proces s Secondar y/TRICARE Rx to ECME (PRO) opt ion will p rompt for a Rx#.
	3011	The Proces s Secondar y/TRICARE Rx to ECME (PRO) opt ion will d isplay the Rx inform ation to a llow the u ser to ens ure the co rrect Rx# was entere d and prom pt the use r to confi rm they wi sh to cont inue.
	3012	The Proces s Secondar y/TRICARE Rx to ECME (PRO) opt ion will a sk the use r to selec t a fill/r efill from the list provided b y the soft ware.
	3013	The Proces s Secondar y/TRICARE Rx to ECME (PRO) opt ion will a sk the use r to selec t the Paye r Sequence to bill ( primary or secondary ).
	3014	The Proces s Secondar y/TRICARE Rx to ECME (PRO) opt ion will a sk the use r if they wish to ed it the ins urance com pany data. If the us er enters YES to thi s prompt, they will be able to edit the user's ins urance via the Patie nt Insuran ce Informa tion Scree n
	3015	Example 6. 3.1-1: Ini tial Promp ts for the Process S econdary/T RICARE Rx to ECME op tion
	3016	Select PRE SCRIPTION RX #: 1003 0 LI DOCAINE 0. 5% W/EPI I NJ MDV
	3017	Patient RX# Dru g Name RX Stat us
	3018	ECMEPatie nt, Two 100 30 L IDOCAINE 0 .5% W/EPI INJ ACTIV E
	3019	DO YOU WAN T TO CONTI NUE?(Y/N)? Y// ES
	3020	RX #10030 has the fo llowing fi lls:
	3021	Fill Date
	3022	==== ==========
	3023	0 07/02/2010
	3024	1 10/12/2010
	3025	SELECT A F ILL TO BIL L: 07/02/2 010
	3026	Select pay er sequenc e for bill ing:
	3027	1 PRIM ARY
	3028	2 SECO NDARY
	3029	SELECT PAY ER SEQUENC E: 2 SECO NDARY
	3030	Drug name NDC Da te RX# RE F# TYPE STATUS
	3031	========== ========== ========== ========== ========== ========== ========== =========
	3032	LIDOCAINE 0. 001860 14001 09 /10 10030$ 0/00 03098 W RT **/R REJECTED
	3033	There is a n existing rejected/ reversed s econdary e -claim(s) for the RX /refill.
	3034	Do you wan t to submi t a new se condary cl aim(Y/N)? N// YES
	3035	DO YOU WIS H TO ADD/E DIT INSURA NCE COMPAN Y DATA FOR THIS PATI ENT?(Y/N)? N// O
	3036	Data for S econdary C laim
	3037	---------- ---------- ----
	3038	Insurance: INSURANC E3 COB: SECONDARY
	3039	Rate Type: REIMBURS ABLE INS.
	3040	Other Cove rage Code: 02 (OTHE R COVERAGE EXISTS - PAYMENT CO LLECTED)
	3041	Other Paye r Coverage Type: 01 (PRIMARY)
	3042	Other Paye r ID Quali fier: 03 (BANK INFO RMATION NU MBER (BIN) )
	3043	Other Paye r ID: 123 456
	3044	Other Paye r Date: O ct 15, 201 0
	3045	Other Paye r Paid Qua lifier: 0 7 (DRUG BE NEFIT)
	3046	Other Paye r Amount P aid: 40.0 0
	3047	Do you wan t to edit this Secon dary Claim Informati on (Y/N)? N// YES
	3048	Insura nce CO B Subscri ber ID Gro up Ho lder Eff ective Ex pires
	3049	====== ======= == == ======= ====== === ======= == ====== === ======= == ========
	3050	1 INSURA NC2 PR I AAA INS . PA TIENT 03/ 10/2010
	3051	2 INSURA N3 SE C 5487357 9430 GR PA TIENT 03/ 26/2010
	3052	SECONDARY INSURANCE POLICY: 2/ / INSURA NCE3 (SECO NDARY) - B RIAN'S GRP
	3053	SELECT RAT E TYPE: RE IMBURSABLE INS.// Who's Re sponsible: INSURER
	3054	OTHER COVE RAGE CODE: 02// O THER COVER AGE EXISTS - PAYMENT COLLECTED
	3055	OTHER PAYE R ID: 1234 56//
	3056	OTHER PAYE R DATE: O ct 15, 201 0//
	3057	Edit Paid Amounts or Reject Co des (PAID AMOUNTS/RE JECT CODES ): PAID A MOUNTS//
	3058	OTHER PAYE R AMOUNT P AID QUALIF IER: 07// DRUG BE NEFIT
	3059	OTHER PAYE R AMOUNT P AID: (0-9 99999): 40 .00//
	3060	OTHER PAYE R AMOUNT P AID QUALIF IER:
	3061	SUBMIT CLA IM TO INSU RANCE3 ?(Y /N)? Y// E S
	3062	Veteran Pr escription 10030 suc cessfully submitted to ECME fo r claim ge neration.
	3063	Processing Secondary claim...
	3064	Claim Stat us:
	3065	IN PROGRES S-Building the claim
	3066	IN PROGRES S-Building the HL7 p acket
	3067	IN PROGRES S-Transmit ting
	3068	E PAYABLE
	3069	6.3.2
	3070	Submitting Primary C laims for TRICARE an d Dual Eli gibility P atients XE "Submitti ng Primary Claims fo r TRICARE and Dual E ligibility Patients"
	3071	This secti on shows a n example of how the option ca n be used to submit claims for prescript ions/refil ls entered for TRICA RE patient s or patie nts with d ual eligib ility (e.g . Veteran and TRICAR E) and tha t were ide ntified by the Poten tial Claim s Report f or Dual El igible.
	3072	When proce ssing a cl aim for TR ICARE and dual eligi bility pat ients, use rs are ask ed for pat ient’s nam e and the fill/refil l from the list prov ided by th e software .
	3073	Example 6. 3.2-1: Pro mpt for th e Process Secondary/ TRICARE Rx to ECME o ption
	3074	Select ECM E Pharmacy COB Optio n: PRO Pr ocess Seco ndary/ TRI CARE Rx to ECME
	3075	Select PRE SCRIPTION RX #: 1030 27 B ETHANECHOL 10MG TAB
	3076	Patient RX# Drug Nam e RX Status
	3077	ECMEpatie nt,One 103027 BETHANEC HOL 10MG T AB ACTIVE
	3078	DO YOU WAN T TO CONTI NUE?(Y/N)? Y// ES
	3079	RX #103027 has the f ollowing f ills:
	3080	Fill Date
	3081	==== ==========
	3082	0 10/27/2009
	3083	SELECT A F ILL TO BIL L: 0 10/2 7/2009
	3084	Select pay er sequenc e for bill ing:
	3085	1 PRIM ARY
	3086	2 SECO NDARY
	3087	SELECT PAY ER SEQUENC E: 1 PRIM ARY
	3088	SELECT RAT E TYPE: ?
	3089	Answer wi th RATE TY PE NUMBER, or NAME
	3090	Do you wa nt the ent ire 17-Ent ry RATE TY PE List? y (Yes)
	3091	Choose from:
	3092	1 CRIM E VICTIM Who's Resp onsible: I NSURER
	3093	2 DENT AL Who's Responsibl e: PATIENT
	3094	3 HUMA NITARIAN Who's Resp onsible: P ATIENT
	3095	4 INTE RAGENCY W ho's Respo nsible: OT HER (INSTI TUTION)
	3096	5 MEAN S TEST Wh o's Respon sible: PAT IENT
	3097	6 MEDI CARE ESRD Who's Res ponsible: OTHER (INS TITUTION)
	3098	7 NO F AULT INS. Who's Res ponsible: INSURER
	3099	8 REIM BURSABLE I NS. Who's Responsib le: INSURE R
	3100	9 SHAR ING AGREEM ENT Who's Responsib le: OTHER (INSTITUTI ON)
	3101	10 TORT FEASOR W ho's Respo nsible: IN SURER
	3102	11 WORK ERS' COMP. Who's Re sponsible: INSURER
	3103	12 CATE GORY C Wh o's Respon sible: PAT IENT
	3104	13 CHAM PVA REIMB. INS. Who 's Respons ible: INSU RER
	3105	14 CHAM PVA Who's Responsib le: INSURE R
	3106	15 TRIC ARE REIMB. INS. Who 's Respons ible: INSU RER
	3107	16 TRIC ARE Who's Responsib le: INSURE R
	3108	17 INEL IGIBLE Wh o's Respon sible: PAT IENT
	3109	SELECT RAT E TYPE: 15 TRICARE REIMB. INS . Who's R esponsible : INSURER
	3110	DO YOU WIS H TO ADD/E DIT INSURA NCE COMPAN Y DATA FOR THIS PATI ENT?(Y/N)? N// NO
	3111	Insuranc e COB Subscrib er ID Grou p Hol der Eff ective Ex pires
	3112	======== ====== === = ======== ===== ==== ====== === ====== === ======= == ========
	3113	EXPRESS SCRIP PRI XXXXXX DODA PAT IENT 12/ 27/2008
	3114	PRIMARY IN SURANCE PO LICY: SH T RICARE (PR IMARY) - T RICARE PLA N
	3115	SUBMIT CLA IM TO SH T RICARE ?(Y /N)? Y// y YES
	3116	TRICARE Pr escription 2055242 s ubmitted t o ECME for claim gen eration.
	3117	7
	3118	Accessing the Pharma cy ECME Ma nager Menu XE "Acces sing Pharm acy ECME M anager Men u"
	3119	The Pharma cy ECME Ma nager Menu option al lows Autom ated Data Processing Applicati on Coordin ators (ADP AC) and In formation Resources Management Service ( IRMS) to c onfigure t he Electro nic Claims Managemen t Engine ( ECME) syst em with ph armacy sit e-specific options. It is acce ssed by en tering MGR at the “S elect ECME Option:” prompt on the ECME M ain Menu o ption.
	3120	You must h old the BP S MANAGER key to vie w the Phar macy ECME Manager Me nu option. Example 7 -1: Access ing the Ph armacy ECM E Manager Menu Optio n
	3121	*** ****** ****** ****** ****** **
	3122	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3123	* XXXXXX VAMC *
	3124	* Main M enu *
	3125	*** ****** ****** ****** ****** **
	3126	U ECME User Screen
	3127	COB ECME Pharm acy COB .. .
	3128	MGR Pharmacy E CME Manage r Menu ...
	3129	RPT Pharmacy E lectronic Claims Rep orts ...
	3130	Select ECM E Option: MGR Pharm acy ECME M anager Men u
	3131	Example 7- 2: Display ing Pharma cy ECME Ma nager Menu Options
	3132	*** ****** ****** ****** ****** **
	3133	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3134	* XXXXXXX VAMC *
	3135	* Phar macy ECME Manager Me nu *
	3136	*** ****** ****** ****** ****** **
	3137	MNT ECME trans action mai ntenance o ptions ...
	3138	SET Pharmacy E CME Setup Menu ...
	3139	STAT Statistics Screen
	3140	Select Pha rmacy ECME Manager M enu Option :
	3141	You must h old the BP SMENU and BPS MANAGE R keys to view the S tatistics Screen (ST AT) and EC ME transac tion maint enance opt ions (MNT) options. You must a lso hold t he BPS MAS TER key to view the Edit Basic ECME Para meters (BA S), the Ed it ECME Ph armacy Dat a (PHAR), the Regist er Pharmac y with Aus tin Inform ation Tech nology Cen ter (REG), and the P harmacy EC ME Setup M enu (SET) options. 7 .1 ECME Tr ansaction Maintenanc e Options XE "ECME T ransaction Maintenan ce Options ”
	3142	This optio n provides functiona lity that provides u nique prog rammatic s olutions t o address ECME proce ssing requ irements. The only o ption iden tified so far is the functiona lity to un strand cla ims.
	3143	Example 7. 1-1: Acces sing the E CME Transa ction Main tenance Op tions
	3144	*** ****** ****** ****** ****** **
	3145	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3146	* XXXXX V AMC *
	3147	* Phar macy ECME Manager Me nu *
	3148	*** ****** ****** ****** ****** **
	3149	MNT ECME trans action mai ntenance o ptions ...
	3150	SET Pharmacy E CME Setup Menu ...
	3151	STAT Statistics Screen
	3152	Select Pha rmacy ECME Manager M enu Option : MNT ECM E transact ion mainte nance opti ons
	3153	**** ****** ****** ****** ****** ***
	3154	* Elec tronic Cla ims Manage ment Engin e (ECME) v 1.0 *
	3155	* XXXXX VAMC *
	3156	* B PS MENU MA INTENANCE *
	3157	**** ****** ****** ****** ****** ***
	3158	UNS View/Unstr and Submis sions Not Completed
	3159	ROC Re Open CL OSED Claim
	3160	Select ECM E transact ion mainte nance opti ons Option :
	3161	7.1.1 View /Unstrand Submission s Not Comp leted XE " View/Unstr and Claims ”
	3162	This optio n provides you with options to override any curren t transmis sion statu s of claim s that hav e not reac hed the po int of com pletion to a status of “Done”.
	3163	When a cla im is unst randed via this opti on, the st atus of th e claim is changed t o ‘E UNSTR ANDED’ for billing r equests an d ‘E REVER SAL UNSTRA NDED’ for reversals. This stat us message is displa yed on the ECME User Screen, t he Further Research menu, the Developer Log action of the EC ME user sc reen, and the Recent Transacti on report.
	3164	Even thoug h you perf orm the Vi ew/Unstran d Submissi ons Not Co mpleted op tion, the final adju dicating p ayer claim status of either 'P ayable' or 'Rejected ' will not be known unless fur ther actio n is taken on the cl aim. This will requi re manual interventi on for the claim to be resubmi tted to th e adjudica ting payer after thi s option i s run.(A) Enter UNS at the “S elect ECME transacti on mainten ance optio ns Option: ” to acces s the unst rand optio ns.
	3165	Example 7. 1.1-1: Acc essing the View/Unst rand Submi ssions Not Completed Option
	3166	UNS View/Unstr and Submis sions Not Completed
	3167	ROC Re Open CL OSED Claim
	3168	Select ECM E transact ion mainte nance opti ons Option : UNS Vie w/Unstrand Submissio ns Not Com pleted
	3169	Please be aware that if there are submis sions appe aring on t he ECME Us er Screen
	3170	with a sta tus of 'In progress - Transmit ting', the n there ma y be a pro blem
	3171	with HL7 o r with sys tem connec tivity wit h the Aust in Automat ion Center (AAC).
	3172	Please con tact your IRM to ver ify that c onnectivit y to the A AC is work ing
	3173	and the HL 7 link BPS NCPDP is processing messages before usi ng this op tion
	3174	to unstran d submissi ons with a status of 'In progr ess - Tran smitting'.
	3175	Do you wan t to conti nue? NO//
	3176	(B) You wi ll be prom pted for a date rang e to displ ay all str anded clai ms. The sy stem will accept a d ate range with or wi thout a ti me attache d to it.
	3177	First Tran saction Da te: If a date only is entered for a sta rt date, t he system will assum e the star t date is the date e ntered and the time will be th e beginnin g of the 2 4 hour clo ck (.0001) otherwise the syste m will acc ept the en tered time parameter .
	3178	Last Trans action Dat e: If a d ate only i s entered for the en ding date range, the system wi ll assume the ending of a 24 h our clock (.2359) ex cept if yo u enter th e current date. If y ou enter t oday’s dat e as the e nding date of the da te range, the system will auto matically assign the ending ti me to be 3 0 minutes prior to t he current time to e nsure that you do no t interrup t any tran smissions that may b e currentl y processi ng.
	3179	Example 7. 1.1-2: Ent ering Date Range for View/Unst rand Submi ssions Not Completed Option
	3180	FIRST TRAN SACTION DA TE: // T-1 20
	3181	LAST TRANS ACTION DAT E: T// T
	3182	Please wai t...
	3183	Example 7. 1.1-3: Di splaying t he View/Un strand Sub missions N ot Complet ed Actions
	3184	ECME UNSTR AND SUBMIS SIONS Oct 08, 20 10@15:12:0 8 Page: 1 of 1
	3185	Submission s Stranded from 09/2 8/2010 thr ough 10/08 /2010
	3186	Sorted by Transactio n Date
	3187	## Trans DT Patie nt Name ID RX/Fill D OS Ins Co
	3188	* CLA IMS *
	3189	1 10/07/ 2010 ECMEp atient,One 2637 101297/1 06/24/2009 AETNA
	3190	In Pro gress - Do ne
	3191	2 10/07/ 2010 ECMEp atient,One 2637 101320/1 04/27/2009 AETNA
	3192	In Pro gress - Do ne
	3193	3 10/07/ 2010 2637 1100349/0 10/07/201 0 AETNA
	3194	In Pro gress - Pr ocessing r equest
	3195	* REVER SALS *
	3196	4 10/07/ 2010 ECMEp atient,One 2637 101298/1 06/25/2009 AETNA
	3197	In Pro gress - Do ne
	3198	* E LIGIBILITY INQUIRIES *
	3199	5 10/08/ 2010 ECMEp atient,One 2637 10/ 08/2010 AE TNA
	3200	In Pro gress - Pa rsing resp onse
	3201	Enter ?? f or more ac tions >>>
	3202	ALL Unstra nd Current Submissio ns PRT Print Current Su bmissions
	3203	SEL Select Submissio ns to Unst rand EX Exit
	3204	7.1.2 REOP EN a CLOSE D ECME Cla im XE " V ariations to the Clo se claim p rocess"
	3205	The Reopen a Closed Claim opti on allows you to reo pen an ele ctronic cl aim after it has bee n Closed. The prescr iption can be Releas ed or Not Released. You are pr ompted to enter a pa tient name and date range to s elect clos ed claims by date of service. Once a cla im is Reop ened, you may resubm it the cla im to the payer for payment.
	3206	Enter ROC at the “Se lect ECME transactio n maintena nce option s Option:” to access the Re Op en CLOSED Claim opti on.
	3207	Example 7. 1.2-1: Acc essing the Re Open C LOSED Clai m Option
	3208	UNS View/Unstr and Submis sions Not Completed
	3209	ROC Re Open CL OSED Claim
	3210	Select ECM E transact ion mainte nance opti ons Option : ROC Re Open CLOSE D Claim
	3211	You will b e prompted for a pat ient name.
	3212	Example 7. 1.2-2: Ent ering Pati ent Name t o Display Closed Cla ims for th is Option
	3213	Select PATIENT NA ME: ECMEpa tient,One 6 -1-60 6 66006666
	3214	NSC VET ERAN
	3215	You will b e prompted for a dat e range fo r the date s of servi ce of clos ed claims.
	3216	Example 7. 1.2-3: Ent ering Date s of Servi ce for Clo sed Claims Listing
	3217	START W ITH DATE:T ODAY//6/13 /06 (Jun 1 3, 2006)
	3218	GO TO DATE :TODAY//T (JUL 05, 2006)
	3219	Enter Reop en and cho ose the li ne item of the close d claim th at will be reopened.
	3220	Example 7. 1.2-4: Cho osing to R eopen a Cl osed Claim and Selec ting a Lin e Item
	3221	REOPEN CLO SED CLAIM Jul 05, 20 06@15:29:2 1 Page: 1 of 1
	3222	PATIENT: E CMEpatient ,One ( XXXX) Closed cla ims from 0 7/05/06 to 07/05/06
	3223	# DRUG NDC DO S RX# REF/ ECME# LOC RX IN FO
	3224	1 RESER PINE 0.25M G 00083- 0036-45 07 /05 100004 093$ 0/00 0000504727 W RT AC /R
	3225	Enter ?? f or more ac tions
	3226	RE Reopen Claim EX Exit
	3227	Select act ion: Quit/ / R Reop en Claim
	3228	Select ite m: 1
	3229	You are pr ompted to enter a te xt comment , Reopen C omments, a fter claim informati on is disp layed.
	3230	Example 7. 1.2-5: Ent ering Text Comment f or Reopene d Closed C laim
	3231	PATIENT NAME: ECM Epatient,O ne RX#: 100000000 $ 0 DRU G: RESERPI NE 0.25MG
	3232	CLOSED JUL 5,200 6@15:13:42
	3233	ECME#: 000005047 27, DOS: J UL 5,2006, RELEASE D ATE: JUL 5 ,2006@15:1 2:11
	3234	PLAN: HIPPA05 IN SURANCE: M EDCO
	3235	CLOSE REASON: RE FILL TOO S OON
	3236	DROP T O PAPER: N O
	3237	CLOSE USER: ECME user,One
	3238	You have s elected th e CLOSED e lectronic claim list ed above.
	3239	REOPEN COM MENTS: Cla im reopene d for new refill
	3240	Example 7. 1.2-6: Ent ering Yes to “Are Yo u Sure” Pr ompt
	3241	ARE YOU SU RE YOU WAN T TO RE-OP EN THIS CL AIM? (Y/N) ? No// YES
	3242	ReOpening Claim: VA2 006=171288 4=000014=0 006687 ... OK
	3243	1 claim ha s been reo pened.
	3244	Enter RETU RN to cont inue or '^ ' to exit:
	3245	7.2 Pharma cy ECME Se tup Menu X E "Pharmac y ECME Set up Menu”
	3246	The Pharma cy ECME Se tup Menu o ption allo ws the ADP AC or IRMS to config ure ECME t o VAMC spe cification s.
	3247	You must h old the BP SMENU, BPS MANAGER, and BPS MA STER keys to view th e Pharmacy ECME Setu p Menu (SE T) option. Access the menu by e ntering “S ET” at the “Select P harmacy EC ME Setup M enu Option :” prompt in the Pha rmacy ECME Manager M enu option .
	3248	Example 7. 2-1: Acces sing the P harmacy EC ME Manager Menu Opti on
	3249	*** ****** ****** ****** ****** **
	3250	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3251	* XXXX V AMC *
	3252	* Phar macy ECME Manager Me nu *
	3253	*** ****** ****** ****** ****** **
	3254	MNT ECME trans action mai ntenance o ptions ...
	3255	SET Pharmacy E CME Setup Menu ...
	3256	STAT Statistics Screen
	3257	Select Pha rmacy ECME Manager M enu Option : SET Pha rmacy ECME Setup Men u
	3258	You must h old the BP S MASTER k ey to view the Edit Basic ECME Parameter s (BAS), E dit ECME P harmacy Da ta (PHAR), and Regis ter Pharma cy with Au stin Autom ation Cent er (REG) o ptions.Exa mple 7.2-2 : Pharmacy ECME Setu p Menu Opt ions
	3259	*** ****** ****** ****** ****** **
	3260	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3261	* XXXXXXX VAMC *
	3262	* Pha rmacy ECME Setup Men u *
	3263	*** ****** ****** ****** ****** **
	3264	BAS Edit Basic ECME Para meters
	3265	PHAR Edit ECME Pharmacy D ata
	3266	REG Register P harmacy wi th Austin Informati on Technol ogy Center
	3267	Select Pha rmacy ECME Setup Men u Option:
	3268	7.2.1 Edit Basic ECM E Paramete rs XE "Edi t Basic Ph armacy ECM E Paramete rs”
	3269	The Edit B asic ECME Parameters option al lows the A DPAC or IR MS to dete rmine how data will be input t o ECME.
	3270	This optio n should n ot be used after the initial s etup unles s any of t he informa tion chang es for the pharmacy. Access the menu by e ntering BA S at the “ Select Pha rmacy ECME Setup Men u Option:” prompt in the Pharm acy ECME S etup Menu option.
	3271	Example 7. 2.1-1: Acc essing the Edit Basi c ECME Par ameters Op tion
	3272	*** ****** ****** ****** ****** **
	3273	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3274	* XXXXXX VAMC *
	3275	* Pha rmacy ECME Setup Men u *
	3276	*** ****** ****** ****** ****** **
	3277	BAS Edit Basic ECME Para meters
	3278	PHAR Edit ECME Pharmacy D ata
	3279	REG Register P harmacy wi th Austin Informatio n Technolo gy Center
	3280	Select Pha rmacy ECME Setup Men u Option: BAS Edit Basic ECME Parameter s
	3281	The Edit B asic ECME Parameters option al lows you t o enter/ed it the num ber of sec onds that the Outpat ient Pharm acy applic ation wait s for a re sponse to come back from the t hird party payer. As delivered , the syst em will ha ve a defau lt timeout of 10 sec onds but i t is up to each site to determ ine how lo ng their p harmacists wait for a response from the payer. The ECME time out can be populated once the system is installed. After thi s amount o f time has passed, c laims proc essing wil l continue but you w ill not se e messages indicatin g the proc ess.
	3282	This optio n will pro mpt for th e Default Eligibilit y Pharmacy . Once ent ered, this Pharmacy will be pl aced on th e NCPDP El igibility Verificati on request when it i s initiate d by the n ew option in IB.
	3283	One import ant reason for this is DUR (Dr ug Utiliza tion Revie w) /79 rej ects. If t he payer i ndicates t hat there is a probl em with th e drug (e. g., overdo se), the p harmacists will have to act on that resp onse.This option als o allows y ou to set the “Insur er Asleep” interval time and n umber of r etries. Th e Insurer Asleep Int erval para meter allo ws an inpu t between 0 and 29 m inutes wit h a defaul t of 20. T he Insurer Asleep Re tries para meter allo ws an inpu t between 0 and 99 r etries wit h a defaul t of 10. I f either t he Insurer Asleep In terval or the Insure r Asleep R etries par ameter is set to 0, the functi onality wi ll be disa bled. If t he user do es disable this func tionality, any claim s that are in an Ins urer Aslee p state wi ll automat ically be resubmitte d to the p ayer.
	3284	Occasional ly, Emdeon or the th ird-party payer will return a reject cod e indicati ng that th e destinat ion system is not av ailable. A s one exam ple, the t hird-party payer may be down f or regular system ma intenance and any cl aims submi tted durin g this tim e will be rejected. When this situation does occur , Emdeon o r the thir d-party pa yer will g enerally r eturn one or more of the NCPDP system pr ocessing r eject code s shown in the table below. Th ese reject codes are automatic ally resub mitted by ECME at th e interval s specifie d in the “ insurer as leep” para meter.
	3285	Reject Cod eExplanati on90Host H ung Up91Ho st Respons e Error92S ystem Unav ailable/Ho st Unavail able95Time Out96Sche duled Down time97Paye r Unavaila ble98Conne ction To P ayer Is Do wnExample 7.2.1-2: E ntering Ed it Basic E CME Parame ters
	3286	Select Pha rmacy ECME Setup Men u Option: BAS Edit Basic ECME Parameter s
	3287	Edit Pharm acy ECME c onfigurati on
	3288	ECME timeo ut? (0 to 30 seconds ): 30//
	3289	Insurer As leep Inter val (0 to 29 minutes ): 5//
	3290	Insurer As leep Retri es (0 to 9 9): 3//
	3291	Default El igibility Pharmacy: PHARMACY-1 //
	3292	7.2.2 Edit ECME Phar macy Data XE "Edit E CME Pharma cy Data"
	3293	The Edit E CME Pharma cy Data op tion enabl es pharmac y users to edit spec ific param eters that affect th e electron ic submiss ion of thi rd party p rescriptio n claims. The pharma cy site wi ll use thi s option t o control whether th e transmis sion of pr escription s to the C MOP dispen sing site will autom atically s ubmit elec tronic thi rd party p rescriptio n claims t o the insu rance paye rs. This o ption is a lso where the pharma cy site wi ll set the parameter of how ma ny days wi ll pass be fore a rev ersal is a utomatical ly process ed for a n on-release d prescrip tion.
	3294	You must h old the BP S MASTER k ey to view the Edit Basic ECME Parameter s (BAS), E dit ECME P harmacy Da ta (PHAR), and Regis ter Pharma cy with Au stin Autom ation Cent er (REG) o ptions.
	3295	Access the option by entering PHAR at th e “Select Pharmacy E CME Manage r Menu Opt ion:” prom pt in the Pharmacy E CME Manage r Menu opt ion.
	3296	Example 7. 2.2-1: Acc essing the Edit ECME Pharmacy Data Optio n
	3297	*** ****** ****** ****** ****** **
	3298	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3299	* XXXXXX VAMC *
	3300	* Pha rmacy ECME Setup Men u *
	3301	*** ****** ****** ****** ****** **
	3302	BAS Edit Basic ECME Para meters
	3303	PHAR Edit ECME Pharmacy D ata
	3304	REG Register P harmacy wi th Austin Informatio n Technolo gy Center
	3305	Select Pha rmacy ECME Manager M enu Option : PHAR Ed it Pharmac y ECME Pha rmacy Data
	3306	Example 7. 2.2-2: Ent ering Edit ECME Phar macy Data Options
	3307	Select BPS PHARMACIE S NAME: XX XXXX VAMC PHARMACY
	3308	NAME: XXXX XX VAMC PH ARMACY
	3309	STATUS: AC TIVE
	3310	NCPDP #: 1 111111
	3311	NPI: 12345 67893
	3312	Select OUT PATIENT SI TE: XXXXXX VAMC PHAR MACY // <E NTER>
	3313	OUTPATIE NT SITE: X XXXXX VAMC PHARMACY // <ENTER>
	3314	Select OUT PATIENT SI TE: <ENTE R>
	3315	CMOP SWITC H: CMOP ON // <ENTER>
	3316	AUTO-REVER SE PARAMET ER: 0// 5
	3317	DEFAULT DE A #: AG123 45
	3318	The follow ing table describes the Edit E CME Pharma cy Data op tion field s:
	3319	Table 7.2. 2-1: Descr iption of Edit ECME Pharmacy D ata Option Fields
	3320	EntryDescr iptionBPS PHARMACIE S NAMEPhar macy in a specific V AMC (Depar tment of V eterans Af fairs Medi cal Center ) database . The phar macy user may enter a new BPS pharmacy, which must be 3-30 a lphabetica l characte rs.NAMEDis play-only field that displays the full p harmacy na me entered .NCPDP #A 7-digit nu mber assig ned to the specified pharmacy by the Nat ional Coun cil for Pr escription Drug Prog rams (NCPD P). It is also known as NABP.N PINational Provider Identifier . A 10-dig it number required b y the Heal th Insuran ce Portabi lity and A ccountabil ity Act of 1996 (HIP AA) to ide ntify indi vidual and organizat ional prov iders, suc h as outpa tient site s. The NPI has a usa ge require ment date beginning May 23, 20 08.STATUST he status of the BPS Pharmacy is either ACTIVE or INACTIVE. The STATUS of the ph armacy may be revise d through the Regist er Pharmac y with Aus tin Inform ation Tech nology Cen ter option .OUTPATIEN T SITESOne or more O utpatient Sites (fro m File 59) may be li nked with a single B PS Pharmac y entry. H owever, an Outpatien t Site can only be l inked with a single BPS Pharma cy. All of the sites linked wi th a BPS P harmacy sh ould have the same N CPDP numbe r. When an Outpatien t Site is linked to an active BPS Pharma cy entry, the ECME s witch for that site is conside red ENABLE D. If an O utpatient Site is li nked to an incorrect BPS Pharm acy, it mu st be remo ved from t he incorre ct entry b efore it c an be link ed to the correct en try.CMOPON if the tr ansmission of prescr iptions to the CMOP (Consolida ted Mail O utpatient Pharmacy) dispensing site will automatic ally submi t electron ic third p arty presc ription cl aims to th e insuranc e payers. See note b elow for e xplanation of claims generated before an d after sw itch is tu rned on or off.AUTO- REVERSE PA RAMETEREnt er numbers from 1 to 30 for th e number o f days to wait befor e ECME rev erses non- released p rescriptio n claims w ith a PAYA BLE payer- returned r esponse. E ntering a zero, (“0” ), the def ault, disa bles the A uto-Revers e process. Each site ’s busines s practice will dict ate what t his value should be. DEFAULT DE A #The pha rmacy’s Dr ug Enforce ment Admin istration (DEA) numb er. An Out patient Si te is cons idered ECM E active i f the Outp atient Sit e is linke d to a BPS Pharmacy, and if th at BPS Pha rmacy is A CTIVE. Onc e an Outpa tient Site is ECME a ctive, cla ims for th e Outpatie nt Site ca n be trans mitted to the third- party paye r.
	3321	If an Outp atient Sit e is activ ated after a claim i s already sent to EC ME, ECME w ill NOT ge nerate an electronic claim.
	3322	If an Outp atient Sit e is inact ivated (by unlinking it from a BPS Pharm acy or by changing t he STATUS field), re versals fo r that sit e will be processed but new su bmissions will not.7 .2.3 Regis ter Pharma cy with Au stin Infor mation Tec hnology Ce nter
	3323	The Regist er Pharmac y with Aus tin Inform ation Tech nology Cen ter option allows th e ADPAC to register a pharmacy with the Austin In formation Technology Center an d update t he contact informati on. This r egistratio n should o nly be per formed on initializa tion of th e pharmacy with ECME . Once the pharmacy has been s et up to u se ECME, t he Edit EC ME Pharmac y Data opt ion should be used t o make any changes.
	3324	The automa ted regist ration pro cess will send an em ail to the Primary S ite Contac t if the r egistratio n has any errors or warnings t o report. The Altern ate Site C ontact wil l be used when the e mail addre ss for the Primary S ite contac t is missi ng. If the alternate site cont act does n ot have an email add ress, the message wi ll be sent to the BP S OPECC ma il group. In additio n, if eith er the pri mary or al ternate si te contact is missin g their em ail addres s, it will be report ed as a wa rning duri ng manual registrati on. Follow ing is a s ample emai l.
	3325	Example 7. 2.3-1: ECM E Pharmacy Registrat ion Proble m Message Subj: ECME Registrat ion Proble m. [#1415 87] 06/09/ 08@15:36 4 lines
	3326	From: ECME PACKAGE In 'IN' ba sket. Pa ge 1 New
	3327	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	3328	Source Pro cess: ECME Pharmacy Registrati on
	3329	ECME Pharm acy Regist ration HL7 Message n ot created .
	3330	PHARMAC Y NAME: TE ST PHARMAC Y 2
	3331	** NPI NUM BER - Miss ing/Invali d
	3332	Enter mess age action (in IN ba sket): Del ete//
	3333	This optio n should n ot be used after the initial s etup unles s any of t he informa tion chang es for the pharmacy. You must h old the BP S MASTER k ey to view the Edit Basic ECME Parameter s (BAS), E dit ECME P harmacy Da ta (PHAR), and Regis ter Pharma cy with Au stin Autom ation Cent er (REG) o ptions.
	3334	Access the menu by e ntering RE G at the “ Select Pha rmacy ECME Setup Men u Option:” prompt in the Pharm acy ECME S etup Menu option. Th e system w ill valida te the dat a and then send an e Pharmacy m essage to the Austin Informati on Technol ogy Center , which no tifies the m that the prospecti ve site is ready to transmit e lectronic pharmacy c laims.
	3335	Example 7. 2.3-2: Acc essing the Register Pharmacy w ith Austin Informati on Technol ogy Center Option
	3336	*** ****** ****** ****** ****** **
	3337	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3338	* XXXXX V AMC *
	3339	* Pha rmacy ECME Setup Men u *
	3340	*** ****** ****** ****** ****** **
	3341	BAS Edit Basic ECME Para meters
	3342	PHAR Edit ECME Pharmacy D ata
	3343	REG Register P harmacy wi th Austin Informatio n Technolo gy Center
	3344	Select Pha rmacy ECME Setup Men u Option: REG Regis ter Pharma cy with Au stin Infor mation Tec hnology Ce nter
	3345	Example 7. 2.3-3: Reg ister Phar macy with Austin Inf ormation T echnology Center wit h Austin I nformation Technolog y Center O ption
	3346	E CME Site R egistratio n
	3347	-- PRIMAR Y SITE CON TACT DATA --
	3348	SITE CONTA CT: ECMEUS ER,ONE// < ENTER>
	3349	OFFICE P HONE: XXX- XXX-XXXX// <ENTER>
	3350	EMAIL ADDR ESS: PII // <ENTER>
	3351	-- ALTERN ATE SITE C ONTACT DAT A --
	3352	ALTERNATE SITE CONTA CT: ECMEUS ER,TWO// < ENTER>
	3353	OFFICE P HONE: XXX- XXX-XXXX// <ENTER>
	3354	EMAIL ADDR ESS: PII //
	3355	Replace < ENTER>
	3356	-- Applica tion Regis tration Va lidation R esults:
	3357	DOMAIN NAME - Req uired - VA LID: XXXXX XXX.XXXXXX -XXX-XXXX. XXX.XX.XXX
	3358	TCP/IP ADDRESS FO R "EPHARM OUT" - Req uired - VA LID: XX.XX X.XXX.XXX
	3359	"EPHARM OUT" PORT NUMBER - Required - VALID: XX XX
	3360	SITE NU MBER - Req uired - VA LID: XXX
	3361	INTERFA CE VERSION - Require d - VALID: 3
	3362	CONTACT NAME - VA LID: ECMEU SER,ONE
	3363	CONTACT ME ANS - VALI D: NET INTERN ET D N S
	3364	ALTERNA TE CONTACT NAME - VA LID: ECMEU SER,TWO
	3365	ALTERNATE CONTACT ME ANS - VALI D: NET INTERN ET PII
	3366	* * Applicat ion Regist ration Dat a VALID **
	3367	Enter RETU RN to cont inue or '^ ' to exit: <ENTER>
	3368	Enter/veri fy Pharmac y Registra tion Data
	3369	Select BPS PHARMACIE S NAME: TE ST PHARMAC Y 3
	3370	--SITE DA TA
	3371	STATUS: IN ACTIVE// < ENTER>
	3372	NCPDP #: X XXXXXX// < ENTER>
	3373	DEFAULT DE A #: XXXXX XXX// <ENT ER>
	3374	SITE ADDRE SS NAME: 1 11 MAIN ST R// <ENTER >
	3375	SITE ADDRE SS 1: 111 MAIN STREE T// <ENTER >
	3376	SITE ADDRE SS 2: <ENT ER>
	3377	SITE CITY: BROOKLYN/ / <ENTER>
	3378	SITE STATE : NEW YORK // <ENTER>
	3379	SITE ZIP C ODE: 11223 // <ENTER>
	3380	REMITTANCE ADDRESS N AME: 1111 TEST STR// <ENTER>
	3381	REMIT ADDR ESS 1: 111 TEST STRE ET// <ENTE R>
	3382	REMIT ADDR ESS 2: <EN TER>
	3383	REMIT CITY : TOPEKA// <ENTER>
	3384	REMIT STAT E: KANSAS/ / <ENTER>
	3385	REMIT ZIP: 66606// < ENTER>
	3386	--PRIMARY CONTACT D ATA
	3387	VA CONTACT : ECMEUSER ,ONE// <EN TER>
	3388	OFFICE P HONE: XXX- XXX-XXXX// <ENTER>
	3389	EMAIL ADDR ESS: PII
	3390	Replace < ENTER>
	3391	TITLE: O I&T STAFF/ / <ENTER>
	3392	--ALTERNA TE CONTACT DATA
	3393	VA ALTERNA TE CONTACT : ECMEUSER ,THREE L// <ENTER>
	3394	OFFICE P HONE: XXX- XXX-XXXX// <ENTER>
	3395	EMAIL ADDR ESS: PII Replace <E NTER>
	3396	TITLE: O I&T STAFF/ / <ENTER>
	3397	--PHARMAC IST DATA
	3398	VA LEAD PH ARMACIST: ECMEUSER,F OUR// <ENT ER>
	3399	OFFICE P HONE: XXX- XXX-XXXX / / <ENTER>
	3400	EMAIL AD DRESS: <EN TER>
	3401	TITLE: O I&T STAFF/ / <ENTER>
	3402	VA LEAD PH ARMACIST L ICENSE #: XXXXXXX// <ENTER>
	3403	-- Pharmac y Registra tion Valid ation Resu lts --
	3404	PHARMAC Y NAME: TE ST PHARMAC Y 3
	3405	-- Pharmac y Registra tion Data VALID. --
	3406	Enter/veri fy Pharmac y Registra tion Data
	3407	Select BPS PHARMACIE S NAME: <E NTER>
	3408	Applicatio n Registra tion Data is VALID
	3409	Pharmacy R egistratio n Data is:
	3410	VALID for TEST P HARMACY 1 and will b e transmit ted.
	3411	*INVALID for TEST P HARMACY 2 and will N OT be tran smitted.
	3412	VALID for TEST P HARMACY 3 and will b e transmit ted.
	3413	Send Appli cation Reg istration: Y/N ? n NO
	3414	Press RETU RN to cont inue...
	3415	7.3 Statis tics Scree n XE "Stat istics Scr een”
	3416	The Statis tics Scree n option a llows ADPA CS and IRM S to view statistics and trans mission pr ogress for all ECME claims.
	3417	You must h old the BP SMENU and BPS MANAGE R keys to view the S tatistics Screen opt ion.Access the menu by enterin g STAT at the “Selec t Pharmacy ECME Mana ger Menu O ption:” pr ompt in th e Pharmacy ECME Mana ger Menu o ption.
	3418	Statistics collectio n begins a t the mome nt of ECME installat ion and co ntinues un til either you use t he Z (clea r) action or ECME is uninstall ed. It dep ends on th e each sit e's busine ss practic e as far a s how ofte n or if th e stats ar e cleared. Example 7. 3-1: Acces sing the S tatistics Screen Opt ion
	3419	*** ****** ****** ****** ****** **
	3420	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3421	* XXXXXX VAMC *
	3422	* Phar macy ECME Manager Me nu *
	3423	*** ****** ****** ****** ****** **
	3424	MNT ECME trans action mai ntenance o ptions ...
	3425	SET Pharmacy E CME Setup Menu ...
	3426	STAT Statistics Screen
	3427	Select Pha rmacy ECME Manager M enu Option : STAT Sta tistics Sc reen
	3428	Example 7. 3-2: Stati stics Scre en
	3429	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	3430	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	3431	* CLAIM STATUS * * CLAIM RES ULTS *
	3432	Waiting to start 0 P aid claims 2,93 4
	3433	Building the trans action 0 R ejected cl aims 2,17 1
	3434	Building the claim 0 D ropped to Paper 1 5
	3435	Building the HL7 p acket 1 D uplicate c laims 0
	3436	Preparin g for tran smit 0 C aptured cl aims 0
	3437	Transmit ting 0 A ccepted Re versals 2,06 7
	3438	Parsing response 0 R ejected Re versals 16 6
	3439	Processi ng respons e 0 A ccepted El igibility 7
	3440	R ejected El igibility 4 4
	3441	E rrors 1 4
	3442	Enter ?? f or more ac tions
	3443	UC Updat e continuo usly Z Zero (cle ar) stats
	3444	U1 Displ ay update EX Exit
	3445	Select Act ion:U1//
	3446	This secti on diagram s and desc ribes the different elements o f the Stat istics Scr een.
	3447	Diagram 7. 3-1: Stati stics Opti on Areas
	3448
	3449
	3450
	3451
	3452
	3453
	3454	The table below desc ribes the Statistics Screen op tion areas :
	3455	Table 7.3- 1: Descrip tion of St atistics S creen Opti on
	3456	Screen Are asDescript ionHeader AreaDispla ys the dat e for whic h you requ ested the Statistics Screen op tion.Stats AreaDispl ays statis tics for a ll ECME cl aims. Clai m Status r eports sta tistics of ECME tran sactions i n progress . Claim Re sults give s statisti cs about c ompleted E CME transa ctions.Mes sage Windo wThis sect ion displa ys informa tional tex t (i.e., E nter ?? fo r more act ions). Act ion AreaAv ailable op tions. A d ouble ques tion mark (??) may b e entered at the "Se lect Actio n:" prompt for a lis t of all L ist Manage r options available. 7.3.1 Upda te Continu ously XE " Update Con tinuously”
	3457	The system can updat e the clai ms statist ics every 3 seconds.
	3458	Enter UC to display statistic s that wil l be updat ed every 3 seconds.
	3459	Example 7. 3.1-1: Acc essing Upd ate Contin uously Opt ion
	3460	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	3461	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	3462	* CLAIM STATUS * * CLAIM RES ULTS *
	3463	Waiting to start 0 P aid claims 2,93 4
	3464	Building the trans action 0 R ejected cl aims 2,17 1
	3465	Building the claim 0 D ropped to Paper 1 5
	3466	Building the HL7 p acket 1 D uplicate c laims 0
	3467	Preparin g for tran smit 0 C aptured cl aims 0
	3468	Transmit ting 0 A ccepted Re versals 2,06 7
	3469	Parsing response 0 R ejected Re versals 16 6
	3470	Processi ng respons e 0 A ccepted El igibility 7
	3471	R ejected El igibility 4 4
	3472	E rrors 1 4
	3473	Enter ?? f or more ac tions
	3474	UC Updat e continuo usly Z Zero (cle ar) stats
	3475	U1 Displ ay update EX Exit
	3476	Select Act ion:U1//UC Update co ntinuously
	3477	Press ^ or Q to stop the updat ing. The s ystem will go back t o the Stat istics Scr een.
	3478	Example 7. 3.1-2: Dis playing Cl aims Statu s and Resu lts in Upd ate Contin uously Mod e
	3479	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	3480	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	3481	* CLAIM STATUS * * CLAIM RES ULTS *
	3482	Waiting to start 0 P aid claims 2,93 4
	3483	Building the trans action 0 R ejected cl aims 2,17 1
	3484	Building the claim 0 D ropped to Paper 1 5
	3485	Building the HL7 p acket 1 D uplicate c laims 0
	3486	Preparin g for tran smit 0 C aptured cl aims 0
	3487	Transmit ting 0 A ccepted Re versals 2,06 7
	3488	Parsing response 0 R ejected Re versals 16 6
	3489	Processi ng respons e 0 A ccepted El igibility 7
	3490	R ejected El igibility 4 4
	3491	E rrors 1 4
	3492	In continu ous update mode: pre ss Q to Qu it
	3493	Q Quit
	3494	7.3.2 Disp lay Update XE "Displ ay Update”
	3495	You can up date the s tatistics once every time the option U1 is entered .
	3496	Example 7. 3.2-1: Acc essing Dis play Updat e Option
	3497	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	3498	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	3499	* CLAIM STATUS * * CLAIM RES ULTS *
	3500	Waiting to start 0 P aid claims 2,93 4
	3501	Building the trans action 0 R ejected cl aims 2,17 1
	3502	Building the claim 0 D ropped to Paper 1 5
	3503	Building the HL7 p acket 1 D uplicate c laims 0
	3504	Preparin g for tran smit 0 C aptured cl aims 0
	3505	Transmit ting 0 A ccepted Re versals 2,06 7
	3506	Parsing response 0 R ejected Re versals 16 6
	3507	Processi ng respons e 0 A ccepted El igibility 7
	3508	R ejected El igibility 4 4
	3509	E rrors 1 4
	3510	Enter ?? f or more ac tions
	3511	UC Updat e continuo usly Z Zero (cle ar) stats
	3512	U1 Displ ay update EX Exit
	3513	Select Act ion:U1//U1 Display u pdate
	3514	7.3.3 Zero (clear) S tatistics XE "Zero ( clear) Sta tistics”
	3515	The system can reset the displ ayed claim s statisti cs to zero . This is useful for looking a t short-te rm average s, such as during a time of he avy activi ty.
	3516	Enter Z to access th e Zero (cl ear) stats option.
	3517	Example 7. 3.3-1: Acc essing Zer o (clear) stats Opti on
	3518	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	3519	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	3520	* CLAIM STATUS * * CLAIM RES ULTS *
	3521	Waiting to start 0 P aid claims 2,93 4
	3522	Building the trans action 0 R ejected cl aims 2,17 1
	3523	Building the claim 0 D ropped to Paper 1 5
	3524	Building the HL7 p acket 1 D uplicate c laims 0
	3525	Preparin g for tran smit 0 C aptured cl aims 0
	3526	Transmit ting 0 A ccepted Re versals 2,06 7
	3527	Parsing response 0 R ejected Re versals 16 6
	3528	Processi ng respons e 0 A ccepted El igibility 7
	3529	R ejected El igibility 4 4
	3530	E rrors 1 4
	3531	Enter ?? f or more ac tions
	3532	UC Updat e continuo usly Z Zero (cle ar) stats
	3533	U1 Displ ay update EX Exit
	3534	Select Act ion:U1//Z Z (clear ) stats
	3535	You may ch oose to ei ther zero out (refre sh) the di splayed co py of the statistics by enteri ng L (Loca l) or to z ero out th e permanen t copy by entering P .
	3536	Choosing P ermanent C opy will p ermanently zero out the statis tics in th e database . You need to realiz e that if this selec tion is ch osen, ther e will no longer be activity h istory.Exa mple 7.3.3 -2: Enteri ng Zero (c lear) stat s Option t o Delete L ocal Claim Results S tatistics
	3537	Selec t one of t he followi ng:
	3538	L Local Copy
	3539	P Permanent Copy
	3540	Delete (L) ocal Copy or (P)erma nent Copy of the sta tistics: L ocal Copy/ / L Local Copy
	3541	When the s ystem asks if you ar e sure, en ter Y to c ontinue or N to stop the delet ion.
	3542	Example 7. 3.3-3: Ent ering Yes to “Are Yo u Sure” Pr ompt
	3543	Are you su re? N// YE S
	3544	Enter Z to access th e Zero (cl ear) stats option.
	3545	Example 7. 3.3-4: Dis playing Ze roed Claim s Statisti cs
	3546	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	3547	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	3548	* CLAIM STATUS * * CLAIM RES ULTS *
	3549	Waiting to start 0 P aid claims 2,93 4
	3550	Building the trans action 0 R ejected cl aims 2,17 1
	3551	Building the claim 0 D ropped to Paper 1 5
	3552	Building the HL7 p acket 1 D uplicate c laims 0
	3553	Preparin g for tran smit 0 C aptured cl aims 0
	3554	Transmit ting 0 A ccepted Re versals 2,06 7
	3555	Parsing response 0 R ejected Re versals 16 6
	3556	Processi ng respons e 0 A ccepted El igibility 7
	3557	R ejected El igibility 4 4
	3558	E rrors 1 4
	3559	Enter ?? for more a ctions
	3560	UC Updat e continuo usly Z Zero (cle ar) stats
	3561	U1 Displ ay update EX Exit
	3562	Select Act ion:U1// Z Zero (c lear) stat s
	3563	Delete (L) ocal Copy or (P)erma nent Copy of the sta tistics: L ocal Copy/ / Local Co py
	3564	Are you su re? N// YE S
	3565	7.3.4 Exit ing the St atistics S creen
	3566	Enter EX o r Q to exi t out of t he Statist ics Screen and retur n to the P harmacy EC ME Manager Menu.
	3567	Example 7. 3.4-1: Acc essing Exi t Option
	3568	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	3569	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	3570	* CLAIM STATUS * * CLAIM RES ULTS *
	3571	Waiting to start 0 P aid claims 2,93 4
	3572	Building the trans action 0 R ejected cl aims 2,17 1
	3573	Building the claim 0 D ropped to Paper 1 5
	3574	Building the HL7 p acket 1 D uplicate c laims 0
	3575	Preparin g for tran smit 0 C aptured cl aims 0
	3576	Transmit ting 0 A ccepted Re versals 2,06 7
	3577	Parsing response 0 R ejected Re versals 16 6
	3578	Processi ng respons e 0 A ccepted El igibility 7
	3579	R ejected El igibility 4 4
	3580	E rrors 1 4
	3581	Enter ?? f or more ac tions
	3582	UC Updat e continuo usly Z Zero (cle ar) stats
	3583	U1 Displ ay update EX Exit
	3584	Select Act ion:U1// E X Exit
	3585	(This page included for two-si ded copyin g.)
	3586	8
	3587	Accessing the Pharma cy Electro nic Claims Reports XE "Pharma cy Electro nic Claims Reports"
	3588	The Pharma cy Electro nic Claims Reports o ption is a menu that allows yo u to obtai n detailed informati on about c laims, tra nsactions, Electroni c Claims M anagement Engine (EC ME) activi ties, and system con figuration s.
	3589	You must h old the BP SMENU and BPS REPORT S keys to view the P harmacy El ectronic C laims Repo rts option . Access i t by enter ing RPT at the “Sele ct ECME Op tion:” pro mpt on the ECME Main Menu opti on screen.
	3590	Example 8- 1: Accessi ng the Pha rmacy Elec tronic Cla ims Report s Option
	3591	*** ****** ****** ****** ****** **
	3592	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3593	* XXXXX V AMC *
	3594	* Main M enu *
	3595	*** ****** ****** ****** ****** **
	3596	U ECME User Screen
	3597	COB ECME Pharm acy COB .. .
	3598	MGR Pharmacy E CME Manage r Menu ...
	3599	RPT Pharmacy E lectronic Claims Rep orts ...
	3600	Select ECM E Option: RPT Pharm acy Electr onic Claim s Reports
	3601	Example 8- 2: Display ing Pharma cy Electro nic Claims Reports O ptions
	3602	*** ****** ****** ****** ****** **
	3603	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3604	* XXXXX V AMC *
	3605	* Pharmacy Electroni c Claims R eports *
	3606	*** ****** ****** ****** ****** **
	3607	CLA Claim Resu lts and St atus ...
	3608	OTH Other Repo rts ...
	3609	Select Pha rmacy Elec tronic Cla ims Report s Option:
	3610	8.1 Claim Results an d Status X E " Claim Results an d Status"
	3611	The Claim Results an d Status o ption is a menu that allows yo u to obtai n reports about the statuses o f claims.
	3612	Access Cla im Results and Statu s by enter ing CLA at the “Sele ct Pharmac y Electron ic Claims Reports Op tion:” pro mpt on the Pharmacy Electronic Claims Re ports opti on screen.
	3613	Example 8. 1-1: Acces sing the C laim Resul ts and Sta tus Option
	3614	*** ****** ****** ****** ****** **
	3615	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3616	* XXXXX VAMC *
	3617	* Pharmacy Electroni c Claims R eports *
	3618	*** ****** ****** ****** ****** **
	3619	CLA Claim Resu lts and St atus ...
	3620	OTH Other Repo rts ...
	3621	Select Pha rmacy Elec tronic Cla ims Report s Option: CLA Claim Results a nd Status
	3622	You have a choice of Claims Re sults and Status rep orts to ch oose from.
	3623	Example 8. 1-2: Displ aying All Claims Res ults and S tatus Opti ons
	3624	*** ****** ****** ****** ****** **
	3625	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3626	* XXXXXX VAMC *
	3627	* Cla im Results and Statu s *
	3628	*** ****** ****** ****** ****** **
	3629	PAY Payable Cl aims Repor t
	3630	REJ Rejected C laims Repo rt
	3631	ECMP CMOP/ECME Activity R eport
	3632	REV Reversal C laims Repo rt
	3633	NYR Claims Sub mitted, No t Yet Rele ased
	3634	REC Recent Tra nsactions
	3635	DAY Totals by Date
	3636	CLO Closed Cla ims Report
	3637	NBS Non-Billab le Status Report
	3638	SPA Spending A ccount Rep ort
	3639	Select Cla im Results and Statu s Option:
	3640	Items/filt ers that p ertain to ALL ECME C laims Resu lts and St atus REPOR TS will be displayed for every option ch osen. You can select these opt ions using the same method as in other V istA appli cations an d as descr ibed in th e Change V iew sectio n.
	3641	Most of th e Claim Re sults and Status rep orts requi re that a device wit h 132 colu mn width b e used. Th ey will no t display correctly using 80 c olumn widt h devices. Example 8. 1-3: Displ aying ECME Report It em/Filter Options fo r ALL REPO RTS
	3642	Selec t one of t he followi ng:
	3643	D DIVISION
	3644	A ALL
	3645	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: <Ent er> ALL
	3646	Selec t one of t he followi ng:
	3647	S Summary
	3648	D Detail
	3649	Display (S )ummary or (D)etail Format: De tail// Sum mary
	3650	Selec t one of t he followi ng:
	3651	I SPECIFIC I NSURANCE(S )
	3652	A ALL
	3653	Select Cer tain (I)NS URANCE or (A)LL): A/ / I SPECI FIC INSURA NCES(S)
	3654	Select INS URANCE: IB INSUR1 123 ANY WHERE ST HER NDON V IRGINIA
	3655	Y
	3656	Selected :
	3657	IBINSUR1
	3658	Select INS URANCE: DE VELOPMENT INS 123 HERE S TREET SAN FR ANCISCO
	3659	CALIFORN IA Y
	3660	Selected :
	3661	DEVELOPMEN T INS
	3662	IBINSUR1
	3663	Select INS URANCE: <E nter>
	3664	Selec t one of t he followi ng:
	3665	C CMOP
	3666	M Mail
	3667	W Window
	3668	A ALL
	3669	Display (C )MOP or (M )ail or (W )indow or (A)LL: ALL // <Enter> ALL
	3670	Selec t one of t he followi ng:
	3671	R Real Time Fills
	3672	B Backbill
	3673	P PRO Option
	3674	S Resubmissi on
	3675	A ALL
	3676	Display (R )ealTime, (B)ackbill s, (P)RO O ption, Re( S)ubmissio n or (A)LL : A// <Ent er> ALL
	3677	Selec t one of t he followi ng:
	3678	D Drug
	3679	C Drug Class
	3680	A ALL
	3681	Display Sp ecific (D) rug or Dru g (C)lass or (A)LL: ALL// <Ent er> ALL
	3682	In additio n to the “ ALL REPORT S” prompts , all of t he Claims Results an d Status R EPORTS exc ept the EC MP report display an other prom pt that wi ll allow y ou to capt ure the re port data in Excel s preadsheet format. I f you answ er Y, addi tional dir ections ar e supplied .
	3683	Example 8. 1-4: Reque sting Repo rt Data in Excel Spr eadsheet F ormat
	3684	Do you wan t to captu re report data for a n Excel do cument? NO // YES
	3685	Befor e continui ng, please set up yo ur termina l to captu re the
	3686	detai l report d ata. On so me termina ls, this c an be done by
	3687	click ing on the 'Tools' m enu above, then clic k on 'Capt ure
	3688	Incom ing Data' to save to Desktop. This repor t may take a
	3689	while to run.
	3690	Note: To avoid undesired wrapping o f the data saved to the
	3691	file, ple ase enter '0;256;999 ' at the ' DEVICE:' p rompt.
	3692	8.1.1 Paya ble Claims Report XE " Payable Claims"
	3693	The Payabl e Claims R eport opti on produce s a report that list s PAYABLE electronic claims th at have be en success fully tran smitted to the payer and have not been r eversed.
	3694	You must h old the BP SMENU and BPS REPORT S keys to view the P ayable Cla ims Report option. T he Payable Claims Re port optio n has the most acces sible info rmation on payable c laims from the BPS C laims File . A FileMa n inquiry into the B PS Claims File will find that the inform ation is i n NCPDP (N ational Co uncil for Prescripti on Drug Pr ograms) V. D.0 form ats. Acces s the repo rt by ente ring PAY a t the “Sel ect Claim Results an d Status O ption:” pr ompt on th e Claim Re sults and Status opt ion screen .
	3695	Example 8. 1.1-1: Acc essing the Payable C laims Repo rt Option
	3696	*** ****** ****** ****** ****** **
	3697	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3698	* XXXXX V AMC *
	3699	* Cla im Results and Statu s *
	3700	*** ****** ****** ****** ****** **
	3701	PAY Payable Cl aims Repor t
	3702	REJ Rejected C laims Repo rt
	3703	ECMP CMOP/ECME Activity R eport
	3704	REV Reversal C laims Repo rt
	3705	NYR Claims Sub mitted, No t Yet Rele ased
	3706	REC Recent Tra nsactions
	3707	DAY Totals by Date
	3708	CLO Closed Cla ims Report
	3709	NBS Non-Billab le Status Report
	3710	SPA Spending A ccount Rep ort
	3711	Select Cla im Results and Statu s Option: PAY Payab le Claims Report
	3712	After you have made selections from the “ALL REPOR TS” prompt s, you wil l be promp ted to sel ect a repo rt date ra nge; Relea sed, Not R eleased or All claim s; Certain Eligibili ty Type or All; and Excel disp lay format and devic e selectio n.
	3713	Example 8. 1.1-2: Add itional pr ompts aske d by the P ayable Cla ims Report Option
	3714	START WITH TRANSACTI ON DATE: T -1// T-99
	3715	GO TO TR ANSACTION DATE: T// <Enter>
	3716	Selec t one of t he followi ng:
	3717	R RELEASED
	3718	N NOT RELEAS ED
	3719	A ALL
	3720	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	3721	Selec t one of t he followi ng:
	3722	V VETERAN
	3723	T TRICARE
	3724	C CHAMPVA
	3725	A ALL
	3726	Include Ce rtain Elig ibility Ty pe or (A)l l: V// ALL
	3727	Data field s VA Ingre dient Cost , VA Dispe nsing Fee, Ingredien t Cost Pai d, Dispens ing Fee Pa id and Pat ient Respo nsibility (INS) will only be i ncluded wh en the rep ort is cap tured for an Excel d ocument. All additi onal data fields may not be pr esent for all report s.
	3728	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	3729	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	3730	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	3731	DEVICE: HO ME// <Ente r> IP net work
	3732	Please wai t...
	3733	(This page included for two-si ded copyin g.)
	3734	Example 8. 1.1-3: Pay able Claim s Report
	3735	ECME PAYAB LE CLAIMS DETAIL REP ORT Print Da te: MAY 21 , 2008@11: 41:54 Pag e: 1
	3736	DIVISION(S ): ALL Fi ll Locatio ns: C,M,W Fill type : RT,BB,RS
	3737	Insurance: DEVELOPME NT INS, IB INSUR1 D rugs/Class es: ALL
	3738	Eligibilit y: ALL
	3739	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 02/12/ 08 through 05/21/08
	3740	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =====
	3741	PATIENT NA ME Pt. ID ELIG RX# REF/ECM E# DA TE $B ILLED $ INS RESPON SE $CO LLECT
	3742	DRUG NDC REL EASED ON RX INFO BILL# R X COB
	3743	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =====
	3744	DIVISION: PHARMACY-1
	3745	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -----
	3746	DEVELOPMEN T INS
	3747	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -----
	3748	ECMEpatien t,One (XX XX) TRI 100222$ 2/000000 111264 04/15/0 8 51 .00 40.00
	3749	AMITRI PTYLINE 10 MG TAB 00182-10 18-10 04/ 15/08 W RT A C/R K8000K9 p
	3750	ECMEpatien t, Three (XX XX) VET 222$ 0/000000 000492 03/1 0/08 51.00 68 .32
	3751	METHAD ONE 10MG T AB W RT E X/N
	3752	-------- -- - ---------
	3753	SUBTOTALS for INS:DE VELOPMENT INS 102. 00 108.32 0.00
	3754	COUNT 2 2 2
	3755	MEAN 51. 00 54.16 0.00
	3756	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -----
	3757	IBINSUR1
	3758	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -----
	3759	ECMEpatien t, Two (XX XX) VET 100574$ 0/000000 000484 03/0 5/08 51.00 40 .00
	3760	NEODEC ADRON OPHT MALIC SOL. 00006-76 39-03 03/ 05/08 W RT A C/R K8000H6 p
	3761	ECMEpatien t, Two (XX XX) VET 100575$ 0/000000 000485 03/0 5/08 51.00 40 .00
	3762	PENTAE RYTHRITOL 10MG TAB 00725-20 64-10 03/ 05/08 W RT A C/R K8000H7 p
	3763	...
	3764	SUBTOTALS for INS:IB INSUR1 2142. 00 1652.28 5.00
	3765	COUNT 42 42 42
	3766	MEAN 51. 00 39.34 0.12
	3767	-------- -- --------- ----- -----
	3768	SUBTOTALS for DIV:PH ARMACY-1 2244. 00 1760.60 5.00
	3769	COUNT 44 44 44
	3770	MEAN 51. 00 40.01 0.11
	3771	-------- -- --------- ----- -----
	3772	GRAND TOTA LS 2244. 00 1760.60 5.00
	3773	COUNT 44 44 44
	3774	MEAN 51. 00 40.01 0.11
	3775	Press RETU RN to cont inue:
	3776	(This page included for two-si ded copyin g.)
	3777	8.1.2 Reje cted Claim s Report X E " Payabl e Rejected Claims"
	3778	The Reject ed Claims Report opt ion produc es a repor t that lis ts electro nic claims that have been succ essfully t ransmitted to the pa yer and ha ve been re jected.
	3779	You must h old the BP SMENU and BPS REPORT S keys to view the R ejected Cl aims Repor t option. The Reject ed Claims Report opt ion has th e most acc essible in formation on rejecte d claims f rom the BP S Claims F ile. A Fil eMan inqui ry into th e BPS Clai ms File wi ll find th at the inf ormation i s in NCPDP V. D.0 fo rmats. Acc ess the re port by en tering REJ at the “S elect Clai m Results and Status Option:” prompt on the Claim Results an d Status o ption scre en.
	3780	Example 8. 1.2-1: Acc essing the Rejected Claims Rep ort Option
	3781	*** ****** ****** ****** ****** **
	3782	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3783	* XXXXX V AMC *
	3784	* Cla im Results and Statu s *
	3785	*** ****** ****** ****** ****** **
	3786	PAY Payable Cl aims Repor t
	3787	REJ Rejected C laims Repo rt
	3788	ECMP CMOP/ECME Activity R eport
	3789	REV Reversal C laims Repo rt
	3790	NYR Claims Sub mitted, No t Yet Rele ased
	3791	REC Recent Tra nsactions
	3792	DAY Totals by Date
	3793	CLO Closed Cla ims Report
	3794	NBS Non-Billab le Status Report
	3795	SPA Spending A ccount Rep ort
	3796	Select Cla im Results and Statu s Option: REJ Rejec ted Claims Report
	3797	After you have made selections from the “ALL REPOR TS” prompt s, you wil l be given the follo wing promp ts for dat e range, R eleased/No t Released /All claim s, All/Spe cific Reje ct Codes, Veteran/TR ICARE/CHAM PVA/All El igibility, Excel dis play forma t and devi ce selecti on.
	3798	Example 8. 1.2-2: Add itional pr ompts aske d by the R ejected Cl aims Repor t Option
	3799	START WITH TRANSACTI ON DATE: T -1// T-30
	3800	GO TO TR ANSACTION DATE: T// <Enter>
	3801	Selec t one of t he followi ng:
	3802	R RELEASED
	3803	N NOT RELEAS ED
	3804	A ALL
	3805	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	3806	Selec t one of t he followi ng:
	3807	S Specific R eject Code
	3808	A ALL
	3809	Include (S )pecific R eject Code or (A)LL: ALL// <En ter>
	3810	Selec t one of t he followi ng:
	3811	O OPEN
	3812	C CLOSED
	3813	A ALL
	3814	Include (O )pen, (C)l osed, or ( A)ll Claim s: O// ALL
	3815	Selec t one of t he followi ng:
	3816	V VETERAN
	3817	T TRICARE
	3818	C CHAMPVA
	3819	A ALL
	3820	Include Ce rtain Elig ibility Ty pe or (A)l l: V// ALL
	3821	Data field s VA Ingre dient Cost and VA Di spensing F ee will on ly be incl uded when the report is captur ed for an Excel docu ment. All additiona l data fie lds may no t be prese nt for all reports.
	3822	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	3823	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	3824	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	3825	DEVICE: HO ME// <Ente r> IP net work
	3826	Please wai t...
	3827	Example 8. 1.2-3: Rej ected Clai ms Report
	3828	ECME REJEC TED CLAIMS DETAIL RE PORT Prin t Date: MA Y 21, 2008 @17:20:35 Page: 1
	3829	DIVISION(S ): ALL Fill Locat ions: C,M, W Fill ty pe: RT,BB, RS
	3830	Insurance: IBINSUR1, OPINSUR1 Drugs/ Classes: A LL
	3831	Reject Cod e: ALL Elig ibility: A LL Open/Close d: ALL
	3832	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 05/01/ 08 through 05/21/08
	3833	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	3834	PATIENT NA ME Pt.ID ELIG RX# REF/ ECME# DATE RELEASED O N RX INFO RX COB OPEN/ CLOSED
	3835	CARDHOL D.ID GR OUP ID $B ILLED QT Y NDC# DRUG
	3836	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	3837	DIVISION: PHARMACY-1
	3838	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	3839	IBINSUR1
	3840	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	3841	ECMEPATIEN T,ONE (XXXX) VET 100 888$ 0/00 0000000808 0 5/04/08 0 5/04/08 W RT D S/R s Op en
	3842	123456 55 5 51.00 90 00777 -0877-03 FENOPRO FEN 300MG CAP
	3843	Claim ID: VA2008=400 0000016=00 0010=00018 15
	3844	07:M/I Car dholder ID Number
	3845	ECMEPATIEN T,ONE (XXXX) VET 100 892$ 0/00 0000000812 0 5/04/08 0 5/04/08 W RT D S/R s Closed
	3846	123456 55 5 51.00 90 00777 -0877-03 FENOPRO FEN 300MG CAP
	3847	Claim ID: VA2008=400 0000016=00 0010=00018 22
	3848	07:M/I Car dholder ID Number
	3849	ECMEPATIEN T,ONE (XXXX) VET 100 893$ 0/00 0000000813 0 5/04/08 0 5/04/08 W RT D S/R p Closed
	3850	123456 55 5 51.00 90 00777 -0877-03 FENOPRO FEN 300MG CAP
	3851	Claim ID: VA2008=400 0000016=00 0010=00018 23
	3852	07:M/I Car dholder ID Number
	3853	--------- -
	3854	SUBTOTALS for INS:IB INSUR1 153.0 0
	3855	COUNT 3
	3856	MEAN 51.0 0
	3857	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	3858	OPINSUR1
	3859	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	3860	ECMEPATIEN T,TWO (XXXX) VET 100 896$ 0/00 0000000816 0 5/06/08 W RT DS /N p Open
	3861	111 51.00 1 80 0000 3-0626-50 CHLORAL HYDRATE 5 00MG CAP
	3862	Claim ID: VA2008=400 0000016=00 0010=00018 33
	3863	12:M/I Pat ient Locat ion
	3864	ECMEPATIEN T,TWO (XXXX) VET 100 899$ 0/00 0000000819 0 5/06/08 W RT DS /N p Open
	3865	111 51.00 1 80 0014 9-0030-66 DANTROL ENE 25MG C AP
	3866	Claim ID: VA2008=400 0000016=00 0010=00018 34
	3867	75:Prior A uthorizati on Require d
	3868	ECMEPATIEN T,TWO (XXXX) VET 100 901$ 0/00 0000000821 0 5/06/08 W RT DS /N p Open
	3869	111 51.00 9 0 0059 1-5521-04 PHENYLB UTAZONE 10 0MG TAB
	3870	05/06/08 - Prior Aut horization Code (8/3 2432242) s ubmitted.
	3871	Claim ID: VA2008=400 0000016=00 0010=00018 35
	3872	75:Prior A uthorizati on Require d
	3873	ECMEPATIEN T,TWO (XXXX) VET 100 902$ 0/00 0000000822 0 5/06/08 W RT DS /N p Open
	3874	111 51.00 1 80 0002 3-4534-67 BACLOFE N 10MG TAB S
	3875	05/06/08 - Clarifica tion Code 4,3 submit ted.
	3876	Claim ID: VA2008=400 0000016=00 0010=00018 40
	3877	79:Refill Too Soon
	3878	ECMEPATIEN T,TWO (XXXX) VET 100 903$ 0/00 0000000823 0 5/06/08 W RT DS /N s Open
	3879	111 51.00 1 80 0002 3-4534-67 BACLOFE N 10MG TAB S
	3880	05/06/08 - Clarifica tion Code 4,3 submit ted.
	3881	Claim ID: VA2008=400 0000016=00 0010=00018 41
	3882	79:Refill Too Soon
	3883	ECMEPATIEN T,TWO (XXXX) VET 100 906$ 0/00 0000000826 0 5/06/08 M RT DS /N p Open
	3884	111 51.00 1 80 0083 9-7221-06 DOXEPIN 25MG CAP
	3885	05/06/08 - Clarifica tion Code 4,3 submit ted.
	3886	Claim ID: VA2008=400 0000016=00 0010=00018 43
	3887	79:Refill Too Soon
	3888	ECMEPATIEN T,TWO (XXXX) VET 100 907$ 0/00 0000000827 0 5/06/08 M RT AC /N p Open
	3889	111 51.00 1 80 0008 1-0635-35 CHLORAM BUCIL 2MG TAB.
	3890	Claim ID: VA2008=400 0000016=00 0010=00018 45
	3891	79:Refill Too Soon
	3892	ECMEPATIEN T,TWO (XXXX) VET 100 915$ 0/00 0000000835 0 5/07/08 W RT DS /N p Open
	3893	111 51.00 1 80 0002 3-4534-67 BACLOFE N 10MG TAB S
	3894	05/07/08 - DAFASFDAF DASFDASFAS
	3895	Claim ID: VA2008=400 0000016=00 0010=00018 68
	3896	75:Prior A uthorizati on Require d
	3897	ECMEPATIEN T,TWO (XXXX) VET 100 938$ 0/00 0000000858 0 5/08/08 W RT AC /N p Open
	3898	111 51.00 3 0 0002 4-2253-04 STANOZO LOL 2MG
	3899	Claim ID: VA2008=400 0000016=00 0010=00018 92
	3900	75:Prior A uthorizati on Require d
	3901	ECMEPATIEN T,TWO (XXXX) VET 100 939$ 0/00 0000000859 0 5/08/08 W RT DS /N p Open
	3902	111 51.00 1 80 0007 8-0005-10 THIORID AZINE 100M G TAB
	3903	05/08/08 - FDDSFADFA
	3904	Claim ID: VA2008=400 0000016=00 0010=00018 93
	3905	75:Prior A uthorizati on Require d
	3906	ECMEPATIEN T,TWO (XXXX) VET 100 942$ 0/00 0000000862 0 5/08/08 W RT AC /N p Open
	3907	111 51.00 1 80 0002 8-0105-10 TERBUTA LINE 5MG T ABS
	3908	Claim ID: VA2008=400 0000016=00 0010=00018 94
	3909	75:Prior A uthorizati on Require d
	3910	79:Refill Too Soon
	3911	ECMEPATIEN T,TWO (XXXX) VET 100 945$ 0/00 0000000865 0 5/08/08 W RT DS /N p Open
	3912	111 51.00 1 80 0004 5-0412-60 TOLMETI N 200MG TA BS
	3913	Claim ID: VA2008=400 0000016=00 0010=00018 97
	3914	75:Prior A uthorizati on Require d
	3915	79:Refill Too Soon
	3916	ECMEPATIEN T,TWO (XXXX) VET 101 002$ 0/00 0000000926 0 5/14/08 W RT DS /N p Open
	3917	111 51.00 1 80 0002 3-4534-67 BACLOFE N 10MG TAB S
	3918	Claim ID: VA2008=400 0000016=00 0010=00019 89
	3919	64:Claim S ubmitted D oes Not Ma tch Prior Authorizat ion
	3920	ECMEPATIEN T,TWO (XXXX) VET 101 011$ 0/00 0000000935 0 5/14/08 W RT D S/N p Open
	3921	111 51.00 1 80 0078 1-1367-10 BENZTRO PINE 2MG T AB
	3922	Claim ID: VA2008=400 0000016=00 0010=00020 05
	3923	12:M/I Pat ient Locat ion
	3924	Press RETU RN to cont inue, '^' to exit:
	3925	(This page included for two-si ded copyin g.)
	3926	8.1.3 CMOP /ECME Acti vity Repor t XE " CMO P/ECME Act ivity Repo rt"
	3927	The CMOP/E CME Activi ty Report option pro duces a re port used for monito ring Conso lidated Ma il Outpati ent Pharma cy (CMOP) activity d uring both the Contr olled Subs tances and General C MOP Transm issions. T he report contains r eference i nformation from mult iple VistA sources. You will n ot be prom pted for s elections from the “ ALL REPORT S” section , but you need to se lect a rep ort date r ange, a di vision or all divisi ons and a printer de vice. This report is not a 132 column re port and y ou can cho ose to dis play it on the scree n
	3928	You must h old the BP SMENU and BPS REPORT S keys to view the C MOP/ECME A ctivity Re port optio n. Access the report by enteri ng ECMP at the “Sele ct Claim R esults and Status Op tion:” pro mpt on the Claim Res ults and S tatus opti on screen.
	3929	Example 8. 1.3-1: Acc essing the CMOP/ECME Activity Report Opt ion
	3930	*** ****** ****** ****** ****** **
	3931	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3932	* XXXXX V AMC *
	3933	* Cla im Results and Statu s *
	3934	*** ****** ****** ****** ****** **
	3935	PAY Payable Cl aims Repor t
	3936	REJ Rejected C laims Repo rt
	3937	ECMP CMOP/ECME Activity R eport
	3938	REV Reversal C laims Repo rt
	3939	NYR Claims Sub mitted, No t Yet Rele ased
	3940	REC Recent Tra nsactions
	3941	DAY Totals by Date
	3942	CLO Closed Cla ims Report
	3943	NBS Non-Billab le Status Report
	3944	SPA Spending A ccount Rep ort
	3945	Select Cla im Results and Statu s Option: ECMP CMOP /ECME Acti vity Repor t
	3946	ENTER BEGI NNING TRAN SMISSION D ATE: 8/31
	3947	ENTER ENDI NG TRANSMI SSION DATE : 9/1
	3948	SELECTION OF DIVISIO N(S)
	3949	Selec t one of t he followi ng:
	3950	A ALL DIVISI ONS
	3951	S SELECT DIV ISIONS
	3952	Enter resp onse: SELE CT DIVISIO NS
	3953	1 XXXXX XXXXX
	3954	2 YYYYY YYYYY
	3955	3 ZZZZZ ZZZZZ
	3956	Select Div ision(s) : (1-4): 1
	3957	You have s elected:
	3958	1 XXXXX XXXXX
	3959	Is this co rrect? YES // <Enter>
	3960	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	3961	Select Pri nter: HOME ;132;999 IP network
	3962	Example 8. 1.3-2: CMO P/ECME Act ivity Repo rt
	3963	CMOP/ ECME ACTIV ITY REPORT for XXXXX XXXXX
	3964	For AUG 31 ,2005 thr u SEP 1,2 005 Printed: N OV 23,2005 @10:25:49
	3965	========== ========== ========== ========== ========== ========== ========== ========== =========
	3966	TRA NSMISSION: 2671
	3967	STA TUS: TRANS MITTED
	3968	DIV ISION: XXXXX XXXXX
	3969	CMO P SYSTEM: LEAVE NWORTH
	3970	TRA NSMISSION DATE/TIME: AUG 3 1, 2005@16 :17:14
	3971	TOT AL PATIENT S: 3
	3972	TOT AL RXS: 3
	3973	NAME ECME#/ RX#/FL# NDC S ENT NDC RECV D CMOP-STAT
	3974	DRUG INSUR ANCE PAY- STAT BILL # REL-DA TE
	3975	========== ========== ========== ========== ========== ========== ========== ========== =========
	3976	ECMEpatien t,One (XXX X) 000001 106254/909 911$e/0 00000-0158 -23 TRANS MI
	3977	AT ORVASTATIN CALCI WEBMD E PA YAB
	3978	8.1.4 Reve rsal Claim s Report X E " Revers al Claims Report"
	3979	The Revers al Claims Report opt ion lists claims tha t have bee n successf ully trans mitted to the payer to REVERSE a previou sly PAYABL E claim an d have not been RESU BMITTED.
	3980	You must h old the BP SMENU and BPS REPORT S keys to view the R eversal Cl aims Repor t option. Access the report by entering REV at the “Select C laim Resul ts and Sta tus Option :” prompt on the Cla im Results and Statu s option s creen.
	3981	Example 8. 1.4-1: Acc essing the Reversal Claims Rep ort Option
	3982	*** ****** ****** ****** ****** **
	3983	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3984	* XXXXX V AMC *
	3985	* Cla im Results and Statu s *
	3986	*** ****** ****** ****** ****** **
	3987	PAY Payable Cl aims Repor t
	3988	REJ Rejected C laims Repo rt
	3989	ECMP CMOP/ECME Activity R eport
	3990	REV Reversal C laims Repo rt
	3991	NYR Claims Sub mitted, No t Yet Rele ased
	3992	REC Recent Tra nsactions
	3993	DAY Totals by Date
	3994	CLO Closed Cla ims Report
	3995	NBS Non-Billab le Status Report
	3996	SPA Spending A ccount Rep ort
	3997	Select Cla im Results and Statu s Option: REV Rever sal Claims Report
	3998	After you have made selections from the “ALL REPOR TS” prompt s, you wil l be given the follo wing promp ts for dat e range, R eleased/No t Released /All Claim s, Auto-Re versed/All Claims, A ccepted/Re jected/All Claims, V eteran/TRI CARE/CHAMP VA/All Eli gibility, Excel disp lay format and devic e selectio n.
	3999	Example 8. 1.4-2: Add itional Pr ompts for the Revers al Claims Report Opt ion
	4000	START WITH TRANSACTI ON DATE: T -1// T-30
	4001	GO TO TR ANSACTION DATE: T// <Enter>
	4002	Selec t one of t he followi ng:
	4003	R RELEASED
	4004	N NOT RELEAS ED
	4005	A ALL
	4006	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	4007	Selec t one of t he followi ng:
	4008	R AutoRevers ed
	4009	A ALL
	4010	Include Au to(R)evers ed or (A)L L: ALL// < Enter>
	4011	Selec t one of t he followi ng:
	4012	C Accepted
	4013	R Rejected
	4014	A ALL
	4015	Include A( C)cepted o r (R)eject ed or (A)L L: Rejecte d// ALL
	4016	Selec t one of t he followi ng:
	4017	V VETERAN
	4018	T TRICARE
	4019	C CHAMPVA
	4020	A ALL
	4021	Include Ce rtain Elig ibility Ty pe or (A)l l: V// ALL
	4022	Data field s VA Ingre dient Cost , VA Dispe nsing Fee, Ingredien t Cost Pai d, Dispens ing Fee Pa id and Pat ient Respo nsibility (INS) will only be i ncluded wh en the rep ort is cap tured for an Excel d ocument. All additi onal data fields may not be pr esent for all report s.
	4023	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	4024	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	4025	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	4026	DEVICE: HO ME// <Ente r> IP net work
	4027	Please wai t...
	4028	Example 8. 1.4-3: Rev ersal Clai ms Report
	4029	ECME REVER SED CLAIMS DETAIL RE PORT Prin t Date: AP R 17, 2009 @14:17:15 Page: 1
	4030	DIVISION(S ): ALL Fill Locat ions: C,M, W Fill ty pe: RT,BB, RS
	4031	Insurance: ALL ALL R eversals ALL R eturned St atus Dru gs/Classes : ALL
	4032	Eligibilit y: ALL
	4033	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 03/18/ 09 through 04/17/09
	4034	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	4035	PATIENT NA ME Pt.ID EL IG RX# REF/ECME # D ATE $ BILLED $INS RES PONSE $COLLECT
	4036	DRUG NDC RX INFO RX COB
	4037	RELE ASED ON REVERSAL METHOD/RE TURN STATU S/REASON
	4038	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	4039	DIVISION: YYYYYYYY
	4040	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	4041	COB INSURA NCE
	4042	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	4043	ECMEPATIEN T,ONE (XXXX) TRI 102445$ 0/000001 13725 03/20/ 09 21.88 40. 00 0.00
	4044	OXYTOC IN 10 UNIT INJ 00071-416 0-03 W RT AC /R s
	4045	03/1 8/09 REGULAR/ ACCEPTED/2
	4046	-------- -- --- ------- ----- -----
	4047	SUBTOTALS for INS:CO B INSURANC E 21.88 40. 00 0.00
	4048	COUNT 1 1 1
	4049	MEAN 21.88 40. 00 0.00
	4050	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	4051	ECME INSUR ANCE
	4052	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	4053	ECMEPATIEN T,TWO (XXXX) VET 102446$ 0/000001 13727 03/20/ 09 11.00 40.00 0.00
	4054	DACARB AZINE 100M G INJ 00 026-8151-1 0 W RT DS /R s
	4055	03/2 0/09 REGULAR/ ACCEPTED/R EVERSING P RIMARY CLA IM
	4056	--------- - ---- ------ ------- ---
	4057	SUBTOTALS for INS:EC ME INSURAN CE 11.00 40. 00 0.00
	4058	COUNT 1 1 1
	4059	MEAN 11.00 40. 00 0.00
	4060	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	4061	ECME1 INSU RANCE
	4062	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	4063	ECMEPATIEN T,TWO (XXXX) VET 102422$ 1/000001 13698 03/20/0 9 0.00 68.3 2 0.00
	4064	GENTAM ICIN OPHTH ALMIC OINT . 00719-70 58-61 W RT DS /N p
	4065	REGULAR/ ACCEPTED/R X DISCONTI NUED
	4066	ECMEPATIEN T,ONE (XXXX) TRI 102435$ 0/000001 13713 04/06/0 9 0.00 40.0 0 0.00
	4067	METHOX AMINE 10MG /CC INJ 00081-0957 -10 W RT AC /N p
	4068	REGULAR/ ACCEPTED/ RX DISCONT INUED
	4069	--------- - ---- ------ ------- ---
	4070	SUBTOTALS for INS:EC ME1 INSURA NCE 0.00 108. 32 0.00
	4071	COUNT 2 2 2
	4072	MEAN 0.00 54. 16 0.00
	4073	--------- - ---- ------ ------- ---
	4074	SUBTOTALS for DIV:YY YYYYYY 32.88 188. 32 0.00
	4075	COUNT 4 4 4
	4076	MEAN 8.22 47. 08 0.00
	4077	--------- - ---- ------ ------- ---
	4078	GRAND TOTA LS 32.88 188. 32 0.00
	4079	COUNT 4 4 4
	4080	MEAN 8.22 47 .08 0.00
	4081	8.1.5 Clai ms Submitt ed, Not Ye t Released XE "Clai ms Submitt ed, Not Ye t Released "
	4082	The Claims Submitted , Not Yet Released o ption list s all pres cription c laims that have been successfu lly submit ted to the payer, ha ve been re turned PAY ABLE but t he prescri ptions hav e not been released.
	4083	You must h old the BP SMENU and BPS REPORT S keys to view the C laims Subm itted, Not Yet Relea sed Report option. A ccess the report by entering N YR at the “Select Cl aim Result s and Stat us Option: ” prompt o n the Clai m Results and Status option sc reen.
	4084	Example 8. 1.5-1: Acc essing Cla ims Submit ted, Not Y et Release d Option
	4085	*** ****** ****** ****** ****** **
	4086	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4087	* XXXXX V AMC *
	4088	* Cla im Results and Statu s *
	4089	*** ****** ****** ****** ****** **
	4090	PAY Payable Cl aims Repor t
	4091	REJ Rejected C laims Repo rt
	4092	ECMP CMOP/ECME Activity R eport
	4093	REV Reversal C laims Repo rt
	4094	NYR Claims Sub mitted, No t Yet Rele ased
	4095	REC Recent Tra nsactions
	4096	DAY Totals by Date
	4097	CLO Closed Cla ims Report
	4098
	4099	NBS Non-Billab le Status Report
	4100	SPA Spending A ccount Rep ort
	4101	Select Cla im Results and Statu s Option: NYR Claim s Submitte d, Not Yet Released
	4102	After you have made selections from the “ALL REPOR TS” prompt s, you wil l be given the follo wing promp ts for dat e range, E xcel displ ay format and device selection .
	4103	Example 8. 1.5-2: Add itional pr ompts to C laims Subm itted, Not Yet Relea sed Option
	4104
	4105	START WITH TRANSACTI ON DATE: T -1// T
	4106	GO TO TR ANSACTION DATE: T// T
	4107	Data field s VA Ingre dient Cost , VA Dispe nsing Fee, Ingredien t Cost Pai d, Dispens ing Fee Pa id and Pat ient Respo nsibility (INS) will only be i ncluded wh en the rep ort is cap tured for an Excel d ocument. All additi onal data fields may not be pr esent for all report s.
	4108	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	4109	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	4110	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	4111	DEVICE: HO ME// <Ente r> IP net work
	4112	Example 8. 1.5-3: Cla ims Submit ted, Not Y et Release d Report
	4113	ECME SUBMI T,NOT RELE ASED CLAIM S DETAIL R EPORT Prin t Date: SE P 23, 2005 @15:01:21 Page: 1
	4114	DIVISION(S ): ALL Fi ll Locatio ns: C,M,W Fill type: RT,BB,RS
	4115	Insurance: ALL Drugs/Clas ses: ALL
	4116	PRESCRIPTI ONS (NOT R ELEASED) B Y TRANSACT ION DATE: From 09/23 /05 throug h 09/23/05
	4117	========== ========== ========== ========== ========== ========== ========== ========== ========
	4118	PATIENT NA ME Pt. ID RX# REF/ECM E# DATE $BILLED $INS RESPONSE
	4119	DRUG RX INF O RX COB
	4120	========== ========== ========== ========== ========== ========== ========== ========== ========
	4121	DIVISION: ZZZZZZZ
	4122	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------
	4123	WEBMD
	4124	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------
	4125	ECMEpatien t,One (XX XX) 909716 $ 0/00000 1105959 0 9/23/05 45.0 0 40.00
	4126	PROTAM INE SULFAT E 5ML INJ W RT AC/N p
	4127	---- ------ -- --------
	4128	SUBTOTALS for INS:WE BMD 45.00 40.00
	4129	COUNT 1 1
	4130	MEAN 45.00 40.00
	4131	---- ------ -- --------
	4132	SUBTOTALS for DIV:ZZ ZZZZZ 4 5.00 40.00
	4133	COUNT 1 1
	4134	MEAN 45.00 40.00
	4135	GRAND TOTA LS 45.00 40.00
	4136	COUNT 1 1
	4137	MEAN 45.00 40.00
	4138	8.1.6 Rece nt Transac tions XE " Recent Tr ansactions "
	4139	The Recent Transacti ons option lists cla ims that h ave been s uccessfull y transmit ted to the payer. Th ese claims include s ubmissions , reversal s and resu bmissions. Closed Cl aims will NOT show u p on this report sin ce this re port displ ays activi ty between ECME and the payer only.
	4140	You must h old the BP SMENU and BPS REPORT S keys to view the R ecent Tran sactions R eport opti on. Access the repor t by enter ing REC at the “Sele ct Claim R esults and Status Op tion:” pro mpt on the Claim Res ults and S tatus opti on screen.
	4141	Example 8. 1.6-1: Rec ent Transa ctions Opt ion
	4142	*** ****** ****** ****** ****** **
	4143	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4144	* XXXXX V AMC *
	4145	* Cla im Results and Statu s *
	4146	*** ****** ****** ****** ****** **
	4147	PAY Payable Cl aims Repor t
	4148	REJ Rejected C laims Repo rt
	4149	ECMP CMOP/ECME Activity R eport
	4150	REV Reversal C laims Repo rt
	4151	NYR Claims Sub mitted, No t Yet Rele ased
	4152	REC Recent Tra nsactions
	4153	DAY Totals by Date
	4154	CLO Closed Cla ims Report
	4155	NBS Non-Billab le Status Report
	4156	SPA Spending A ccount Rep ort
	4157	Select Cla im Results and Statu s Option: REC Recen t Transact ions
	4158	After you have made selections from the “ALL REPOR TS” prompt s, you wil l be given the follo wing promp ts for dat e range, R eleased/No t Released /All Claim s, Excel d isplay for mat and de vice selec tion.
	4159	Example 8. 1.6-2: Add itional pr ompts aske d by the R ecent Tran sactions O ption
	4160	START WITH TRANSACTI ON DATE: T -1// T
	4161	GO TO TR ANSACTION DATE: T// T
	4162	Selec t one of t he followi ng:
	4163	R RELEASED
	4164	N NOT RELEAS ED
	4165	A ALL
	4166	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	4167	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	4168	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	4169	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	4170	DEVICE: HO ME// <Ente r> IP netw ork
	4171	Please wai t...
	4172	(This page included for two-si ded copyin g.)
	4173	Example 8. 1.6-3: Rec ent Transa ctions Rep ort
	4174	ECME RECEN T TRANSACT IONS DETAI L REPORT P rint Date: NOV 03, 2 010@17:10: 39 Page: 1
	4175	DIVISION(S ): ALL Fill Lo cations: C ,M,W Fill type: RT,B B,RS
	4176	Insurance: ALL Dru gs/Classes : ALL
	4177	PRESCRIPTI ONS BY TRA NSACTION D ATE: From 10/04/10 t hrough 11/ 03/10
	4178	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	4179	PATIENT NA ME Pt. ID RX# REF /ECME# COMPL ETED TRANS T YPE PAYER RESP ONSE RX CO B
	4180	DRUG NDC RX INFO I NSURANCE ELAP TIM E IN SECON DS
	4181	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	4182	DIVISION: XXXXXXXX
	4183	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	4184	ECMEPATIEN T,THREE ( XXXX) 102 128$ 1 /000000002 509 10/04/10 02:52PM SUBMIT E REJECT ED p
	4185	DIAZEP AM 10MG S. T. 00 555-0164-0 4 M RT EX/N RE J OPI NSUR1 9
	4186	ECMEPATIEN T,THREE ( XXXX) 110 0249$ 1 / 10/ 06/10 11:2 9AM SUBMI T E UNSTRA NDED p
	4187	GENTAM ICIN OPHTH ALMIC O 00 719-7058-6 1 W RT AC/N OPI NSUR1 502339
	4188	ECMEPATIEN T,SIX ( XXXX) 110 0341$ 0 /000000003 126 10/ 07/10 12:0 6AM SUBMI T E REJECT ED p
	4189	DOXEPI N 25MG CAP 00 839-7221-0 6 W RT AC/R RE J OPI NSUR2 7
	4190	ECMEPATIEN T,SIX ( XXXX) 110 0342$ 0 /000000003 127 10/ 07/10 01:5 9PM SUBMI T E PAYABL E p
	4191	CORTIC OTROPIN 40 UNIT HP 00 053-1330-0 1 W RT AC/R OPI NSUR2 4
	4192	ECMEPATIEN T,SIX ( XXXX) 110 0336$ 0 /000000003 120 10/ 07/10 03:0 5PM REVER SAL E REVERS AL OTHER p
	4193	TRIAMT ERENE 50MG , HCTZ 00 484-3590-3 0 W RT DS/R OPI NSUR2 3
	4194	ECMEPATIEN T,ONE ( XXXX) 100 952$ 0 /000000000 874 10/07/10 05:29PM SUBMIT E UNSTRA NDED p
	4195	MEDROX YPROGESTRO NE 10MG 00 009-0050-0 2 W RT DS/N OPI NSUR1 76220585
	4196	ECMEPATIEN T,ONE ( XXXX) 100 933$ 0 /000000000 853 10/07/10 07:45PM SUBMIT E REJECT ED p
	4197	DOXEPI N 25MG CAP 00 839-7221-0 6 M RT DS/N RE J OPI NSUR1 7
	4198	ECMEPATIEN T,ONE ( XXXX) 101 814$ 0 /000000002 181 10/08/10 04:11PM REVERSAL E REVERS AL UNSTRAN DED p
	4199	IMIPRA MINE 25MG TAB 00 779-0588-3 0 W RT DS/N OPI NSUR1 57199104
	4200	ECMEPATIEN T,ONE ( XXXX) 100 954$ 0 /000000000 876 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	4201	DOXEPI N 25MG CAP 00 839-7221-0 6 M RT DS/N OPI NSUR1 76194694
	4202	ECMEPATIEN T,ONE ( XXXX) 100 991$ 0 /000000000 915 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	4203	BACLOF EN 10MG TA BS 00 023-4534-6 7 W RT DS/N OPI NSUR1 75772098
	4204	ECMEPATIEN T,ONE ( XXXX) 101 860$ 0 /000000002 228 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	4205	IMIPRA MINE 25MG TAB 00 779-0588-3 0 W RT EX/N OPI NSUR1 57199347
	4206	ECMEPATIEN T,ONE ( XXXX) 101 861$ 0 /000000002 229 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	4207	CHLORA L HYDRATE 500MG C 00 003-0626-5 1 W RT DS/N OPI NSUR1 57199249
	4208	ECMEPATIEN T,ONE ( XXXX) 101 959$ 0 /000000002 331 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	4209	LIDOCA INE 2% 50M L INJ M 00 186-0240-0 2 W RT DS/N OPI NSUR1 51602609
	4210	ECMEPATIEN T,THREE ( XXXX) 102 225$ 0 /000000002 607 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	4211	BIPERI DEN 2MG TA B 00 044-0120-0 4 M RT DS/N OPI NSUR1 46160110
	4212	(This page included for two-si ded copyin g.)
	4213	8.1.7 Tota ls by Date XE " Tot als by Dat e"
	4214	The Totals by Date o ption tota ls the dai ly ECME ac tivity cla ims that h ave been s uccessfull y transmit ted to the payer, ha ve been re turned PAY ABLE or RE JECTED but have not been REVER SED.
	4215	You must h old the BP SMENU and BPS REPORT S keys to view the T otals by D ay Report option. Ac cess the r eport by e ntering DA Y at the “ Select Cla im Results and Statu s Option:” prompt on the Claim Results a nd Status option scr een.
	4216	Example 8. 1.7-1: Tot als by Dat e Option
	4217	*** ****** ****** ****** ****** **
	4218	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4219	* XXXXX V AMC *
	4220	* Cla im Results and Statu s *
	4221	*** ****** ****** ****** ****** **
	4222	PAY Payable Cl aims Repor t
	4223	REJ Rejected C laims Repo rt
	4224	ECMP CMOP/ECME Activity R eport
	4225	REV Reversal C laims Repo rt
	4226	NYR Claims Sub mitted, No t Yet Rele ased
	4227	REC Recent Tra nsactions
	4228	DAY Totals by Date
	4229	CLO Closed Cla ims Report
	4230	NBS Non-Billab le Status Report
	4231	SPA Spending A ccount Rep ort
	4232	Select Cla im Results and Statu s Option: DAY Total s by Date
	4233	After you have made selections from the “ALL REPOR TS” prompt s, you wil l be given the follo wing promp ts for dat e range, R eleased/No t Released /All Claim s, Excel d isplay for mat and de vice selec tion.
	4234	Example 8. 1.7-2: Add itional pr ompts aske d by the T otals by D ay Option
	4235	START WITH TRANSACTI ON DATE: T -1// T-30
	4236	GO TO TR ANSACTION DATE: T// <Enter>
	4237	Selec t one of t he followi ng:
	4238	R RELEASED
	4239	N NOT RELEAS ED
	4240	A ALL
	4241	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	4242	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	4243	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	4244	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	4245	DEVICE: HO ME// <Ente r> IP netw ork
	4246	Please wai t...
	4247	Example 8. 1.7-3: Tot als by Dat e Report ( Compacted to fit int o document )
	4248	ECME TOTAL S DETAIL R EPORT Print D ate: SEP 2 3, 2005@15 :18:52 Pa ge: 1
	4249	DIVISION(S ): ALL Fil l Location s: C,M,W F ill type: RT,BB,RS
	4250	Insurance: DEVELOPME NT INS, OP INSUR1 D rugs/Class es: ALL
	4251	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 09/23/ 05 through 09/23/05
	4252	========== ========== ========== ========== ========== ========== ========== ========== ======
	4253	AMOUNT RETURNE D RETURNE D AMO UNT
	4254	DATE #CLAIMS SUBMITTED REJECTE D PAYABL E TO RECE IVE DIFF ERENCE
	4255	========== ========== ========== ========== ========== ========== ========== ========== ======
	4256	DIVISION: ZZZZZZZ
	4257	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------
	4258	09/23/05 2 90.00 45.0 0 45.0 0 40 .00 5.00
	4259	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------
	4260	TOTALS 2 90.00 45.0 0 45.0 0 40 .00 5.00
	4261	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------
	4262	GRAND TOTA LS 2 90.00 45.0 0 45.0 0 40 .00 5.00
	4263	Press RETU RN to cont inue:
	4264	8.1.8 Clos ed Claims Report XE " Closed C laims Repo rt"
	4265	The Closed Claims Re port optio n lists cl aims that have been successful ly transmi tted to th e payer, h ave been r eturned RE JECTED and have been CLOSED us ing the Cl ose Claim action wit hin the EC ME User Sc reen. The Excel disp lay format of the re port displ ays the Am ount Bille d and the Amount Bil led is onl y on the E xcel displ ay format.
	4266	You must h old the BP SMENU and BPS REPORT S keys to view the C losed Clai ms Report option. Ac cess the r eport by e ntering CL O at the “ Select Cla im Results and Statu s Option:” prompt on the Claim Results a nd Status option scr een.
	4267	Example 8. 1.8-1: Acc essing the Closed Cl aims Repor t Option
	4268	*** ****** ****** ****** ****** **
	4269	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4270	* XXXXX V AMC *
	4271	* Cla im Results and Statu s *
	4272	*** ****** ****** ****** ****** **
	4273	PAY Payable Cl aims Repor t
	4274	REJ Rejected C laims Repo rt
	4275	ECMP CMOP/ECME Activity R eport
	4276	REV Reversal C laims Repo rt
	4277	NYR Claims Sub mitted, No t Yet Rele ased
	4278	REC Recent Tra nsactions
	4279	DAY Totals by Date
	4280	CLO Closed Cla ims Report
	4281	NBS Non-Billab le Status Report
	4282	SPA Spending A ccount Rep ort
	4283	Select Cla im Results and Statu s Option: CLO Close d Claims R eport
	4284	After you have made selections from the “ALL REPOR TS” prompt s, you wil l be given the follo wing promp ts for dat e range, R eleased/No t Released /All claim s, All/Spe cific Clos e Claim Re ason, Vete ran/TRICAR E/CHAMPVA/ All Eligib ility, Exc el display format an d device s election.
	4285	Example 8. 1.8-2: Sel ecting Spe cific Clos e Claim Re ason Optio n
	4286	START WITH CLOSE DAT E: T-1// T -50
	4287	GO TO CL OSE DATE: T// <Enter >
	4288	Selec t one of t he followi ng:
	4289	R RELEASED
	4290	N NOT RELEAS ED
	4291	A ALL
	4292	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	4293	Select one of th e followin g:
	4294	S Specific C lose Claim Reason
	4295	A ALL
	4296	Include (S )pecific C lose Claim Reason or (A)LL: AL L// <Enter >
	4297	Selec t one of t he followi ng:
	4298	V VETERAN
	4299	T TRICARE
	4300	C CHAMPVA
	4301	A ALL
	4302	Include Ce rtain Elig ibility Ty pe or (A)l l: V// ALL
	4303	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	4304	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	4305	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	4306	DEVICE: HO ME// <Ente r> IP netw ork
	4307	Please wai t...
	4308	Example 8. 1.8-2: Clo sed Claims Report
	4309	ECME CLOSE D CLAIMS D ETAIL REPO RT P rint Date: APR 17, 2 009@14:21: 22 Page: 1
	4310	DIVISION(S ): ALL Fill Lo cations: C ,M,W Fill type: RT, BB,RS
	4311	Insurance: ALL Close Rea son: ALL Drugs/ Classes: A LL
	4312	Eligibilit y: ALL
	4313	RELEASED P RESCRIPTIO NS BY CLOS E DATE: Fr om 03/18/0 9 through 04/17/09
	4314	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	4315	PATIENT NA ME Pt.ID ELIG RX# REF/EC ME# RX I NFO DRUG NDC
	4316	CARDHOL D.ID GROUP ID CLOSE DAT E/TIME C LOSED BY CLO SE REASON
	4317	RX COB
	4318	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	4319	DIVISION: YYYYYYYY
	4320	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	4321	ECME1 INSU RANCE
	4322	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	4323	ECMEPATIEN T,TWO (XXXX) T RI 102446 $ 0/00000 00113727 W RT D S/R DACAR BAZINE 100 MG INJ 00 026-8151-1 0
	4324	1234098 7 10001 03/20/09 03:55PM E CMEUSER,ON E IN VALID NDC FROM CMOP
	4325	p
	4326	Claim ID: VA2009=500 0000021=00 0010=00054 94
	4327	54:Non-M atched Pro duct/Servi ce ID Numb er
	4328	SUBTOTALS for INS: E CMEUSER,ON E
	4329	ECMEPAT ,ONE 1
	4330	-----
	4331	CLOSED CLA IMS SUBTOT AL 1
	4332	SUBTOTALS for DIV:YY YYYYYY
	4333	ECMEUSE R,ONE 1
	4334	-----
	4335	CLOSED CLA IMS SUBTOT AL 1
	4336	GRAND TOTA LS (ALL DI VISIONS) B Y BILLER
	4337	ECMEUSE R,ONE 1
	4338	-----
	4339	CLOSED CLA IMS GRAND TOTAL 1
	4340	8.1.9 Non- Billable S tatus Repo rt XE " No n-Billable Status Re port"
	4341	The ECME R eports men u includes a Non-Bil lable Stat us Report for ECME R xs. This r eport prov ides users with a to ol to easi ly identif y prescrip tions that the ePhar macy softw are determ ines are n ot being b illed (e.g ., OTC pro ducts, no insurance on file or not activ e). The re port ensur es that pr escription s are bill ed for TRI CARE and/o r CHAMPVA patients i n a timely manner.
	4342	You must h old the BP SMENU and BPS REPORT S keys to view the N on-Billabl e Status R eport opti on. Access the repor t by enter ing NBS at the “Sele ct Claim R esults and Status Op tion:” pro mpt on the Claim Res ults and S tatus opti on screen.
	4343	Example 8. 1.9-1: Acc essing the Non-Billa ble Status Report Op tion
	4344	*** ****** ****** ****** ****** **
	4345	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4346	* XXXXX V AMC *
	4347	* Cla im Results and Statu s *
	4348	*** ****** ****** ****** ****** **
	4349	PAY Payable Cl aims Repor t
	4350	REJ Rejected C laims Repo rt
	4351	ECMP CMOP/ECME Activity R eport
	4352	REV Reversal C laims Repo rt
	4353	NYR Claims Sub mitted, No t Yet Rele ased
	4354	REC Recent Tra nsactions
	4355	DAY Totals by Date
	4356	CLO Closed Cla ims Report
	4357	NBS Non-Billab le Status Report
	4358	SPA Spending A ccount Rep ort
	4359	Select Cla im Results and Statu s Option: NBS Non-B illable St atus Repor t
	4360	After you have made selections from the “ALL REPOR TS” prompt s, you wil l be given a series of prompts as shown below:
	4361	Example 8. 1.9-2: Sel ecting Non -Billable Status Rep ort option
	4362	Selec t one of t he followi ng:
	4363	D DIVISION
	4364	A ALL
	4365	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: DIVI SION
	4366	Select ECM E Pharmacy Division( s): GEN ERIC PHARM ACY
	4367	Selected :
	4368	GENERIC PH ARMACY
	4369	Select ECM E Pharmacy Division( s):
	4370	Selec t one of t he followi ng:
	4371	S Summary
	4372	D Detail
	4373	Display (S )ummary or (D)etail Format: De tail//
	4374	Selec t one of t he followi ng:
	4375	I SPECIFIC I NSURANCE(S )
	4376	A ALL
	4377	Select Cer tain (I)NS URANCE or (A)LL): A/ / LL
	4378	Selec t one of t he followi ng:
	4379	C CMOP
	4380	M Mail
	4381	W Window
	4382	A ALL
	4383	Display (C )MOP or (M )ail or (W )indow or (A)LL: ALL //
	4384	Selec t one of t he followi ng:
	4385	D Drug
	4386	C Drug Class
	4387	A ALL
	4388	Display Sp ecific (D) rug or Dru g (C)lass or (A)LL: ALL//
	4389	START WITH TRANSACTI ON DATE: T -1// T-10 (MAY 29, 2015)
	4390	GO TO TRAN SACTION DA TE: T// T (JUN 08, 2015)
	4391	Selec t one of t he followi ng:
	4392	R RELEASED
	4393	N NOT RELEAS ED
	4394
	4395	A
	4396
	4397	ALL
	4398	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: ALL//
	4399	R Most Recen t
	4400	A ALL
	4401	Select Mos t (R)ecent or (A)ll: MOST RECE NT//
	4402	Selec t one of t he followi ng:
	4403	E ELIGIBILIT Y
	4404	A ALL
	4405	Select Cer tain (E)li gibilities or (A)LL: ALL//
	4406	Selec t one of t he followi ng:
	4407	S NON-BILLAB LE STATUS
	4408	A ALL
	4409	Select Cer tain Non-B illable (S )tatus or (A)ll: ALL //
	4410	Do you wan t to captu re report data for a n Excel do cument? NO //
	4411	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	4412	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	4413	DEVICE: HO ME// HOM E (CRT) Right Ma rgin: 80// 132
	4414	Please wai t...
	4415	Example 8. 1.9-3: Non -Billable Status Rep ort
	4416	ECME RXs W ITH Non-Bi llable STA TUS REPORT
	4417
	4418
	4419	Print Date : Sept 26, 2014@11:4 1:54 Page : 1
	4420	DIVISION(S ): GENERIC Fill Locat ions: C,M, W
	4421	Insurance: ALL D rugs/Class es: ALL
	4422	Eligibilit ies: ALL
	4423	NON-BILLAB LE STATUS: ALL
	4424	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 2/22/0 9 through 09/23/14
	4425	========== ========== ========== ========== ========== ========== ========== ========== ========== =======
	4426	PATIENT NA ME Pt. ID ELIG RX# REF DATE $DRUG COST
	4427	DRUG NDC REL EASED ON RX INFO NON-B ILLABLE ST ATUS
	4428	========== ========== ========== ========== ========== ========== ========== ========== ========== =======
	4429	DIVISION: GENERIC DI VISION
	4430	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------
	4431	GENERIC IN S
	4432	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------
	4433	ECMEpatien t,One (XX XX) TRI ######$ 2 04/15/ 09 5 1.00
	4434	AMITRI PTYLINE 10 MG TAB 00182-10 18-10 04/ 15/09 W AC/R Plan not active , local
	4435	ECMEpatien t, Three (XX XX) VET ######$ 0 03/10/ 09 5 1.00
	4436	METHAD ONE 10MG T AB 000054-8 554-2 03/ 10/09 W EX/N Plan not linked to Payer
	4437	------ ----
	4438	SUBTOTALS for INS:GE NERIC INS
	4439	102.00
	4440	COUNT
	4441	2
	4442	MEAN
	4443	51.00
	4444	Press RETU RN to cont inue
	4445	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------
	4446	GENERIC IN SURANCE 2
	4447	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------
	4448	ECMEpatien t, Two (XX XX) VET 100574$ 0 03/05/ 09 5 1.00
	4449	NEODEC ADRON OPHT MALIC SOL. 00006-76 39-03 03/ 05/08 W AC/R Plan n ot found
	4450	ECMEpatien t, Two (XX XX) VET 100575$ 0 03/05/ 09 5 1.00
	4451	PENTAE RYTHRITOL 10MG TAB 00725-20 64-10 03/ 05/08 W AC/R Plan D eactivated
	4452	...
	4453	SUBTOTALS for INS:GE NERIC INSU RANCE 2 214 2.00
	4454	COUNT 42
	4455	MEAN 5 1.00
	4456	------ ----
	4457	SUBTOTALS for DIV:GE NERIC DIVI SION 224 4.00
	4458	COUNT 44
	4459	MEAN 5 1.00
	4460	------ ----
	4461	GRAND TOTA LS 224 4.00
	4462	COUNT 44
	4463	MEAN 5 1.00
	4464	Press RETU RN to cont inue:
	4465	(This page included for two-si ded copyin g.
	4466	8.1.10 Spe nding Acco unt Report XE " Spen ding Accou nt Report"
	4467	The Spendi ng Account Report op tion lists the balan ce from th e patient’ s spending account a fter the s pecific tr ansaction was applie d, the amo unt from t he health plan-funde d assistan ce account that was applied to the Patie nt Pay Amo unt and th e various amounts st ill to be collected from the p atient.
	4468	Access the report by entering SPA at the “Select C laim Resul ts and Sta tus Option :” prompt on the Cla im Results and Statu s option s creen.
	4469	Example 8. 1.10-1: Ac cessing th e Spending Account R eport Opti on
	4470	*** ****** ****** ****** ****** **
	4471	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4472	* XXXXX V AMC *
	4473	* Cla im Results and Statu s *
	4474	*** ****** ****** ****** ****** **
	4475	PAY Payable Cl aims Repor t
	4476	REJ Rejected C laims Repo rt
	4477	ECMP CMOP/ECME Activity R eport
	4478	REV Reversal C laims Repo rt
	4479	NYR Claims Sub mitted, No t Yet Rele ased
	4480	REC Recent Tra nsactions
	4481	DAY Totals by Date
	4482	CLO Closed Cla ims Report
	4483	NBS Non-Billab le Status Report
	4484	SPA Spending A ccount Rep ort
	4485	Select Cla im Results and Statu s Option: SPA Spe nding Acco unt Report
	4486	Example 8. 1.10-2: Se lecting Sp ending Acc ount Repor t Option
	4487	Selec t one of t he followi ng:
	4488	D DIVISION
	4489	A ALL
	4490	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: DIVI SION
	4491	Select ECM E Pharmacy Division( s): XXXXXX X
	4492	Selected :
	4493	XXXXXXXX
	4494	Select ECM E Pharmacy Division( s): YYYYYY Y CBOC X XX
	4495	Selected :
	4496	XXXXXXXX
	4497	XXXXX
	4498	Select ECM E Pharmacy Division( s):
	4499	Selec t one of t he followi ng:
	4500	S Summary
	4501	D Detail
	4502	Display (S )ummary or (D)etail Format: De tail//
	4503	Selec t one of t he followi ng:
	4504	I SPECIFIC I NSURANCE(S )
	4505	A ALL
	4506	Select Cer tain (I)NS URANCE or (A)LL): A/ / ALL
	4507	Selec t one of t he followi ng:
	4508	C CMOP
	4509	M Mail
	4510	W Window
	4511	A ALL
	4512	Display (C )MOP or (M )ail or (W )indow or (A)LL: ALL //
	4513	Selec t one of t he followi ng:
	4514	R Real Time Fills
	4515	B Backbill
	4516	S ReSubmissi on
	4517	A ALL
	4518	Display (R )ealTime, (B)ackbill s, (P)RO O ption, Re( S)ubmissio n or (A)LL : A//
	4519	Selec t one of t he followi ng:
	4520	D Drug
	4521	C Drug Class
	4522	A ALL
	4523	Display Sp ecific (D) rug or Dru g (C)lass or (A)LL: ALL//
	4524	START WITH TRANSACTI ON DATE: T -1//
	4525	GO TO TR ANSACTION DATE: T//
	4526	Selec t one of t he followi ng:
	4527	R RELEASED
	4528	N NOT RELEAS ED
	4529	A ALL
	4530	Include R xs - (R)EL EASED or ( N)OT RELEA SED or (A) LL: RELEAS ED//
	4531	Selec t one of t he followi ng:
	4532	S Specific R eject Code
	4533	A ALL
	4534	Include ( S)pecific Reject Cod e or (A)LL : ALL//
	4535	Do you wan t to captu re report data for a n Excel do cument? NO //
	4536	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	4537	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	4538	DEVICE: HO ME//
	4539	Please wai t...
	4540	Example 8. 1.10-3: Sp ending Acc ount Repor t – Summar y
	4541	ECME SPEND ING ACCOUN T REPORT S UMMARY REP ORT P rint Date: DEC 02, 2 011@16:51: 34 Page: 1
	4542	DIVISION(S ): ALL F ill Locati ons: C,M,W Fill typ e: RT,BB,P 2,RS
	4543	Insurance: ALL Dru gs/Classes : ALL
	4544	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 06/05/ 11 through 12/02/11
	4545	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	4546	PATIENT NA ME Pt. ID RX# REF /ECME# DA TE $BILLED $IN S RESPONSE $COLLE CT
	4547	DRUG RX INFO INS GR OUP# I NS GROUP N AME BILL#
	4548	$PROVI DER NETWOR K $BRAND DRUG $N ON-PREF FO RM $BRA ND NON-PRE F FORM $COVERAGE GAP $HEA LTH ASST $SPEND AC CT REMAINI NG
	4549	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	4550	DIVISION: XXXXXX
	4551	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	4552	-- -------- ---------- -------- --
	4553	SUBTOTALS for INS:EP HARM INSUR ANCE 12.00 999999.99 0. 00
	4554	0.00 0 .00 0.00 0.00 0.0 0 0.00 12.3 0
	4555	COUNT 1 1 1
	4556	1 1 1 1 1 1 1
	4557	MEAN 12.00 999999.99 0. 00
	4558	0.00 0 .00 0.00 0.00 0.0 0 0.00 12.3 0
	4559	-- -------- ---------- -------- --
	4560	SUBTOTALS for INS:EX PRESS SCRI PTS 9 99999.99 999999.99 0. 00
	4561	0.00 0 .00 0.00 0.00 0.0 0 0.00 15.4 1
	4562	COUNT 1 1 1
	4563	1 1 1 1 1 1 1
	4564	MEAN 9 99999.99 999999.99 0. 00
	4565	0.00 0 .00 0.00 0.00 0.0 0 0.00 15.4 1
	4566	-- -------- ---------- -------- --
	4567	SUBTOTALS for DIV:XX XXXX 10 00011.99 1999999.98 0. 00
	4568	0.00 0 .00 0.00 0.00 0.0 0 0.00 27.7 1
	4569	COUNT 2 2 2
	4570	2 2 2 2 2 2 2
	4571	MEAN 5 00006.00 999999.99 0. 00
	4572	0.00 0 .00 0.00 0.00 0.0 0 0.00 13.8 6
	4573	-- -------- ---------- -------- --
	4574	GRAND TOTA LS 10 00011.99 1999999.98 0. 00
	4575	0.00 0 .00 0.00 0.00 0.0 0 0.00 27.7 1
	4576	COUNT 2 2 2
	4577	2 2 2 2 2 2 2
	4578	MEAN 5 00006.00 999999.99 0. 00
	4579	0.00 0 .00 0.00 0.00 0.0 0 0.00 13.8 6
	4580	Press RETU RN to cont inue:
	4581	Example 8. 1.10-4: Sp ending Acc ount Repor t – Detail
	4582	ECME SPEND ING ACCOUN T REPORT D ETAIL REPO RT P rint Date: DEC 02, 2 011@17:16: 36 Page: 1
	4583	DIVISION(S ): ALL F ill Locati ons: C,M,W Fill typ e: RT,BB,P 2,RS
	4584	Insurance: ALL Dru gs/Classes : ALL
	4585	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 06/05/ 11 through 12/02/11
	4586	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	4587	PATIENT NA ME Pt. ID RX# REF /ECME# DA TE $BILLED $IN S RESPONSE $COLLE CT
	4588	DRUG RX INFO INS GR OUP# I NS GROUP N AME BILL#
	4589	$PROVI DER NETWOR K $BRAND DRUG $N ON-PREF FO RM $BRA ND NON-PRE F FORM $COVERAGE GAP $HEA LTH ASST $SPEND AC CT REMAINI NG
	4590	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	4591	DIVISION: XXXXXX
	4592	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	4593	EPHARM INS URANCE
	4594	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	4595	OPCOB,ONEC NF (16 6P) 27193 07 0/4 316136 08 /24/11 12.00 999999.99 0. 00
	4596	ATENOLOL 25MG TAB W P2 EX/R T00010 E PHARM INSU RANCE K1000F7
	4597	0.00 0.00 0. 00 0.00 0.00 0.00 12.30
	4598	Claim ID: VA2011=405 0000015=00 0010=00010 47
	4599	-- -------- ---------- -------- --
	4600	SUBTOTALS for INS:EP HARM INSUR ANCE 12.00 999999.99 0. 00
	4601	0.00 0 .00 0.00 0.00 0.0 0 0.00 12.3 0
	4602	COUNT 1 1 1
	4603	1 1 1 1 1 1 1
	4604	MEAN 12.00 999999.99 0. 00
	4605	0.00 0 .00 0.00 0.00 0.0 0 0.00 12.3 0
	4606	EXPRESS SC RIPTS
	4607	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	4608	OPCOB,ONEC NF (16 6P) 27193 07 0/4 316136 08 /24/11 9 99999.99 999999.99 0. 00
	4609	ATENOLOL 25MG TAB W P2 EX/R T10000 0 E XPRESS SCR IPTS K1000F6
	4610	0.00 0.00 0. 00 0.00 0.00 0.00 15.41
	4611	Claim ID: VA2011=405 0000015=00 0010=00010 46
	4612	-- -------- ---------- -------- --
	4613	SUBTOTALS for INS:EX PRESS SCRI PTS 9 99999.99 999999.99 0. 00
	4614	0.00 0 .00 0.00 0.00 0.0 0 0.00 15.4 1
	4615	COUNT 1 1 1
	4616	1 1 1 1 1 1 1
	4617	MEAN 9 99999.99 999999.99 0. 00
	4618	0.00 0 .00 0.00 0.00 0.0 0 0.00 15.4 1
	4619	-- -------- ---------- -------- --
	4620	SUBTOTALS for DIV:XX XXXX 10 00011.99 1999999.98 0. 00
	4621	0.00 0 .00 0.00 0.00 0.0 0 0.00 27.7 1
	4622	COUNT 2 2 2
	4623	2 2 2 2 2 2 2
	4624	MEAN 5 00006.00 999999.99 0. 00
	4625	0.00 0 .00 0.00 0.00 0.0 0 0.00 13.8 6
	4626	-- -------- ---------- -------- --
	4627	GRAND TOTA LS 10 00011.99 1999999.98 0. 00
	4628	0.00 0 .00 0.00 0.00 0.0 0 0.00 27.7 1
	4629	COUNT 2 2 2
	4630	2 2 2 2 2 2 2
	4631	MEAN 5 00006.00 999999.99 0. 00
	4632	0.00 0 .00 0.00 0.00 0.0 0 0.00 13.8 6
	4633	Press RETU RN to cont inue:
	4634	8.2 Other Reports XE " Other R eports"
	4635	The Other Reports op tion allow s you to a ccess list s of elect ronic clai ms formats and NCPDP V. D0 fie lds.
	4636	Access the Other Rep orts optio n by enter ing OTH at the “Sele ct Pharmac y Electron ic Claims Reports Op tion:” pro mpt on the Pharmacy Electronic Claims Re ports opti on screen.
	4637	Example 8. 2-1: Acces sing the O ther Repor ts Option
	4638	*** ****** ****** ****** ****** **
	4639	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4640	* XXXX X *
	4641	* Pharmacy Electroni c Claims R eports *
	4642	*** ****** ****** ****** ****** **
	4643	CLA Claim Resu lts and St atus ...
	4644	OTH Other Repo rts ...
	4645	Select Pha rmacy Elec tronic Cla ims Report s Option: OTH Other Reports
	4646	Example 8. 2-2: Displ aying Othe r Reports Options
	4647	*** ****** ****** ****** ****** **
	4648	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4649	* XXXX X *
	4650	* Other Re ports *
	4651	*** ****** ****** ****** ****** **
	4652	CRI ECME Claim s-Response Inquiry
	4653	PAY Payer Shee t Detail R eport
	4654	PHAR ECME Setup - Pharmac ies Report
	4655	TAT Turn-aroun d time sta tistics
	4656	VER View ePhar macy Rx
	4657	OPR OPECC Prod uctivity R eport
	4658	Select Oth er Reports Option:
	4659	8.2.1 ECME Claims-Re sponse Inq uiry Optio n XE " ECM E Claims-R esponse In quiry"
	4660	The ECME C laims-Resp onse Inqui ry option allows the user to e nter a VA Claim ID a nd see the transacti on data, t he claim d ata sent t o the thir d-party pa yer and th e response data that was retur ned. This option may assist th e sites an d/or the V istA Maint enance Pro ject (VMP) team in d etermining the cause of a reje ct that is received from a pay er.
	4661	Access the ECME Clai ms-Respons e Inquiry option by entering C RI at the “Select Ot her Report s Option:” prompt on the Pharm acy Electr onic Claim s Reports, Other Rep orts optio n screen.
	4662	Example 8. 2.1-1: Acc essing the ECME Clai ms-Respons e Inquiry Option
	4663	*** ****** ****** ****** ****** **
	4664	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4665	* XXXX X *
	4666	* Other Re ports *
	4667	*** ****** ****** ****** ****** **
	4668	CRI ECME Claim s-Response Inquiry
	4669	PAY Payer Shee t Detail R eport
	4670	PHAR ECME Setup - Pharmac ies Report
	4671	TAT Turn-aroun d time sta tistics
	4672	VER View ePhar macy Rx
	4673	OPR OPECC Prod uctivity R eport
	4674	Select Oth er Reports Option: C RI ECME C laims-Resp onse Inqui ry
	4675	Example 8. 2.1-2: ECM E Claims-R esponse In quiry Opti on
	4676	Select VA Claim ID: VA2009=500 0000021=10 5220=00055 24 VA2009 =500000002 1=105220=0
	4677	005524
	4678	Note: This report co ntains thr ee separat e sections - transac tion data, claims
	4679	data , and resp onse data. There wi ll be a pa ge break/f orm feed a fter
	4680	each section r egardless of the pag e length s pecified i n the devi ce input.
	4681	DEVICE: HO ME// <Ente r> UCX/T ELNET R ight Margi n: 80// < Enter>
	4682	ECME Claim s-Response Inquiry R eport Pr int Date: 04/17/09
	4683	VA CLAIM I D: VA2009= 5000000021 =105220=00 05524
	4684	BPS TRANSA CTION/BPS LOG OF TRA NSACTION D ATA:
	4685	ENTRY#: 11 3414.00042 STATUS: 99
	4686	PHARMACY : PHARM1 PRESCRIPTI ON #: 1021 79
	4687	RXI-INTE RNAL (c): 113414
	4688	PLAN NAM E: COB INS URANCE PHARMACY P LAN ID: VA 105220
	4689	CLAIM IE N (c): 552 4 RESPONSE I EN (c): 53 69
	4690	Press RETU RN to cont inue, '^' to exit:
	4691	BPS CLAIMS FILE DATA :
	4692	CLAIM ID: VA2009=500 0000021=10 5220=00055 24
	4693	ELECTRON IC PAYER: MNMEDB1 TRANSMIT F LAG: YES ( POINT OF S ALE)
	4694	TRANSMIT TED ON: AP R 17,2009@ 14:54:27 CREATED ON : APR 17,2 009@14:54: 27
	4695	TRANSACT ION: 11341 4.00042 PATIENT NA ME: ECMEpa tient,One
	4696	GROUP IN SURANCE PL AN: COB IN SURANCE BIN NUMBER : 610459
	4697	VERSION RELEASE NU MBER: D0 TRANSACTIO N CODE: B1
	4698	PROCESSO R CONTROL NUMBER: MH CP TRANSACTIO N COUNT: 1
	4699	SOFTWARE VENDER CE RT ID: SERVICE PR OVIDER ID: 500000002 1
	4700	SERVICE PROVIDER I D QUAL: 01 GROUP ID: C19977
	4701	CARDHOLD ER ID: C2X XXXXX PERSON COD E: C301
	4702	DATE OF BIRTH: C4X XXXXXXX PATIENT GE NDER CODE: MALE
	4703	PATIENT RELATIONSH IP CODE: C ARDHOLDER
	4704	PLACE OF SERVICE: C700 ELIGIBILIT Y CLARIFIC ATION CODE : C90
	4705	PATIENT FIRST NAME : CAONE PATIENT LA ST NAME: C BECMEPATIE NT
	4706	CARDHOLD ER FIRST N AME: CCONE
	4707	CARDHOLD ER LAST NA ME: CDECME PATIENT
	4708	HOME PLA N: CE36
	4709	PATIENT STREET ADD RESS: CM13 DFG
	4710	PATIENT CITY ADDRE SS: CNXXXX XXXX
	4711	PATIENT STATE PROV ADDRESS: COXX PATIENT ZI P POSTAL Z ONE: CPXXX XX
	4712	PATIENT PHONE NUMB ER: CQXXXX XXXXX PATIENT ID QUALIFIER : CX01
	4713	PATIENT ID: CYXXXX XXXX EMPLOYER I D: CZ
	4714	SMOKER I NDICATOR: 1C PREGNANCY INDICATOR: 2C
	4715	FACILITY ID: 8C
	4716	MEDICATION ORDER: 1 MEDICATION NAME: BET AZOLE 50MG /ML INJ
	4717	PRESCRIP TION NUMBE R: 102179 OTHER COVE RAGE CODE: C800
	4718	ALTERNAT E ID: CW00 0000000000 00000000
	4719	COB OTHER PAYMENT CO UNTER: 4C1 OTHER PAYE R COVERAGE TYPE: 5C0 1
	4720	OTHER PA YER ID QUA LIFIER: 6C 03 OTHER PAYE R ID: 7C12 3456
	4721	OTHER PA YER DATE: APR 14,200 9 OTHER PAYE R AMOUNT P AID COUNT: HB1
	4722	OTHER PA YER REJECT COUNT: 5E 00
	4723	OTHER PAYE R AMT PAID QUALIFIER : HC08 OTHER PAYE R AMOUNT P AID: DV004 00{
	4724	DATE OF SE RVICE: APR 14,2009 PR ESCRIPTION REFERENCE NUMBER: D 20113414
	4725	FILL NUM BER: D304 DAYS SUPPL Y: D5001
	4726	COMPOUND CODE: D61
	4727	PRODUCT SERVICE ID : D7000021 43916
	4728	DISPENSE AS WRITTE N: D80 INGREDIENT COST SUBM ITTED: D90 000510{
	4729	PRESCRIB ER ID: DBX XXXXXXXX DISPENSING FEE SUBMI TTED: DC00 000000
	4730	DATE PRE SCRIPTION WRITTEN: D E20090112
	4731	NUMBER O F REFILLS AUTHORIZED : DF05 LEVEL OF S ERVICE: DI 00
	4732	PRESCRIP TION ORIGI N CODE: DJ 1 SUBMISSION CLARIFICA TION CODE: DK00
	4733	BASIS OF COST DETE RMINATION: DN07 USUAL AND CUSTOMARY CHARGE: DQ 0000510{
	4734	SPECIAL PACKAGING INDICATOR: DT0 GROSS AMOU NT DUE: DU 0000510{
	4735	PRESCRIB ER LAST NA ME: ECMEPR ESCRIBER
	4736	OTHER PA YER AMOUNT : DV00400{
	4737	PATIENT PAID AMOUN T SUBMITTE D: DX00000 00{
	4738	PRODUCT SERVICE ID QUALIFIER : E103 QUANTITY D ISPENSED: E700000010 00
	4739	ORIGINAL LY PRESCRI BED QUANTI TY: EB0000 001000
	4740	SCHEDULE D RX ID NU MBER: EK00 0000000000
	4741	PRESCRIP TION SERVI CE REFEREN CE: EM1 QUANTITY P RESCRIBED: ET0000001 000
	4742	PRIOR AU THORIZATIO N TYPE COD E: EU00
	4743	PRIOR AU THORIZATIO N SUBMITTE D: EV00000 000000
	4744	INTERMED IARY AUTH TYPE ID: E W00
	4745	INTERMED IARY AUTHO RIZATION I D: EX
	4746	PRESCRIB ER ID QUAL IFIER: EZ0 1 PRESCRIBER LOCATION CODE: 1E
	4747	PC PROVI DER LOCATI ON CODE: H 5036 PC PROVIDE R LAST NAM E: 4EECMEP ROVIDER
	4748	PROFESSI ONAL FEE S UBMITTED: BE00000000
	4749	FLAT SAL ES TAX SUB MITTED: HA 00000000
	4750	PERCENTA GE SALES T AX SUBMITT ED: GE0000 000{
	4751	PERCENTA GE SALES T AX RATE: H E0000000 PERCENTAGE SALES TAX BASIS: JE
	4752	PRESCRIB ER PHONE N UMBER: PMX XXXXXXXXX
	4753	DATE OF SERVICE: 2 0090414 PLAN ID: F OECME INS
	4754	RAW DATA SENT:
	4755	61045951B 1MHCP 101500000 0021 2 0090414
	4756	AM01CX01C YXXXXXXXXX C41960010 1C51CAONEC BECMEPATIE NT CM13
	4757	DFG CNX XXXXXXX C OXXCPXXXXX CQXXXX XXXXXXC700
	4758	CZ 1C 2C
	4759	AM04C2234 234CCONECD ECMEPATIEN T CE36 FOECME INS C908C C1997 7
	4760	C301 C61
	4761	AM07EM1D2 0113414E10 3D70000214 3916 E7000000 1000D304D5 001D61D80D E20090112D
	4762	F05DJ1DK00 ET00000010 00C800DT0E B000000100 0CW0000000 0000000000 000EK00000 0000000DI0
	4763	0EU00EV000 00000000EW 00EX
	4764	AM02
	4765	AM03EZ01D BXXXXXXXXX X 1E ECMEPRESC RIBER H50364 EECMEPROVI DER
	4766	AM054C15C 016C037C12 3456 E8 20090414HB 1DV00400{
	4767	AM11D9000 0510{DC000 00000BE000 00000DX000 0000{HA000 00000GE000 0000{HE000 0000JE DQ
	4768	0000510{DU 0000510{DN 07
	4769	Press RETU RN to cont inue, '^' to exit:
	4770	BPS RESPON SE FILE DA TA:
	4771	BPS CLAIM: VA2009=50 00000021=1 05220=0005 524
	4772	DATE RES PONSE RECE IVED: APR 17, 2009@1 4:54:30
	4773	VERSION RELEASE NU MBER: D0 TRANSACTIO N CODE: B1
	4774	TRANSACT ION COUNT: 1 SERVICE PR OVIDER ID: XXXXXXXXX X
	4775	SERVICE PROVIDER I D QUALIFIE R: 01 DATE OF SE RVICE: APR 14,2009
	4776	RESPONSE STATUS: R EJECTED
	4777	MESSAGE: EV161-MAN DATORY FIE LD HC MISS ING IN SEG 05
	4778	MEDICATION ORDER: 1 TRANSACTIO N RESPONSE STATUS: R EJECTED
	4779	PRESCRIP TION RESPO NSE STATUS : REJECTED CLAIM
	4780	REJECT C OUNT: 04
	4781	REJECT COD E: 85 (Cla im Not Pro cessed)
	4782	REJECT COD E: NN (Tra nsaction R ejected At Switch Or Intermedi ary
	4783	REJECT COD E: R8 (Syn tax Error)
	4784	REJECT COD E: HC (M/I Other Pay er Amount Paid Quali fier)
	4785	REJECT COD E: 79 (REF ILL TOO SO ON)
	4786	NEXT AVA IL FILL DA TE: APR 20 ,2009
	4787	RAW DATA RECEIVED:
	4788	VA2009=XX XXXXXXXX=1 05220=000x xxxxxB11R0 1XXXXXXXXX X
	4789	20090414\ X1E\\X1C\A M20\X1C\F4 EV161-MAND ATORY FIEL D HC MISSI NG IN SEG
	4790	05\X1D\\X 1E\\X1C\AM 21\X1C\ANR \X1C\FA04\ X1C\FB85\X 1C\FBNN\X1 C\FBR8\X1C \FBHC
	4791	Press RETU RN to cont inue:
	4792	8.2.2 Paye r Sheet De tail Repor t Option X E " Payer Sheet Deta il"
	4793	The Payer Sheet Deta il Report option all ows you to list the informatio n on payer sheets us ed for ele ctronic cl aims. Paye r sheets a re templat es defined by each p ayer used to create NCPDP tran smissions. The sheet s indicate which fie lds to sen d in the t ransmissio ns, as wel l as the a cceptable values tha t may appe ar in the fields. Yo u may also express c onditions for when p articular values are to be use d.
	4794	Access the Payer She et Detail Report opt ion by ent ering PAY at the “Se lect Other Reports O ption:” pr ompt on th e Pharmacy Electroni c Claims R eports, Ot her Report s option s creen.
	4795	Example 8. 2.2-1: Acc essing the Payer She et Detail Report Opt ion
	4796	*** ****** ****** ****** ****** **
	4797	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4798	* XXXXX V AMC *
	4799	* Other Re ports *
	4800	*** ****** ****** ****** ****** **
	4801	CRI ECME Claim s-Response Inquiry
	4802	PAY Payer Shee t Detail R eport
	4803	PHAR ECME Setup - Pharmac ies Report
	4804	TAT Turn-aroun d time sta tistics
	4805	VER View ePhar macy Rx
	4806	OPR OPECC Prod uctivity R eport
	4807	Select Oth er Reports Option: P AY Payer Sheet Deta il Report
	4808	Example 8. 2.2-2: Pay er Sheet D etail Repo rt Option
	4809	Select Pay er Sheet: ABCTEST1
	4810	DEVICE: HO ME// IP network
	4811	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 1
	4812	Payer Sh eet Name: ABCTEST1 Version Number: 7
	4813	Status: PRODUCTION NCPDP Version: V ersion D.0
	4814	Seq Field Fie ld Name Proc Mode
	4815	--- ----- --- ------- ---------
	4816	* Trans action Hea der Segmen t *
	4817	1 101-A 1 BIN NUMBER S
	4818	2 102-A 2 VER SION/RELEA SE NUMBER S
	4819	3 103-A 3 TRA NSACTION C ODE S
	4820	5 104-A 4 PRO CESSOR CON TROL NUMBE R S
	4821	17 202-B 2 SER V PROVIDER ID QUALIF IER S
	4822	19 201-B 1 SER VICE PROVI DER ID S
	4823	21 401-D 1 DAT E FILLED S
	4824	Press RETU RN to cont inue, '^' to exit: < Enter>
	4825	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 2
	4826	Payer Sh eet Name: ABCTEST1 Version Number: 7
	4827	Seq Field Fie ld Name Proc Mode
	4828	--- ----- --- ------- ---------
	4829	* Trans action Hea der Segmen t *
	4830	22 110-A K SOF TWARE VEND OR/CERT ID S
	4831	* Patient Se gment *
	4832	31 111-A M SEG MENT IDENT IFICATION S
	4833	33 331-C X PAT IENT ID QU ALIFIER S
	4834	35 332-C Y PAT IENT ID S
	4835	36 304-C 4 DAT E OF BIRTH S
	4836	37 305-C 5 SEX CODE S
	4837	39 307-C 7 CUS TOMER LOCA TION S
	4838	40 335-2 C PRE GNANCY IND ICATOR S
	4839	* I nsurance S egment *
	4840	49 111-A M SEG MENT IDENT IFICATION S
	4841	51 302-C 2 CAR DHOLDER ID NUMBER S
	4842	53 301-C 1 GRO UP NUMBER S
	4843	Press RETU RN to cont inue, '^' to exit: < Enter>
	4844	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 3
	4845	Payer Sh eet Name: ABCTEST1 Version Number: 7
	4846	Seq Field Fie ld Name Proc Mode
	4847	--- ----- --- ------- ---------
	4848	* I nsurance S egment *
	4849	54 306-C 6 REL ATIONSHIP CODE S
	4850	* Claim Seg ment *
	4851	64 111-A M SEG MENT IDENT IFICATION S
	4852	66 455-E M RX/ SERVICE RE F NUMBER Q UAL S
	4853	69 402-D 2 PRE SCRIPTION NUMBER S
	4854	71 436-E 1 PRO DUCT/SERV ID QUAL S
	4855	73 407-D 7 PRO DUCT/SERVI CE ID S
	4856	75 442-E 7 QUA NTITY DISP ENSED S
	4857	77 403-D 3 NEW /REFILL CO DE S
	4858	78 405-D 5 DAY S SUPPLY S
	4859	79 406-D 6 COM POUND CODE S
	4860	80 408-D 8 OTH ER COVERAG E CODE S
	4861	82 414-D E DAT E PRESCRIP TION WRITT EN S
	4862	85 308-C 8 OTH ER COVERAG E CODE S
	4863	Press RETU RN to cont inue, '^' to exit: < Enter>
	4864	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 4
	4865	Payer Sh eet Name: ABCTEST1 Version Number: 7
	4866	Seq Field Fie ld Name Proc Mode
	4867	--- ----- --- ------- ---------
	4868	* Claim Seg ment *
	4869	87 429-D T UNI T DOSE IND ICATOR S
	4870	89 453-E J ORI G PRESCR P ROD/SERV I D QUAL S
	4871	92 445-E A ORI G PRESCRIB ED PROD/SE RV CODE S
	4872	95 446-E B ORI GINALLY PR ESCRIBED Q TY S
	4873	97 418-D I LEV EL OF SERV ICE S
	4874	99 461-E U PRI OR AUTHORI ZATION TYP E CODE S
	4875	102 462-E V PRI OR AUTHORI ZATION NUM SUB S
	4876	106 463-E W INT ERMED AUTH TYPE ID S
	4877	109 464-E X INT ERMEDIARY AUTHORIZAT ION ID S
	4878	112 343-H D DIS PENSING ST ATUS S
	4879	114 344-H F QTY INTENDED TO BE DISP ENSED S
	4880	117 345-H G DAY S SUPPLY I NTEND TO B E DISP S
	4881	* Pharm acy Provid er Segment *
	4882	127 111-A M SEG MENT IDENT IFICATION S
	4883	Press RETU RN to cont inue, '^' to exit: < Enter>
	4884	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 5
	4885	Payer Sh eet Name: ABCTEST1 Version Number: 7
	4886	Seq Field Fie ld Name Proc Mode
	4887	--- ----- --- ------- ---------
	4888	* Pharm acy Provid er Segment *
	4889	129 465-E Y PRO VIDER ID Q UALIFIER S
	4890	131 444-E 9 PRO VIDER ID S
	4891	* P rescriber Segment *
	4892	140 111-A M SEG MENT IDENT IFICATION S
	4893	142 466-E Z PRE SCRIBER ID QUALIFIER S
	4894	144 411-D B PRE SCRIBER ID S
	4895	146 427-D R PRE SCRIBER LA ST NAME S
	4896	148 498-P M PRE SCRIBER TE LEPHONE NU MBER S
	4897	150 468-2 E PRI MARY CARE PROV ID QU AL S
	4898	153 421-D L PRI MARY PRESC RIBER S
	4899	155 469-H 5 PRI M CARE PRO V LOCATION CODE S
	4900	158 470-4 E PRI M CARE PRO VIDER LAST NAME S
	4901	Press RETU RN to cont inue, '^' to exit: < Enter>
	4902	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 6
	4903	Payer Sh eet Name: ABCTEST1 Version Number: 7
	4904	Seq Field Fie ld Name Proc Mode
	4905	--- ----- --- ------- ---------
	4906	* COB/O ther Payme nts Segmen t *
	4907	168 111-A M SEG MENT IDENT IFICATION S
	4908	170 337-4 C COB /OTHER PAY MENTS COUN TER S
	4909	172 338-5 C OTH ER PAYER C OVERAGE TY PE S
	4910	174 339-6 C OTH ER PAYER I D QUALIFIE R S
	4911	177 340-7 C OTH ER PAYER I D S
	4912	180 443-E 8 Oth er Payer D ate S
	4913	182 341-H B OTH ER PAYER A MOUNT PAID COUNT S
	4914	185 342-H C OTH PYR AMOUN T PAID QUA L. S
	4915	188 431-D V OTH ER PAYOR A MOUNT S
	4916	190 471-5 E OTH ER PAYER R EJECT COUN T S
	4917	192 472-6 E OTH ER PAYER R EJECT CODE S
	4918	* Workers ' Compensa tion Segme nt *
	4919	202 111-A M SEG MENT IDENT IFICATION S
	4920	205 434-D Y DAT E OF INJUR Y S
	4921	Press RETU RN to cont inue, '^' to exit: < Enter>
	4922	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 7
	4923	Payer Sh eet Name: ABCTEST1 Version Number: 7
	4924	Seq Field Fie ld Name Proc Mode
	4925	--- ----- --- ------- ---------
	4926	* Workers ' Compensa tion Segme nt *
	4927	* DUR/PPS Se gment *
	4928	213 111-A M SEG MENT IDENT IFICATION S
	4929	215 473-7 E DUR /PPS CODE COUNTER S
	4930	218 439-E 4 DUR CONFLICT CODE S
	4931	220 440-E 5 DUR INTERVENT ION CODE S
	4932	222 441-E 6 DUR OUTCOME C ODE S
	4933	224 474-8 E DUR /PPS LEVEL OF EFFORT S
	4934	227 475-J 9 DUR CO-AGENT ID QUALIFI ER S
	4935	230 476-H 6 DUR CO-AGENT ID S
	4936	* Pricing Se gment *
	4937	240 111-A M SEG MENT IDENT IFICATION S
	4938	242 409-D 9 ING REDIENT CO ST S
	4939	244 412-D C DIS PENSING FE E SUBMITTE D S
	4940	Press RETU RN to cont inue, '^' to exit: < Enter>
	4941	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 8
	4942	Payer Sh eet Name: ABCTEST1 Version Number: 7
	4943	Seq Field Fie ld Name Proc Mode
	4944	--- ----- --- ------- ---------
	4945	* Pricing Se gment *
	4946	246 477-B E PRO FESSIONAL SERV FEE S UBMIT S
	4947	249 433-D X PAT IENT PAID AMOUNT S
	4948	252 481-H A FLA T SALES TA X AMOUNT S UBMIT S
	4949	255 482-G E PER CENTAGE SA LES TAX AM T SUB S
	4950	258 484-J E PER CENT SALES TAX BASIS SUB S
	4951	261 426-D Q USU AL & CUSTO MARY CHARG E S
	4952	264 430-D U GRO SS AMOUNT DUE S
	4953	266 423-D N BAS IS OF COST DETERMINA TION S
	4954	* Coupon Se gment *
	4955	275 111-A M SEG MENT IDENT IFICATION S
	4956	277 485-K E COU PON TYPE S
	4957	278 486-M E COU PON NUMBER S
	4958	279 487-N E COU PON VALUE AMOUNT S
	4959	Press RETU RN to cont inue, '^' to exit: < Enter>
	4960	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 9
	4961	Payer Sh eet Name: ABCTEST1 Version Number: 7
	4962	Seq Field Fie ld Name Proc Mode
	4963	--- ----- --- ------- ---------
	4964	* Compound S egment *
	4965	288 111-A M SEG MENT IDENT IFICATION S
	4966	290 450-E F Com pound Dose Form Desc Code S
	4967	293 451-E G Com pound Disp ense Unt F orm Ind S
	4968	295 452-E H Com pound Rout e of Admin S
	4969	297 447-E C Com pound Ingr ed Comp Co unt S
	4970	299 488-R E Com pound Prod uct ID Qua lifier S
	4971	301 489-T E Com pound Prod uct ID S
	4972	302 448-E D Com pound Ingr edient Qua ntity S
	4973	304 449-E E Com pound Ingr edient Dru g Cost S
	4974	307 490-U E Com p Ingred B asis Cost Determ S
	4975	Press RETU RN to cont inue:
	4976	8.2.3 ECME Setup – P harmacies Report XE " ECME Set up - Pharm acies"
	4977	This optio n will pro duce a rep ort that d isplays se tup inform ation for each pharm acy config ured for a facility.
	4978	Access the report by entering PHAR at th e “Select Other Repo rts Option :” prompt on the Pha rmacy Elec tronic Cla ims Report s, Other R eports opt ion screen .
	4979	Example 8. 2.3-1: Acc essing ECM E Setup – Pharmacies Report Op tion
	4980	*** ****** ****** ****** ****** **
	4981	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4982	* XXXXX V AMC *
	4983	* Other Re ports *
	4984	*** ****** ****** ****** ****** **
	4985	CRI ECME Claim s-Response Inquiry
	4986	PAY Payer Shee t Detail R eport
	4987	PHAR ECME Setup - Pharmac ies Report
	4988	TAT Turn-aroun d time sta tistics
	4989	VER View ePhar macy Rx
	4990	OPR OPECC Prod uctivity R eport
	4991	Select Set up (Config uration) R eports Opt ion: PHAR ECME Setup - Pharmac ies Report
	4992	DEVICE: IP network
	4993	Example 8. 2.3-2: ECM E Setup - Pharmacies Report Op tion
	4994	BPS PHARMA CIES LIST SEP 9,2005 07:17 P AGE 1
	4995	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	4996	NU MBER: 2
	4997	NAME: XXXX XXXXX NCPDP #: X XXXXXX
	4998	DEFAULT DEA #: AGX XXXX CMOP SWITC H: CMOP ON
	4999	AUTO-REV ERSE PARAM ETER: 0 STATUS: AC TIVE
	5000	SITE ADD RESS 1: 10 1 MAIN STR EET
	5001	SITE CIT Y: XXXXXXX XX SITE STATE : XXXXX
	5002	SITE ZIP CODE: XXX XX SITE ADDRE SS NAME: 1 01 MAIN ST REET
	5003	HOURS OF OPERATION : 24 START DAY RANGE: MON
	5004	END DAY RANGE: MON START HOUR RANGE: 08 00
	5005	END HOUR RANGE: 16 00~TUE NPI: XXXXX XXXXX
	5006	DATE/TIM E OF LAST NPI CHANGE : OCT 10, 2006@15:05 :05
	5007	OUTPATIENT SITE: XXX XXXXXXXXX
	5008	REMITTAN CE ADDRESS NAME: MAI N REMIT ADDR ESS 1: 101 MAIN STRE ET
	5009	REMIT CI TY: XXXXXX XXX REMIT STAT E: XXXXXX
	5010	REMIT ZI P: XXXXX VA CONTACT : CONTACT, ONE
	5011	VA ALTER NATE CONTA CT: CONTAC T,ONE VA LEAD PHAR MACIST: CO NTACT,ONE
	5012	VA LEAD PHARMACIST LICENSE # : XXXXXXXX
	5013	Monday C lose Time: 1600 Tuesday Cl ose Time: 1600
	5014	Wednesda y Close Ti me: 1600 Thursday C lose Time: 1600
	5015	Friday C lose Time: 1600 Saturday C lose Time: 1600
	5016	Monday O pen Time: 0800 Tuesday Op en Time: 0 800
	5017	BPS PHARMA CIES LIST SEP 09, 2005@ 17:17 P AGE 2
	5018	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5019	Wednesda y Open Tim e: 0800 Thursday O pen Time: 0800
	5020	Friday O pen Time: 0800 Saturday O pen Time: 0800
	5021	NU MBER: 3
	5022	NAME: XXXX XXXXXXX NCPDP #: X XXXXXX
	5023	DEFAULT DEA #: AGX XXXX CMOP SWITC H: CMOP ON
	5024	AUTO-REV ERSE PARAM ETER: 2 STATUS: AC TIVE
	5025	SITE ADD RESS 1: 10 1 MAIN AVE
	5026	SITE CIT Y: XXXXXXX XXXX SITE STATE : XXXXXX
	5027	SITE ZIP CODE: XXX XX SITE ADDRE SS NAME: 1 01 MAIN AV E
	5028	HOURS OF OPERATION : 24 START DAY RANGE: MON
	5029	END DAY RANGE: MON START HOUR RANGE: 08 00
	5030	END HOUR RANGE: 16 00~TUE NPI: 00000 00006
	5031	DATE/TIM E OF LAST NPI CHANGE : OCT 10, 2006@15:05 :05
	5032	OUTPATIENT SITE: XXX XXXXXXX VA
	5033	OUTPATIENT SITE: XXX XXXXXX CBO C
	5034	OUTPATIENT SITE: XXX XX VA CBOC
	5035	REMITTAN CE ADDRESS NAME: XXX XXXXXXX XX XXXX
	5036	REMIT AD DRESS 1: 1 01 XXXXXXX XXXXXXXXX
	5037	REMIT CI TY: XXXXXX XXXXX REMIT STAT E: XXXXXXX X
	5038	REMIT ZI P: XXXXX VA CONTACT : CONTACT, ONE
	5039	VA ALTER NATE CONTA CT: CONTAC T,TWO
	5040	VA LEAD PHARMACIST : PHARMACI ST,ONE Monday Cl ose Time: 1600
	5041	Tuesday Close Time : 1600 Wednesday Close Time : 1600
	5042	Thursday Close Tim e: 1600 Friday Clo se Time: 1 600
	5043	BPS PHARMA CIES LIST SEP 09, 2005@ 17:17 P AGE 3
	5044	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5045	Saturday Close Tim e: 1600 Monday Ope n Time: 08 00
	5046	Tuesday Open Time: 0800 Wednesday Open Time: 0800
	5047	Thursday Open Time : 0800 Friday Ope n Time: 08 00
	5048	Saturday Open Time : 0800
	5049	Press ENTE R to conti nue:
	5050	8.2.4 Turn -around ti me statist ics XE " T urn-around time stat istics"
	5051	The Turn-a round time statistic s option s hows the l ength of t ime for cl aims to co mplete, in cluding br eakouts fo r various steps of c laims crea tion. The end of the report ha s the aver age time f or the cla ims displa yed.
	5052	Access the Turn-arou nd time st atistics o ption by e ntering TA T at the “ Select Oth er Reports Option:” prompt on the Pharma cy Electro nic Claims Reports, Other Repo rts option screen.
	5053	Example 8. 2.4-1: Acc essing the Turn-arou nd time st atistics R eport Opti on
	5054	*** ****** ****** ****** ****** **
	5055	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	5056	* XXXXX V AMC *
	5057	* Other Re ports *
	5058	*** ****** ****** ****** ****** **
	5059	CRI ECME Claim s-Response Inquiry
	5060	PAY Payer Shee t Detail R eport
	5061	PHAR ECME Setup - Pharmac ies Report
	5062	TAT Turn-aroun d time sta tistics
	5063	VER View ePhar macy Rx
	5064	OPR OPECC Prod uctivity R eport
	5065	Select Oth er Reports Option: T AT Turn-a round time statistic s
	5066	Example 8. 2.4-2: Dis playing th e Turn-aro und time s tatistics Report
	5067	START WITH DATE: T-1 // <Enter > (SEP 08, 2005)
	5068	GO TO DATE : T// <En ter> (SEP 09, 2005)
	5069	For Prescr iption: 1106378.00 001 (Rx#: 382992)
	5070	Begin 08:19:48
	5071	Gathering informatio n 08:19:52
	5072	Claim ID c reated 08:19:55
	5073	Claim Sent 08:19:56
	5074	Response s tored 08:20:04
	5075	Completed at: 08:20:04
	5076	Turn-aroun d time 16
	5077	For Prescr iption: 1106380.00 001 (Rx#: 382994)
	5078	Begin 08:19:48
	5079	Gathering informatio n 08:19:52
	5080	Claim ID c reated 08:19:55
	5081	Claim Sent 08:20:16
	5082	Response s tored 08:20:18
	5083	Completed at: 08:20:18
	5084	Turn-aroun d time 30
	5085	For Prescr iption: 1106379.00 001 (Rx#: 382993)
	5086	Begin 08:19:48
	5087	Gathering informatio n 08:19:52
	5088	Claim ID c reated 08:19:55
	5089	Claim Sent 08:20:06
	5090	Response s tored 08:20:08
	5091	Completed at: 08:20:08
	5092	Turn-aroun d time 20
	5093	For Prescr iption: 1106384.00 001 (Rx#: 909952)
	5094	Begin 11:27:13
	5095	Gathering informatio n 11:27:15
	5096	Claim ID c reated 11:27:16
	5097	Claim Sent 11:27:17
	5098	Response s tored 11:27:23
	5099	Completed at: 11:27:23
	5100	Turn-aroun d time 10
	5101	For Prescr iption: 1106386.00 001 (Rx#: 909954)
	5102	Begin 11:27:13
	5103	Gathering informatio n 11:27:15
	5104	Claim ID c reated 11:27:17
	5105	Claim Sent 11:27:37
	5106	Response s tored 11:27:39
	5107	Completed at: 11:27:39
	5108	Turn-aroun d time 26
	5109	Average Tu rn-around time: 13
	5110	8.2.5 View ePharmacy Rx
	5111	The View e Pharmacy R x option a llows you to view in formation for one pr escription , combinin g informat ion from O utpatient Pharmacy, Integrated Billing a nd ECME.
	5112	Access the View ePha rmacy Rx o ption by e ntering VE R at the “ Select Oth er Reports Option:” prompt on the Pharma cy Electro nic Claims Reports, Other Repo rts option screen.
	5113	Example 8. 2.5-1: Acc essing the View ePha rmacy Rx R eport Opti on
	5114	*** ****** ****** ****** ****** **
	5115	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	5116	* ALASKA V AHSRO *
	5117	* Other Re ports *
	5118	*** ****** ****** ****** ****** **
	5119	CRI ECME Claim s-Response Inquiry
	5120	PAY Payer Shee t Detail R eport
	5121	PHAR ECME Setup - Pharmac ies Report
	5122	TAT Turn-aroun d time sta tistics
	5123	VER View ePhar macy Rx
	5124	OPR OPECC Prod uctivity R eport
	5125	Select Oth er Reports Option: VER View ePharmacy Rx
	5126	Example 8. 2.5-2: Dis playing th e View ePh armacy Rx Report
	5127	Select Pre scription: 2055346
	5128	ATE NOLOL 25MG TAB
	5129	Patient Rx# Dru g Name Rx Stat us
	5130	ECMEPATIE NT,ONE 20553 46 TAM OXIFEN CIT RATE 10MG TA DISCONT INUED
	5131	OK to cont inue? Yes/ / YES
	5132	Rx# 205534 6 has the following fills:
	5133	Fill# Fill Dat e Rele ase Date
	5134	----- -------- -- ---- --------
	5135	0 01/29/20 09 01/2 9/2009
	5136	1 02/26/20 09 02/2 5/2009
	5137	Select Fil l Number: 1 02/26/20 09 02/2 6/2009
	5138	Selec t one of t he followi ng:
	5139	M Most recen t transact ion for ea ch payer
	5140	A All transa ctions
	5141	There ar e 2 ECME t ransaction s for this Rx/fill.
	5142	1 for th e primary payer, 1 f or the sec ondary pay er.
	5143	Select Mos t recent t ransaction for each payer or A ll transac tions: M// All trans
	5144	actions
	5145	Compiling data for V iew Prescr iptions .. .
	5146	Compiling data for t he ECME Cl aim Log .. .
	5147	Compiling data for t he ECME Bi lling Even ts Report ...
	5148	Compiling data for t he ECME Cl aims-Respo nse Inquir y (CRI) Re port ...
	5149	Compiling data for V iew Insura nce Polici es ... ... .......... ......
	5150	Compiling the list o f TPJI bil ls ...
	5151	Compiling data for T PJI Claim Informatio n ...
	5152	Compiling data for T PJI AR Acc ount Profi le ...
	5153	Compiling data for T PJI AR Com ment Histo ry ...
	5154	Compiling data for T PJI ECME R x Response ...
	5155	Compiling data for V iew Regist ration Eli gibility S tatus ...
	5156	Compiling data for V iew Regist ration Eli gibility V erificatio n ...
	5157	View Presc ription
	5158	Rx View (D iscontinue d) Feb 08, 2 011@13:59: 27 P age: 1 of 1
	5159	ECMEPATIEN T,ONE
	5160	PID: 666 -87-4529 Ht(cm): _ ______ (__ ____)
	5161	DOB: OCT 18,1963 ( 47) Wt(kg): _ ______ (__ ____)
	5162	+--------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	5163	Rx # : 2055346$ e (ECME#: 000001615 253)
	5164	Orde rable Item : TAMOXIFE N CITRATE TAB
	5165	CMOP Drug : TAMOXIFE N CITRATE 10MG TAB
	5166	NDC : 00378-01 44-93
	5167	*Dosage : 10MG
	5168	Verb : TAKE
	5169	Disp ense Units : 1
	5170	Noun : TABLET
	5171	*Route : ORAL (BY MOUTH)
	5172	*Schedule : BID
	5173	Patient In structions :
	5174	SIG : TAKE ONE TABLET BY MOUTH TWI CE A DAY
	5175	Pati ent Status : OUTPT NO N-SC
	5176	Issue Date : 01/29/09 Fil l Date: 01 /29/09
	5177	Last Fill Date : 02/26/09 (Mail, Tr ansmitted)
	5178	Last Re lease Date : 02/25/09 Lot #:
	5179	Expires : 01/30/10 MFG:
	5180	D ays Supply : 3 QT Y (TAB): 6 0
	5181	# of Refills : 11 Rem aining: 9
	5182	Provider : ECMEPROV IDER,ONE
	5183	Routing : Window
	5184	Copies : 1
	5185	Method of Pickup :
	5186	Clinic : Not on F ile
	5187	Division: DNS ENNE VAM&R OC (442)
	5188	Pharmacist : ECMEPROV IDER,ONE
	5189	Patient Counseling : NO
	5190	Remarks : New Orde r Created by copying Rx # 2055 345.
	5191	F inished By : ECMEPROV IDER,ONE
	5192	Entry B y: ECMEPRO VIDER,ONE Entry Da te: 01/29/ 09 12:59:3 8
	5193	Original F ill Releas ed: 02/25/ 09 Ro uting: Win dow
	5194	Refill Lo g:
	5195	# Log Dat e Refill Date Qty Routi ng Lot # Phar macist
	5196	========== ========== ========== ========== ========== ========== ========== =========
	5197	1 02/25/ 09 02/25 /09 60 Mail
	5198	Division: 442 Dispensed: 02/25/09 Released : 2/25/09 NDC: 0037 8-0144-91
	5199	2 02/25/ 09 02/26 /09 60 Mail
	5200	Division: 442 Dispensed: 02/26/09 Released :
	5201	Partial Fi lls:
	5202	# Log Da te Date Qty Routing Lot # Pharm acist
	5203	========== ========== ========== ========== ========== ========== ========== =========
	5204	There are NO Partial s for this Prescript ion
	5205	Activity L og:
	5206	# Date Reas on Rx Ref Init iator Of A ctivity
	5207	========== ========== ========== ========== ========== ========== ========== =========
	5208	1 02/25/ 09 SUSP ENSE REFILL 1 ECME PROVIDER,O NE
	5209	Comments: RX Placed on Suspens e for CMOP until 02- 25-09
	5210	2 02/25/ 09 PROC ESSED REFILL 1 ECME PROVIDER,O NE
	5211	Comments: Transmitte d to DALLA S CMOP
	5212	3 02/25/ 09 SUSP ENSE REFILL 2 ECME PROVIDER,O NE
	5213	Comments: RX Placed on Suspens e for CMOP until 02- 26-09
	5214	4 02/25/ 09 SUSP ENSE REFILL 2 ECME PROVIDER,O NE
	5215	Comments: 3/4 of Day s Supply S USPENSE HO LD until 2 /28/09.
	5216	5 03/01/ 09 PROC ESSED REFILL 2 ECME PROVIDER,O NE
	5217	Comments: Transmitte d to DALLA S CMOP
	5218	6 06/11/ 09 DISC ONTINUED REFILL 2 ECME PROVIDER,T WO
	5219	Comments: Discontinu ed During New Prescr iption Ent ry - Dupli cate Drug
	5220	Copay Acti vity Log:
	5221	# Date Reas on Rx Ref Initiato r Of Activ ity
	5222	========== ========== ========== ========== ========== ========== ========== =========
	5223	There's NO Copay act ivity to r eport
	5224	Label Log:
	5225	# Date Rx R ef Printed By
	5226	========== ========== ========== ========== ========== ========== ========== =========
	5227	1 02/25/ 09 ORIG INAL ECMEPROV IDER,ONE
	5228	Comments: From RX nu mber 20553 46
	5229	ECME Log:
	5230	# Date/T ime Rx Ref Initiator Of Activit y
	5231	========== ========== ========== ========== ========== ========== ========== =========
	5232	1 1/29/0 9@12:59:55 ORIGIN AL ECMEPROVID ER,ONE
	5233	Comments: Submitted to ECME:WI NDOW FILL( NDC:00378- 0144-93)-E REJECTED
	5234	2 2/25/0 9@16:49:16 ORIGIN AL ECMEPROVID ER,ONE
	5235	Comments: Submitted to ECME:RE JECT WORKL IST-E PAYA BLE
	5236	3 2/25/0 9@16:51:03 REFILL 1 ECMEPROVID ER,ONE
	5237	Comments: Submitted to ECME:CM OP TRANSMI SSION(NDC: 00378-0144 -91)
	5238	4 3/1/09 @14:00:05 REFILL 2 ECMEPROVID ER,ONE
	5239	Comments: Submitted to ECME:CM OP TRANSMI SSION(NDC: 00378-0144 -91)
	5240	ECME REJEC T Log:
	5241	# Date/Ti me Rcvd Rx Ref Reject Ty pe STA TUS Da te/Time Re solved
	5242	========== ========== ========== ========== ========== ========== ========== =========
	5243	1 1/29/09 @12:59:54 ORIGINAL REFILL TO O SOON RES OLVED 2/ 25/09@16:4 9:04
	5244	Comments: AUTOMATICA LLY CLOSED (CLAIM RE -SUBMITTED )
	5245	CMOP Event Log:
	5246	Date/Time Rx Ref TRN-Order Stat Comment s
	5247	========== ========== ========== ========== ========== ========== ========== =========
	5248	02/25/09@1 656 Ref 1 16346-1 DISP ND C: 0037801 4491
	5249	Carrier: U SPS Pkg ID: P GKID999
	5250	03/01/09@1 403 Ref 2 16360-1 TRAN
	5251	CMOP Lot#/ Expiration Date Log:
	5252	Rx Ref Lot # Expiratio n Date
	5253	========== ========== ========== ========== ========== ========== ========== =========
	5254	Ref 1 A87904 03/22/07
	5255	ECME Claim Log
	5256	PHARMACY E CME Feb 08, 2011@14:0 6:41 Pag e: 1 of 1
	5257	Claim Log informatio n
	5258	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	5259	Pharmacy E CME Log
	5260	VA Rx #: 2055346$ Fill #: 1 ECM E #: 16152 53
	5261	Pati ent Name: ECMEPATIEN T,ONE (452 9)
	5262	Transactio n Number: 1615253.00 011
	5263	Last S ubmitted: FEB 25,200 9@16:51:03
	5264	Last Subm itted By: ECMEPROVID ER,ONE
	5265	Last VA Claim #: VA2009=116 4471991=00 0010=00012 35
	5266	Transmissi on Informa tion (CLAI M REQUEST) (#1236)--- ---------- ---------- ---------
	5267	Created on : FEB 25,2 009@16:51: 04
	5268	VA Claim I D: VA2009= 1164471991 =000010=00 01235
	5269	Submitted By: ECMEPR OVIDER,ONE
	5270	Transactio n Type: RE QUEST
	5271	Date of Se rvice: 02/ 25/2009
	5272	NDC: 00378 -0144-91
	5273	ECME Pharm acy: DNS 9-BOTH NPI & NCPDP
	5274	Days Suppl y: 3
	5275	Qty: 60 Unit Cos t: .928 Total Pr ice: 68.20
	5276	Insurance Name: BLUE MOON INSU RANCE
	5277	Group Name : T-GROUP1
	5278	Rx Coordin ation of B enefits: P RIMARY
	5279	BIN: 12345 6
	5280	PCN: 11234 56789
	5281	NCPDP Vers ion: D.0
	5282	Group ID: 10001
	5283	Cardholder ID:
	5284	Patient Re lationship Code: CAR DHOLDER
	5285	Cardholder First Nam e: ONE
	5286	Cardholder Last Name : OPPATIEN T
	5287	Billing Re quest Paye r Sheet: W BTESTB1
	5288	Reversal P ayer Sheet : WBTESTB2
	5289	Response I nformation (CLAIM R EQUEST)(#1 213)------ ---------- ---------- ---------
	5290	Response R eceived: F EB 25,2009 @16:51:10
	5291	Date of Se rvice: 02/ 25/2009
	5292	Transactio n Response Status: P aid
	5293	Total Amou nt Paid: $ 58.20
	5294	Reject cod e(s):
	5295	Message:
	5296	Additional Message:
	5297	DUR Respon se Info:
	5298	DUR Additi onal Text:
	5299	ECME CRI R EPORT DATA
	5300	ECME Claim s-Response Inquiry R eport Pr int Date: 02/08/11
	5301	VA CLAIM I D: VA2009= 1164471991 =000010=00 01235
	5302	BPS TRANSA CTION/BPS LOG OF TRA NSACTION D ATA:
	5303	ENTRY#: 16 15253.0001 1 STATUS: 99
	5304	PHARMACY: DNS 9-BOTH NPI & NCPDP PRESCRIPTI ON #: 2055 346
	5305	RXI-INTE RNAL (c): 1615253
	5306	PLAN NAM E: BLUE MO ON INSURAN CE PHARMACY P LAN ID: T0 0010
	5307	CLAIM IE N (c): 123 6 RESPONSE I EN (c): 12 13
	5308	BPS CLAIMS FILE DATA :
	5309	CLAIM ID: VA2009=116 4471991=00 0010=00012 35
	5310	ELECTRON IC PAYER: WBTESTB1 TRANSMIT F LAG: YES ( POINT OF S ALE)
	5311	TRANSMIT TED ON: FE B 25,2009@ 16:51:04 CREATED ON : FEB 25,2 009@16:51: 04
	5312	PATIENT NAME: ECME PATIENT,ON E
	5313	GROUP IN SURANCE PL AN: BLUE M OON INSURA NCE
	5314	BIN NUMB ER: 123456 VERSION RE LEASE NUMB ER: D.0
	5315	TRANSACT ION CODE: B1 PROCESSOR CONTROL NU MBER: 1123 456789
	5316	TRANSACT ION COUNT: 1 SOFTWARE V ENDER CERT ID: TATP
	5317	SERVICE PROVIDER I D: 1164471 991 SERVICE PR OVIDER ID QUAL: 01
	5318	GROUP ID : C110001 CARDHOLDER ID: C2
	5319	DATE OF BIRTH: C41 9631018 PATIENT GE NDER CODE: MALE
	5320	PATIENT FIRST NAME : CAONE PATIENT LA ST NAME: C BOPPATIENT
	5321	PATIENT STREET ADD RESS: CM32 OAK STREE T
	5322	PATIENT CITY ADDRE SS: CNBIRM INGHAM
	5323	PATIENT STATE PROV ADDRESS: COAL PATIENT ZI P POSTAL Z ONE: CP352 09
	5324	PATIENT PHONE NUMB ER: CQ2055 559874 PATIENT ID QUALIFIER : CX01
	5325	PATIENT ID: CY6668 74529
	5326	TRANSACTIO N ORDER: 1
	5327	MEDICATI ON NAME: T AMOXIFEN C ITRATE 10M G TAB
	5328	PRESCRIP TION NUMBE R: 2055346 OTHER COVE RAGE CODE: C800
	5329	SUBM CLA RIFICATION CODE COUN T: 1
	5330	SUBMISSION CLRFCTN C ODE CNTR: 1 SUBMISSION CLARIFICA TION CODE: DK02
	5331	DATE OF SERVICE: F EB 25,2009 PRESCRIPTI ON/SERVICE REF NO: D 21615253
	5332	FILL NUM BER: D301 DAYS SUPPL Y: D5003
	5333	COMPOUND CODE: D61
	5334	PRODUCT SERVICE ID : D7003780 14491
	5335	DISPENSE AS WRITTE N: D80 INGREDIENT COST SUBM ITTED: D90 000510{
	5336	PRESCRIB ER ID: DB DISPENSING FEE SUBMI TTED: DC00 000000
	5337	DATE PRE SCRIPTION WRITTEN: D E20090129
	5338	NUMBER O F REFILLS AUTHORIZED : DF11 PRESCRIPTI ON ORIGIN CODE: DJ1
	5339	*SUBMISS ION CLARIF ICATION CO DE: DK02 BASIS OF C OST DETERM INATION: D N07
	5340	USUAL AN D CUSTOMAR Y CHARGE: DQ0000510{
	5341	GROSS AM OUNT DUE: DU0000510{ PRESCRIBER LAST NAME : DROPPROV IDER
	5342	PATIENT PAID AMOUN T SUBMITTE D: DX00000 00{
	5343	PRODUCT SERVICE ID QUALIFIER : E103 QUANTITY D ISPENSED: E700000600 00
	5344	PRESCRIP TION SERVI CE REFEREN CE: EM1 QUANTITY P RESCRIBED: ET0000060 000
	5345	PRESCRIB ER ID QUAL IFIER: EZ0 1 PRESCRIBER LOCATION CODE: 1E
	5346	PC PROVI DER LOCATI ON CODE: H 5001 PC PROVIDE R LAST NAM E: 4EOPPRO VIDER
	5347	PRESCRIB ER PHONE N UMBER: PM0 001234567
	5348	DATE OF SERVICE: 2 0090225
	5349	RAW DATA SENT:
	5350	12345651B 1112345678 9101116447 1991 2 0090225TAT P
	5351	AM01CX01C Y666874529 C41963101 8C51CAONE CB OPPATIENT CM32
	5352	OAK STREET CNB IRMINGHAM C OALCP35209 CQ2055 559874
	5353	AM04C2C11 0001
	5354	AM07EM1D2 1615253E10 3D70037801 4491 E7000006 0000D301D5 003D61D80D E20090129D
	5355	F11DJ1DK02 ET00000600 00C800
	5356	AM02
	5357	AM03EZ01D B 1E DROPPROVI DER H50014EO PPROVIDER
	5358	AM11D9000 0510{DC000 00000DX000 0000{DQ000 0510{DU000 0510{DN07
	5359	BPS RESPON SE FILE DA TA:
	5360	BPS CLAIM: VA2009=11 64471991=0 00010=0001 235
	5361	DATE RES PONSE RECE IVED: FEB 25, 2009@1 6:51:10
	5362	VERSION RELEASE NU MBER: D.0 TRANSACTI ON CODE: B 1
	5363	TRANSACT ION COUNT: 1 SERVICE PR OVIDER ID: 116447199 1
	5364	SERVICE PROVIDER I D QUALIFIE R: 01 DATE OF SE RVICE: FEB 25,2009
	5365	RESPONSE STATUS: A CCEPTED
	5366	TRANSACTIO N ORDER: 1 TRANSACTIO N RESPONSE STATUS: P AID
	5367	PRESCRIP TION REFER ENCE NUMBE R: 1615253
	5368	RX REFER ENCE NUMBE R QUALIFIE R: RX BILL ING
	5369	HEADER R ESPONSE ST ATUS: CLAI M PAYABLE
	5370	AUTHORIZ ATION NUMB ER: WEBMD: PAID PATIENT PA Y AMOUNT: $ 10.00
	5371	INGREDIE NT COST PA ID: $ 55. 70 DISPENSING FEE PAID: $ 12.50
	5372	TOTAL AM OUNT PAID: $ 58.20 INCENTIVE AMOUNT PAI D: $ 1.2 5
	5373	BASIS OF REIMB DET ERMINATION : 08 TAX EXEMPT INDICATOR : NOT TAX EXEMPT
	5374	FLAT SAL ES TAX PAI D: $ 1.0 0 PROFESSION AL SERVICE FEE PAID: $ 4.54
	5375	OTHER AM OUNT PAID COUNT: 1 OTHER PAYE R AMOUNT R ECOGNIZED: $ 0.00
	5376	RAW DATA RECEIVED:
	5377	VA2009=11 64471991=0 00010=0001 23551B11A0 1116447199 1
	5378	20090225\ X1D\\X1E\\ X1C\AM21\X 1C\ANP\X1C \F3WEBMD:
	5379	PAID\X1E\ \X1C\AM22\ X1C\EM1\X1 C\D2161525 3\X1E\\X1C \AM23\X1C\ F50000100{ \X1C\F6000
	5380	0557{\X1C\ F70000125{ \X1C\AV2\X 1C\AW00000 10{\X1C\FL 0000012E\X 1C\J100000 45D\X1C\J2
	5381	1\X1C\J301 \X1C\J4000 0033C\X1C\ J50000000{ \X1C\F9000 0683B\X1C\ FM08
	5382	ECME BILLI NG EVENTS REPORT
	5383	PAGE 1
	5384	BILLI NG ECME EV ENTS (DETA ILED) for ALL DIVISI ONS
	5385	SINGLE PRESCRIPT ION – 2055 346 FILL # 1
	5386	RX# FILL DAT E PA TIENT NAME DRUG
	5387	========== ========== ========== ========== ========== ========== ========== ==========
	5388	1 205534 6 1 02/2 5/09 EC MEPATIENT, ONE TAMOXIFE N CITRATE 10MG TAB
	5389	FINI SH 02/2 5/09 4:51p Status:E CME Billab le
	5390	ELIGIBILIT Y: CV:No
	5391	DRUG:TAMOX IFEN CITRA TE 10MG TA B
	5392	NDC:00378- 0144-91, B ILLED QTY: 60, COST:. 928, DEA:6 PR
	5393	PLAN:T-GRO UP1 INSUR ANCE: BLUE MOON INSU RANCE
	5394	BIN:123456 , PCN:1123 456789, PA YER SHEET B1:WBTESTB 1
	5395	PAYER SHEE T B2:WBTES TB2, PAYER SHEET B3: WBTESTB1
	5396	DISPENSING FEE:0, BA SIS OF COS T DETERM:U SUAL & CUS TOMARY
	5397	COST:68.20 , GROSS AM T DUE:68.2 0, ADMIN F EE:12.50
	5398	USER:POSTM ASTER
	5399	SUBM IT 02/2 5/09 4:51p Status:O K
	5400	ECME#:0000 01615253, FILL DATE :02/25/09
	5401	PAYER RESP ONSE: PAYA BLE
	5402	PLAN:T-GRO UP1, INSUR ANCE: BLUE MOON INSU RANCE
	5403	USER:POSTM ASTER
	5404	RELE ASE 02/2 5/09 4:56p Status:O K
	5405	ECME#:0000 01615253, FILL DATE :02/25/09
	5406	USER:POSTM ASTER
	5407	BILL ING 02/2 5/09 4:56p Status:B ill# K9000 7W created
	5408	ECME#:0000 01615253, FILL DATE :02/25/09, RELEASE DA TE:02/25/0 9
	5409	DRUG:TAMOX IFEN CITRA TE 10MG TA B
	5410	NDC:00378- 0144-91, B ILLED QTY: 60, DAYS S UPPLY:3
	5411	BILLED:68. 20, PAID:5 8.20
	5412	PLAN:T-GRO UP1, INSUR ANCE: BLUE MOON INSU RANCE
	5413	USER:POSTM ASTER
	5414	List of al l bills fo r this Rx (all fills )
	5415	BI LL RX DATE INSURANC E COB PATIE NT
	5416	------ ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5417	1 K9 0007U 205 5346-0 01/29/09 BLUE MOO N INSURANC P ECMEP ATIENT,ONE
	5418	2 K9 0007W 205 5346-1 02/25/09 BLUE MOO N INSURANC P ECMEP ATIENT,ONE
	5419	View Patie nt Insuran ce
	5420	Patient Po licy Infor mation Feb 23, 2011@1 3:24:18 Page: 1 of 1
	5421	Expanded P olicy Info rmation fo r: ECMEPAT IENT,ONE 666-20-458 9
	5422	OPINSUR1 I nsurance C ompany Plan Curre ntly Activ e
	5423	Plan Inf ormation Insur ance Compa ny
	5424	Is Gro up Plan: Y ES Com pany: OPIN SUR1
	5425	Gro up Name: D RUG INS St reet: 32 C ATASTROPHE WAY
	5426	Group Number: 1 11 City/S tate: BIRM INGHAM, AL 35209
	5427	BIN: Billin g Ph:
	5428	PCN: Precer t Ph:
	5429	Type of Plan: P RESCRIPTIO N
	5430	Electron ic Type: C OMMERCIAL
	5431	Plan Fi ling TF:
	5432	ePh armacy Pla n ID: VA10 5220
	5433	ePhar macy Plan Name: MINN ESOTA MEDI CAID
	5434	ePharma cy Natl St atus: ACTI VE
	5435	ePharmac y Local St atus: ACTI VE
	5436	Utilizat ion Review Info Effective Dates & S ource
	5437	Require UR : NO Effec tive Date: 10/12/07
	5438	Requir e Amb Cert : Expira tion Date:
	5439	Requir e Pre-Cert : NO Sourc e of Info: INTERVIEW
	5440	Exclud e Pre-Cond : NO Policy Not Billable: NO
	5441	Benefits Assignable : YES
	5442	Subscrib er Informa tion Subscriber 's Employe r Informat ion
	5443	Whose In surance: V ETERAN E mp Sponsor ed Plan: N o
	5444	Subscrib er Name: E CMEPATIENT ,ONE Employer:
	5445	Relat ionship: S ELF Employment Status:
	5446	Pri mary ID: 5 43252 Retireme nt Date:
	5447	Coord. B enefits: P RIMARY C laims to E mployer: N o, Send to Insurance Company
	5448	Primary P rovider: Street:
	5449	Prim Pro v Phone: Cit y/State:
	5450	Phone:
	5451	Insure d Person's Informati on (use Su bscriber U pdate Acti on)
	5452	Ins ured's DOB : 10/18/19 63 Str 1: 1225 OAK L ANE
	5453	Ins ured's Sex : MALE Str 2:
	5454	Insure d's Branch : ARMY City: HOMEWOOD
	5455	Insu red's Rank : St/Zip: AL 35209
	5456	Phone: 2055555555
	5457	Insuranc e Company ID Numbers (use Subs criber Upd ate Action )
	5458	Subscri ber Primar y ID: 5432 52
	5459	Plan Cov erage Limi tations
	5460	Coverag e Effecti ve Date Covered? Limit Comments
	5461	------- - ------- ------- -------- ----- ---------
	5462	INPATIE NT 08/04/2 008 YES
	5463	07/11/2 008 YES
	5464	06/26/2 008 YES
	5465	02/26/2 008 YES
	5466	01/28/2 008 YES
	5467	10/12/2 007 YES
	5468	06/19/2 007 YES
	5469	04/13/2 007 YES
	5470	01/08/2 007 YES
	5471	06/17/2 006 YES
	5472	OUTPATI ENT 08/04/2 008 YES
	5473	07/11/2 008 YES
	5474	06/26/2 008 YES
	5475	02/26/2 008 YES
	5476	01/28/2 008 YES
	5477	10/12/2 007 YES
	5478	08/02/2 007 YES
	5479	06/19/2 007 YES
	5480	04/13/2 007 YES
	5481	01/08/2 007 YES
	5482	06/17/2 006 YES
	5483	PHARMAC Y 03/17/2 009 YES
	5484	08/06/2 008 YES
	5485	08/04/2 008 YES
	5486	07/11/2 008 YES
	5487	06/26/2 008 YES
	5488	DENTAL 08/04/2 008 YES
	5489	07/11/2 008 YES
	5490	06/26/2 008 YES
	5491	02/26/2 008 YES
	5492	01/28/2 008 YES
	5493	10/12/2 007 YES
	5494	08/02/2 007 YES
	5495	06/19/2 007 YES
	5496	04/13/2 007 YES
	5497	01/08/2 007 YES
	5498	06/17/2 006 YES
	5499	MENTAL HEALTH 08/04/2 008 YES
	5500	07/11/2 008 YES
	5501	06/26/2 008 YES
	5502	02/26/2 008 YES
	5503	01/28/2 008 YES
	5504	10/12/2 007 YES
	5505	08/02/2 007 YES
	5506	06/19/2 007 YES
	5507	04/13/2 007 YES
	5508	01/08/2 007 YES
	5509	06/17/2 006 YES
	5510	LONG TE RM CARE BY DEFAULT
	5511	User Inf ormation Insuranc e Contact (last)
	5512	Ent ered By: E LLZEY,LIND A Person C ontacted:
	5513	Ent ered On: 1 0/12/07 Method of Contact: PHONE
	5514	Last Veri fied By: E LLZEY,LIND A Contact 's Phone:
	5515	Last Veri fied On: 0 2/07/08 Call Ref. No.:
	5516	Last Upd ated By: E LLZEY,LIND A Cont act Date: APR 15, 20 09
	5517	Last Upd ated On: 0 4/15/09
	5518	Comment -- Patient Policy
	5519	None
	5520	Comment -- Group P lan
	5521	Personal Riders
	5522	TPJI – Cla im Informa tion
	5523	Claim Info rmation Fe b 08, 2011 @14:36:24 P age: 1 of 1
	5524	K90007We ECMEPATIE NT,ONE O4 529 DOB: 10 /18/63 S ubsc ID:
	5525	TPJI – Cla im Informa tion
	5526	Claim Info rmation Fe b 08, 2011 @14:36:24 P age: 1 of 1
	5527	K90007We ECMEPATIE NT,ONE O4 529 DOB: 10 /18/63 S ubsc ID:
	5528	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	5529	Insuranc e Demograp hics Subscrib er Demogra phics
	5530	Bill P ayer: BLUE MOON INSU RANCE Group N umber: 100 01
	5531	Claim Add ress: 321 MOON DRIVE Group Name: T-G ROUP1
	5532	BIRM INGHAM, AL 35209 Subscrib er ID:
	5533	Claim P hone: Emp loyer: USA ARMY CONS ULTANTS
	5534	Insured's Name: ECM EPATIENT,O NE
	5535	Relatio nship: PAT IENT
	5536	C laim Infor mation
	5537	Bill Typ e: OUTPATI ENT Charge Type:
	5538	Time Fram e: ADMIT T HRU DISCHA RGE Service Dates: 02/ 25/09 - 02 /25/09
	5539	Rate Typ e: REIMBUR SABLE INS. Orig Claim: 68.20
	5540	AR Statu s: ACTIVE Balanc e Due: 10.00
	5541	Sequenc e: PRIMARY
	5542	Purch Sv c: NO
	5543	ECME N o: 1615253
	5544	ECME Ap N o: WEBMD: PAID
	5545	NP I: 1164471 991
	5546	Provider s: NONE
	5547	En tered: 02/ 25/09 by POSTMASTE R
	5548	Autho rized: 02/ 25/09 by POSTMASTE R
	5549	First Pr inted: 02/ 25/09 by POSTMASTE R
	5550	Related Prescripti on Copay I nformation
	5551	<none f ound>
	5552	TPJI – AR Account Pr ofile
	5553	AR Account Profile Feb 08, 2011@1 4:46:24 Page: 1 of 1
	5554	K90007We ECMEPATIE NT,ONE O4 529 DOB: 10 /18/63 S ubsc ID:
	5555	AR Status: ACTIVE Orig Amt: 68.2 0 Bal ance Due: 10.00
	5556	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	5557	02/25/0 9 IB Sta tus: PRINT ED (First) 68.20 10.00
	5558	Total C ollected: 58 .20
	5559	TPJI – AR Comment Hi story
	5560	Comment Hi story Feb 08, 20 11@14:47:1 0 Page: 1 of 1
	5561	K90007We ECMEPATIE NT,ONE O4 529 DOB: 10 /18/63 S ubsc ID:
	5562	AR Status: ACTIVE Orig Amt: 68.2 0 Bal ance Due: 10.00
	5563	No Comment Transacti ons Exist For This A ccount.
	5564	TPJI – ECM E Claim In formation
	5565	ECME Claim Informati on F eb 08, 201 1@14:48:16 Pag e: 1 of 1
	5566	K90007We ECMEPATIE NT,ONE O4 529 DOB: 10 /18/63 S ubsc ID:
	5567	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	5568	ECME N o: 1615253 Pharmacy NPI: 1164 471991
	5569	ECME Ap N o: WEBMD: PAID Provider NPI: No N PI on file
	5570	Rx N o: 2055346 / 1 Fill Date: 02/2 5/09
	5571	Drug Nam e: TAMOXIF EN CITRATE 10MG TAB N DC #: 0037 8-0144-91
	5572	Billed Am t: 68.2 0 COB: Prim ary
	5573	IB Statu s: CANCEL LED (02/25 /09) Reas on: ECME PRESCRIPTI ON REVERSE D
	5574	Payment I nformation
	5575	Expecte d Payment Amount: 58.20
	5576	Ingredie nt Cost Re im Amt: 0.00 Disp ensing Fee Reim Amt: 0.00
	5577	Patient R esponsibil ity Amount s
	5578	Deducti ble: 0 .00 Co insurance: 0.00 Amount of Copay: 0.00
	5579	Coverage Gap: 0 .00 Proc essor Fee: 0.00 Exceed Be nefit Max: 0.00
	5580	Health Plan-funde d Assistan ce Amount: 0.00
	5581	Product S election A mounts
	5582	P rod Sel Am t: 0.0 0 Prod Sel /Non-Pref Formulary: 0.00
	5583	Prod Sel/B rand Drug: 0.00 Prod S el/Brand N on-Pref Fo rmulary: 0.00
	5584	Provider Network Ad j: 0.0 0
	5585	No COB/Ot her Payer Data on fi le in the ECME Respo nse.
	5586	ELIGIBIL ITY STATUS DATA, SCR EEN <7>
	5587	ECMEPATIEN T,ONE; 666 -20-4589 ACTIVE DUT Y
	5588	========== ========== ========== ========== ========== ========== ========== =========
	5589	<1> Patient Ty pe: ACTIVE DUTY Ve teran: YES
	5590	S vc Connect ed: YES SC Pe rcent: 20%
	5591	S C Award Da te: OCT 12 ,2007 Unemplo yable: NO
	5592	P &T: NO
	5593	R ated Incom p.: NO
	5594	Claim Numb er: 432432 22
	5595	Folder Lo c.: ALBUQU ERQUE
	5596	<2> Aid & Attendan ce: NO House bound: NO
	5597	VA Pensi on: NO VA Disab ility: NO
	5598	Total Check Amou nt: NOT AP PLICABLE
	5599	GI Insuran ce: NO A mount: UNA NSWERED
	5600	<3> Prima ry Elig Co de: SC LES S THAN 50%
	5601	Other Elig Code( s): NO ADD ITIONAL EL IGIBILITIE S IDENTIFI ED
	5602	Perio d of Servi ce: PERSIA N GULF WAR
	5603	<3.1> Comb at Vet Eli g.: EXPIRE D End Date : OCT 11, 2009
	5604	<4> Servic e Connecte d Conditio ns as stat ed by appl icant
	5605	------ ---------- ---------- ---------- ---------- -----
	5606	NONE S TATED
	5607	ELIGIBILIT Y VERIFICA TION DATA
	5608	EL IGIBILITY VERIFICATI ON DATA, S CREEN <11>
	5609	ECMEPATIEN T,ONE; 666 -20-4589 ACTIVE DUT Y
	5610	========== ========== ========== ========== ========== ========== ========== =========
	5611	<1> Eligib ility Stat us: NOT VE RIFIED Status D ate: NOT A PPLICABLE
	5612	Statu s Entered By: NOT AP PLICABLE
	5613	Inte rim Respon se: UNANSW ERED (NOT REQUIRED)
	5614	V erif. Meth od: NOT AP PLICABLE
	5615	V erif. Sour ce: NOT AV AILABLE
	5616	<2> Mo ney Verifi ed: NOT VE RIFIED
	5617	<3> Serv ice Verifi ed: NOT VE RIFIED
	5618	<4> Rated Disabiliti es: SC%: 20 EFF. DATE OF C OMBINED SC %:
	5619	Orig Curr
	5620	Rated D isability Extr Eff D t Eff Dt
	5621	NONE STATE D
	5622	8.2.6 OPEC C Producti vity Repor t XE " OPE CC Product ivity??"
	5623	The OPECC Productivi ty Report option all ows you to track the claims fo r users by transacti on date, w ith the op tion of a summary vi ew, detail view or E xcel downl oad format . If the c laim has b een submit ted multip le times i n the repo rt date ra nge, it wi ll appear on the rep ort only o nce with t he appropr iate count of transa ctions dis played und er the hea der: # of Transacti ons. The status dis played on the report reflects the status of the mo st recent transactio n. A tran saction is anything that resul ts in a cl aim submis sion from the ECME U ser Screen or any ba ck billing claim sub mission fr om Claims Tracking o r the PRO Process Se condary/TR ICARE Rx t o ECME opt ion. An O PECC actio n of open/ close clai m is not c onsidered a transact ion for th e OPECC pr oductivity report.
	5624	You must h old the BP S SUPERVIS OR key to view the O PECC Produ ctivity Re port optio n. Access the OPECC Productivi ty Report option by entering O PR at the “Select Ot her Report s Option:” prompt on the Pharm acy Electr onic Claim s Reports, Other Rep orts optio n screen.
	5625	Example 8. 2.6-1: Acc essing the OPECC Pro ductivity Report Opt ion
	5626	*** ****** ****** ****** ****** **
	5627	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	5628	* ALASKA V AHSRO *
	5629	* Other Re ports *
	5630	*** ****** ****** ****** ****** **
	5631	CRI ECME Claim s-Response Inquiry
	5632	PAY Payer Shee t Detail R eport
	5633	PHAR ECME Setup - Pharmac ies Report
	5634	TAT Turn-aroun d time sta tistics
	5635	VER View ePhar macy Rx
	5636	OPR OPECC Prod uctivity R eport
	5637	Select Oth er Reports Option: VER View ePharmacy Rx
	5638	Example 8.2.6-2: Prompts fo r the OPEC C Producti vity Repor t
	5639	Select Oth er Reports <TEST ACC OUNT> Opti on: OPR O PECC Produ ctivity Re port
	5640	Selec t one of t he followi ng:
	5641	D DIVISION
	5642	A ALL
	5643	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: A// LL
	5644	Selec t one of t he followi ng:
	5645	V VETERAN
	5646	T TRICARE
	5647	C CHAMPVA
	5648	A ALL
	5649	Include Ce rtain Elig ibility Ty pe or (A)l l: A// LL
	5650	Selec t one of t he followi ng:
	5651	U USER
	5652	A ALL
	5653	Display EC ME (U)ser or (A)LL: A// LL
	5654	START WITH TRANSACTI ON DATE: T -1// (OC T 28, 2015 )
	5655	GO TO TR ANSACTION DATE: T// (OCT 29, 2015)
	5656	Selec t one of t he followi ng:
	5657	S Summary
	5658	D Detail
	5659	Display (S )ummary or (D)etail Format: De tail//
	5660	Enter a co de from th e list to indicate t he sort or der.
	5661	Selec t one of t he followi ng:
	5662	D Division
	5663	U User Name
	5664	Sort: (D/ U): User N ame// Divi sion
	5665	Do you wan t to captu re report data for a n Excel do cument? NO //
	5666	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	5667	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	5668	DEVICE: HO ME//0;132
	5669	Example 8. 2.6-3: Dis play of th e Detailed OPECC Pro ductivity Report
	5670	OPECC PROD UCTIVITY D ETAIL REPO RT Prin t Date: Oc t 29, 2015 @10:15:57 Page: 1
	5671	DIVISION(S ): ALL
	5672	ELIGIBILIT Y: ALL
	5673	USERS: ALL
	5674	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 9/29/1 5 through 10/29/15
	5675	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	5676	# TRA NSACTIONS
	5677	USER STAT US DT RA NGE TOTAL ELIG R X# REF/ECME# DOS TRA NS DATE P AID AMT
	5678	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	5679	DIVISION: DIVISION O NE
	5680	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5681	USER,EIGHT REJE CTED 1 1 CVA 1 00888 0/0000001 12004 09/ 29/15 09/ 29/15 6 .62
	5682	USER,EIGHT REJE CTED 1 1 CVA 1 00889 0/0000001 12005 09/ 29/15 09/ 29/15 10 .00
	5683	USER,NINE PAYA BLE 1 1 VET 1 00840G 0/0000001 11960 09/ 30/15 09/ 30/15 10 .00
	5684	USER,NINE REVE RSAL REJEC TED 1 1 VET 1 00845 0/0000001 11942 08/ 25/15 10/ 01/15 10 .00
	5685	USER,NINE REJE CTED 1 1 CVA 1 00895 0/0000001 12012 10/ 01/15 10/ 01/15 7 .43
	5686	USER,NINE REJE CTED 1 1 CVA 1 00895A 0/0000001 12013 10/ 01/15 10/ 01/15 7 .43
	5687	USER,NINE REJE CTED 1 1 CVA 1 00895D 0/0000001 12017 10/ 01/15 10/ 01/15 7 .43
	5688	USER,NINE REJE CTED 1 1 CVA 1 00896 0/0000001 12018 10/ 01/15 10/ 01/15 10 .00
	5689	USER,NINE REJE CTED 1 1 CVA 1 00895F 0/0000001 12020 10/ 01/15 10/ 01/15 7 .43
	5690	USER,NINE REVE RSAL REJEC TED 1 1 VET 1 00840H 0/0000001 12025 10/ 01/15 10/ 01/15 10 .00
	5691	USER,EIGHT REVE RSAL ACCEP TED 1 1 VET 1 00904 0/0000001 12032 10/ 06/15 10/ 06/15 10 .00
	5692	USER,EIGHT REJE CTED 1 1 VET 1 00905 0/0000001 12033 10/ 06/15 10/ 06/15 10 .00
	5693	USER,TWO REVE RSAL ACCEP TED 1 1 TRI 1 00872 0/0000001 11986 09/ 23/15 10/ 08/15 10 .00
	5694	USER,NINE REVE RSAL ACCEP TED 1 1 CVA 1 00896A 0/0000001 12024 10/ 08/15 10/ 08/15 10 .00
	5695	USER,NINE REVE RSAL ACCEP TED 1 1 TRI 1 00917 0/0000001 12046 10/ 14/15 10/ 14/15 10 .00
	5696	USER,NINE REJE CTED 1 1 TRI 1 00917A 0/0000001 12049 10/ 14/15 10/ 14/15 10 .00
	5697	USER,NINE REJE CTED 1 1 TRI 1 00917B 0/0000001 12050 10/ 14/15 10/ 14/15 10 .00
	5698	USER,NINE PAYA BLE 1 1 CVA 1 00881 0/0000001 11997 10/ 15/15 10/ 15/15 5 .23
	5699	USER,FOUR REJE CTED 1 1 TRI 1 00923 0/0000001 12055 10/ 15/15 10/ 15/15
	5700	USER,NINE REVE RSAL REJEC TED 1 1 TRI 1 00922 0/0000001 12054 10/ 15/15 10/ 16/15 10 .00
	5701	USER,FOUR REJE CTED 1 1 TRI 1 00927 0/0000001 12059 10/ 16/15 10/ 16/15
	5702	USER,FOUR REJE CTED 1 1 TRI 1 00929 0/0000001 12061 10/ 16/15 10/ 16/15
	5703	USER,FOUR REJE CTED 1 1 TRI 1 00933 0/0000001 12065 10/ 17/15 10/ 18/15
	5704	USER,FOUR REJE CTED 1 1 TRI 1 00936 0/0000001 12068 10/ 18/15 10/ 18/15
	5705	USER,FOUR REJE CTED 1 1 TRI 1 00832 0/0000001 11902 09/ 25/15 10/ 20/15
	5706	USER,THREE 1 1 TRI 1 00938 0/0000001 12070 10/ 28/15 10/ 28/15 10 .00
	5707	SUBTOTALS FOR DIVISI ON ONE PHA RMACY
	5708	REJE CTED AND N OT REJECTE D AND PAYA BLE
	5709	USER RESO LVED TO PA YABLE ( POSSIBLE B ACK-BILL) TRANS IN DT RANGE AMOUNT PAID
	5710	USER,EIGHT 0 0 4 36.62
	5711	USER,THREE 0 0 1 10.00
	5712	USER,TWO 0 0 1 10.00
	5713	USER,FOUR 0 0 6 0.00
	5714	USER,NINE 2 0 14 124.95
	5715	GRAND TOTA L
	5716	REJE CTED AND N OT REJECTE D AND PAYA BLE
	5717	USER RESO LVED TO PA YABLE ( POSSIBLE B ACK-BILL) TRANS IN DT RANGE AMOUNT PAID
	5718	USER,EIGHT 0 0 4 36.62
	5719	USER,THREE 0 0 1 10.00
	5720	USER,TWO 0 0 1 10.00
	5721	USER,FOUR 0 0 6 0.00
	5722	USER,NINE 2 0 14 124.95
	5723	Example 8. 2.6-4: Dis play of th e Summary OPECC Prod uctivity R eport
	5724	OPECC PROD UCTIVITY S UMMARY REP ORT Prin t Date: Oc t 29, 2015 @10:32:13 Page: 1
	5725	DIVISION(S ): ALL
	5726	ELIGIBILIT Y: ALL
	5727	USERS: ALL
	5728	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 9/29/1 5 through 10/29/15
	5729	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	5730	# TRA NSACTIONS
	5731	USER STAT US DT RA NGE TOTAL ELIG R X# REF/ECME# DOS TRA NS DATE P AID AMT
	5732	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	5733	DIVISION: DIVISION O NE
	5734	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5735	SUBTOTALS FOR DIVISI ON ONE PHA RMACY
	5736	REJE CTED AND N OT REJECTE D AND PAYA BLE
	5737	USER RESO LVED TO PA YABLE ( POSSIBLE B ACK-BILL) TRANS IN DT RANGE AMOUNT PAID
	5738	USER,ONE 0 0 4 36.62
	5739	USER,TWO 0 0 1 10.00
	5740	USER,THREE 0 0 1 10.00
	5741	USER,FOUR 0 0 6 0.00
	5742	USER,FIVE 2 0 14 124.95
	5743	GRAND TOTA L
	5744	REJE CTED AND N OT REJECTE D AND PAYA BLE
	5745	USER RESO LVED TO PA YABLE ( POSSIBLE B ACK-BILL) TRANS IN DT RANGE AMOUNT PAID
	5746	USER,ONE 0 0 4 36.62
	5747	USER,TWO 0 0 1 10.00
	5748	USER,THREE 0 0 1 10.00
	5749	USER,FOUR 0 0 6 0.00
	5750	USER,FIVE 2 0 14 124.95
	5751	(This page included for two-si ded copyin g.)
	5752	9
	5753	BPS Nightl y Backgrou nd Job XE "BPS Night ly Backgro und Job"
	5754	The BPS Ni ghtly Back ground Job is schedu led to run daily at the sites during off -hours at intervals defined by the site staff. One of the fu nctions of this job is to iden tify claim s to be re versed and then to a utomatical ly submit the Revers al Request to the pa yer.
	5755	For inpati ent claims reversals , the prog ram will g o through all WINDOW fills for the date 5 days pri or to the current da te (T-5) a nd check t o see if t he patient is a curr ent inpati ent. If so , the reve rsal would be given the reason CURRENT I NPATIENT t o differen tiate betw een non-re leased pre scriptions and inpat ient rever sals.
	5756	The auto-r eversal pr ocess for outpatient claims is dependent on whethe r the site sets the Auto-Rever sal parame ter to any thing but 0 (see Aut o-Reversal parameter in the Ed it ECME Ph armacy Dat a option o n the ECME Setup men u). All no n-released outpatien t prescrip tions that were init ially retu rned as PA YABLE and are not cu rrently RE VERSED and have a da te older t han the nu mber of da ys set in the Auto-R eversal pa rameter wo uld be rev ersed.
	5757	After the BPS Nightl y Backgrou nd Job ide ntifies cl aims to au to-reverse and proce sses the R eversal Re quest, the system se nds a bull etin to th e members of the “BP S OPECC” m ail group listing bo th reversa ls from th e paramete r setting and the in patient cl aims. This mail grou p needs to be create d at the s ite and sh ould inclu de all OPE CC resourc es.
	5758	Example 9. 1-1 Displa ying the A uto-Revers al Bulleti n
	5759	Subj: ECME AUTO-REVE RSAL PROCE SS [#2473 ] 03/05/05 @01:00 29 lines
	5760	From: BPS PACKAGE I n 'IN' bas ket. Pag e 1 New
	5761	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5762	The ECME N ightly Pro cess compl eted auto- reversing e-Pharmacy claims fo r prescrip tions not released w ithin the specified timeframe.
	5763	TOTAL AUTO -REVERSED CLAIMS: 3
	5764	Claims Aut o-Reversed on 03/06/ 05:
	5765	# RX FIL L FILL DA TE PAT IENT BPS PHARMACY
	5766	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5767	1 908955 1 03/01/0 6 ECM Epatient,O ne ANC
	5768	2 909225 1 03/04/0 6 ECM Epatient,T wo ANC
	5769	3 41581 0 03/04/0 6 ECM Epatient,T hree ANC
	5770	(This page included for two-si ded copyin g.)
	5771	10
	5772	Glossary X E "Glossar y"
	5773	Accredited Standards Committee (ASC)
	5774	An organiz ation that has been accredited by Americ an Nationa l Standard s Institut e (ANSI) f or the dev elopment o f American National Standards.
	5775	Administra tive Code Sets
	5776	Code sets that chara cterize a general bu siness sit uation rat her than a medical c ondition o r service.
	5777	Administra tive Simpl ification (A/S)
	5778	Title II, Subtitle F , of HIPAA , which gi ves the De partment O f Health A nd Human S ervices (D HHS) the a uthority t o mandate the use of standards for the e lectronic exchange o f health c are data; to specify what medi cal and ad ministrati ve code se ts should be used wi thin those standards ; to requi re the use of nation al identif ication sy stems for health car e patients , provider s, payers (or plans) , and empl oyers (or sponsors); and to sp ecify the types of m easures re quired to protect th e security and priva cy of pers onally ide ntifiable health car e informat ion.
	5779	American M edical Ass ociation ( AMA)
	5780	A professi onal assoc iation tha t represen ts the voi ce of the American m edical pro fession an d constitu tes the pa rtnership of physici ans and th eir profes sional ass ociations dedicated to promoti ng the art and scien ce of medi cine and t he betterm ent of pub lic health .
	5781	American N ational St andards (A NS)
	5782	Standards developed and approv ed by orga nizations accredited by ANSI.
	5783	American N ational St andards In stitute
	5784	An organiz ation that accredits various
	5785	(ANSI)
	5786	standards- setting co mmittees, and monito rs their c ompliance with the o pen rule-m aking proc ess that t hey must f ollow to q ualify for ANSI accr editation.
	5787	American S ociety for Testing a nd
	5788	A standard s group th at has pub lished gen eral
	5789	Materials (ASTM)
	5790	guidelines for the d evelopment of standa rds, inclu ding those for healt h care ide ntifiers.
	5791	Back Door
	5792	System acc ess via th e roll and scroll, c haracter a nd Mumps b ased VistA applicati on.
	5793	Blue Cross and Blue Shield Ass ociation
	5794	An associa tion that represents the commo n
	5795	(BCBSA)
	5796	interest o f Blue Cro ss and Blu e Shield h ealth plan s. The BCB SA maintai ns the Cla im Adjustm ent Reason Codes cod e set.
	5797	Business M odel
	5798	A model of a busines s organiza tion or pr ocess.
	5799	CHAMPVA Pa tient
	5800	A CHAMPVA patient is a patient that is r eceiving s ervices du e to being eligible for the CH AMPVA heal th benefit s program. His/her C HAMPVA hea lth benefi t program will be bi lled for t he prescri ption.
	5801	Clean Clai m
	5802	An insuran ce claim t hat has no defect, i mpropriety (includin g any lack of any su bstantial documentat ion) or pa rticular c ircumstanc e requirin g special treatment that preve nts timely payment f rom being made.
	5803	Clearingho use
	5804	For health care, an organizati on that
	5805	(or Health Care Clea ringhouse)
	5806	translates health ca re data to or from a standard format.
	5807
	5808	Centers fo r Medicare & Medicai d
	5809	Centers fo r Medicare & Medicai d Services ,
	5810	Services ( CMS)
	5811	formerly H ealth Care Financing Administr ation (HCF A). The ad ministrati on within the Depart ment of He alth and H uman Servi ces (HHS) that is re sponsible for the na tional adm inistratio n of the M edicaid an d Medicare programs.
	5812	CMS-1450
	5813	CMS’s name for the i nstitution al uniform claim for m, or UB-9 2.
	5814	CMS-1500
	5815	CMS’s name for the p rofessiona l uniform claim form . Also kno wn as the UCF-1500.
	5816	Coordinati on of Bene fits (COB)
	5817	A provisio n that is intended t o avoid cl aims payme nt delays and duplic ation of b enefits wh en a perso n is cover ed by two or more pl ans provid ing benefi ts or serv ices for m edical, de ntal or ot her care o r treatmen t.
	5818	Code Set
	5819	Under HIPA A "codes u sed to enc ode data e lements, t ables of t erms, medi cal concep ts, diagno stic codes , or medic al procedu res. A cod e set incl udes the c odes and d escriptors of the co des." [45 CFR 162.10 3]
	5820	Covered En tity
	5821	Under HIPA A, a healt h plan, he althcare c learinghou se or heal th care pr ovider who transmits informati on in elec tronic for m in conne ction with a transac tion cover ed by this subchapte r 160.103 of 45 CFR.
	5822	Current Pr ocedural T erminology
	5823	A procedur e code set maintaine d and copy righted by the AMA a nd that ha s been sel ected for use under HIPAA for non-instit utional an d non-dent al profess ional tran sactions.
	5824	Data Dicti onary (DD)
	5825	A document or system that char acterizes the data c ontent of a system.
	5826	Data Eleme nt
	5827	Under HIPA A, this is "…the sma llest name d unit of informatio n in a tra nsaction." [45 CFR 1 62.103]
	5828	Data Mappi ng
	5829	The proces s of match ing one se t of data elements o r individu al code va lues to th eir closes t equivale nts in ano ther set o f them.
	5830	Data Model
	5831	A conceptu al model o f the info rmation ne eded to su pport a bu siness fun ction or p rocess.
	5832	Data Set
	5833	Under HIPA A, this is "…a seman tically me aningful u nit of inf ormation e xchanged b etween two parties t o a transa ction." [4 5 CFR 162. 103]
	5834	Designated Code Set
	5835	A medical or adminis trative co de set, wh ich DHHS h as designa ted for us e in one o r more of the HIPAA standards.
	5836	Designated Data Cont ent Commit tee
	5837	An organiz ation, whi ch DHHS ha s
	5838	or Designa ted DCC
	5839	designated for overs ight of th e business data cont ent of one or more o f the HIPA A-mandated transacti on standar ds.
	5840	Designated Standard
	5841	A standard that DHHS has desig nated for use under the author ity provid ed by HIPA A.
	5842	Department of Health and Human
	5843	Per the we bsite addr ess provid ed below,
	5844	Services ( DHHS) or ( HHS)
	5845	'The Depar tment Of H ealth And Human Serv ices is th e United S tates gove rnment's p rincipal a gency for protecting the healt h of all A mericans a nd providi ng essenti al human s ervices, e specially for those who are le ast able t o help the mselves.' The websit e is avail able at <h ttp:// DNS
	5846	Electronic Commerce (EComm)
	5847	The exchan ge of busi ness infor mation by electronic means.
	5848	Electronic Data Inte rchange (E DI)
	5849	The transf er of data between d ifferent c ompanies u sing netwo rks, such as the Int ernet. As more and m ore compan ies are co nnected to the Inter net, EDI i s becoming increasin gly import ant as an industry s tandard fo r companie s to buy, sell, and trade info rmation. A NSI has ap proved a s et of EDI standards known as t he X12 sta ndards.
	5850	Finish
	5851	Term used for comple ting order s from Ord er Entry/R esults Rep orting V. 3.0.
	5852	‘Finish’ a Prescript ion
	5853	This proce ss within VistA Outp atient Pha rmacy V. 7 .0 where a pharmacy prescripti on order h as been re viewed by either a p harmacy te chnician o r pharmaci st and is the first step in pr ocessing a prescript ion in Pha rmacy. If performed by a pharm acist with the appro priate sec urity key, the presc ription ca n be ‘Veri fied’ as w ell. See ‘ Verify a P rescriptio n’ for mor e informat ion.
	5854	Flat File
	5855	This term usually re fers to a file that consists o f a series of fixed- length rec ords that include so me sort of record ty pe code.
	5856	Front Door
	5857	System acc ess via th e Delphi, Graphical User Inter face (GUI) based Vis tA applica tion.
	5858	Graphical User Inter face (GUI)
	5859	A graphica l method o f controll ing how a user inter acts with a computer to perfor m various tasks.
	5860	HCFA Commo n Procedur al Coding
	5861	A medical code set t hat identi fies healt h care
	5862	System (HC PCS)
	5863	procedures , equipmen t, and sup plies for claim subm ission pur poses. It is maintai ned by Hea lth Care F inancing A dministrat ion (HCFA) , and has been selec ted for us e in the H IPAA trans actions. H CPCS Level I contain numeric C PT-4 codes , which ar e maintain ed by the AMA. HCPCS Level II contains a lphanumeri c codes us ed to iden tify vario us items a nd service s that are not inclu ded in the CPT-4 cod e set. The se are mai ntained by HCFA, BCB SA, and He alth Insur ance Assoc iation of America (H IAA). HCPC S Level II I contains alphanume ric codes that are a ssigned by Medicaid State agen cies to id entify add itional it ems and se rvices not included in levels I and II. These are usually ca lled "loca l codes”, and must h ave "W", " X", "Y", o r "Z" in t he first p osition. T hey are no t named as HIPAA sta ndard code s. HCPCS P rocedure M odifier Co des can be used with all three levels, w ith the WA -ZY range used for l ocally ass igned proc edure modi fiers.
	5864	Health Car e Clearing house
	5865	Under HIPA A, this is "… a publ ic or priv ate entity that does either of the follo wing: (1) processes or facilit ates the p rocessing of informa tion recei ved from a nother ent ity in a n onstandard format or containin g nonstand ard data c ontent int o standard data elem ents or a standard t ransaction , or (2) r eceives a standard t ransaction from anot her entity and proce sses or fa cilitates the proces sing of [t hat] infor mation int o nonstand ard format or nonsta ndard data content f or a recei ving entit y." [45 CF R 160.103]
	5866	Health Car e Financin g Administ ration
	5867	The DHHS a gency resp onsible fo r Medicare
	5868	(HCFA)
	5869	and parts of Medicai d. HCFA ha s historic ally maint ained the UB-92 inst itutional Electronic Media Cla ims (EMC) format spe cification s, the pro fessional EMC Nation al Standar d Format ( NSF) speci fications, as well a s specific ations for various c ertificati ons and au thorizatio ns used by the Medic are and Me dicaid pro grams. HCF A also mai ntains the HCPCS med ical code set.
	5870	Health Car e Provider
	5871	Under HIPA A, this is "…a provi der of ser vices as d efined in the sectio n 1861(u) of the [So cial Secur ity] Act, 42 USC 139 5x(u), a p rovider of medical o r other he alth servi ces as def ined in se ction 1861 (s) of the Act, 42 U SC 1395(s) , and any other pers on or orga nization w ho furnish es, bills, or is pai d for heal th care in the norma l course o f business ." [45 CFR 160.103]
	5872	Health Inf ormation
	5873	Under HIPA A this is "… any inf ormation, whether or al or reco rded in an y form or medium tha t (a) is c reated or received b y a health care prov ider, heal th plan, p ublic heal th authori ty, employ er, life i nsurer, sc hool or un iversity, or health care clear inghouse; and (b) re lated to t he past, p resent or future phy sical or m ental heal th or cond ition of a n individu al, the pr ovision of health ca re to an i ndividual, or the pa st, presen t or futur e payment for the pr ovision of health ca re to an i ndividual. " [45 CFR 160.103]
	5874	Health Ins urance Ass ociation o f
	5875	An industr y associat ion that r epresents the
	5876	America ( HIAA)
	5877	interests of commerc ial health care insu rers. The HIAA parti cipates in the maint enance of some code sets, incl uding HCPC S Level II codes.
	5878	Health Ins urance Por tability a nd
	5879	A Federal law that m akes a num ber of
	5880	Accountabi lity Act o f 1996 (HI PAA)
	5881	changes th at have th e goal of allowing p ersons to qualify im mediately for compar able healt h insuranc e coverage when they change th eir employ ment relat ionships. Title II, Subtitle F , of HIPAA gives HHS the autho rity to ma ndate the use of sta ndards for the elect ronic exch ange of he alth care data; to s pecify wha t medical and admini strative c ode sets s hould be u sed within those sta ndards; to require t he use of national i dentificat ion system s for heal th care pa tients, pr oviders, p ayers (or plans), an d employer s (or spon sors); and to specif y the type s of measu res requir ed to prot ect the se curity and privacy o f personal ly identif iable heal th care in formation. Also know n as the K ennedy-Kas sebaum Bil l, the Kas sebaum-Ken nedy Bill, K2, or Pu blic Law 1 04-191.
	5882	Health Pla n
	5883	Under HIPA A this is "…an indiv idual or g roup plan that provi des, or pa y the cost of, medic al care”. [45 CFR 16 0.103]
	5884	Healthcare Financial Managemen t
	5885	An organiz ation for the improv ement
	5886	Associatio n (HFMA)
	5887	of the fin ancial man agement of healthcar e-related organizati ons. The H FMA sponso rs some HI PAA educat ional semi nars.
	5888	Health Lev el Seven ( HL7)
	5889	An ANSI-ac credited g roup that defines st andards fo r the cros s-platform exchange of informa tion withi n a health care orga nization. HL7 is res ponsible f or specify ing the Le vel Seven Open Syste m Intercon nection (O SI) standa rds for th e health i ndustry. S ome HL7 st andards wi ll be enca psulated i n the X12 standards used for t ransmittin g claim at tachments.
	5890	HIPAA Data Dictionar y
	5891	A data dic tionary th at defines and cross -
	5892	or HIPAA D D
	5893	references the conte nts of all X12 trans actions in cluded in the HIPAA mandate. I t is maint ained by X 12N/TG3.
	5894	Implementa tion Guide (IG)
	5895	A document explainin g the prop er use of a standard for a spe cific busi ness purpo se. The X1 2N HIPAA I Gs are the primary r eference d ocuments u sed by tho se impleme nting the associated transacti ons, and a re incorpo rated into the HIPAA regulatio ns by refe rence.
	5896	Implementa tion Speci fication
	5897	Under HIPA A, this is "… the sp ecific ins tructions for implem enting a s tandard [4 5 CFR 160. 103]
	5898
	5899	Informatio n Model
	5900	A conceptu al model o f the info rmation ne eded to su pport a bu siness fun ction or p rocess.
	5901	Internatio nal Classi fication o f Diseases
	5902	A medical code set m aintained by the
	5903	(ICD)
	5904	World Heal th Organiz ation (WHO ). The pri mary purpo se of this code set is to clas sify cause s of death . A United States (U S) extensi on of this coding sy stem, main tained by the Nation al Center for Health Statistic s (NCHS) w ithin the Centers fo r Disease Control (C DC), is us ed to iden tify morbi dity facto rs, or dia gnoses. Th e ICD-9-CM (Revision 9 Clinica l Modifica tion) code s have bee n selected for use i n the HIPA A transact ions.
	5905	Internatio nal Standa rds Organi zation
	5906	An organiz ation that coordinat es the
	5907	(ISO) or I nternation al Organiz ation
	5908	developmen t and adop tion of nu merous
	5909	for Standa rdization
	5910	internatio nal standa rds.
	5911	Joint Comm ission on Accreditat ion
	5912	In the fut ure, the J CAHO may p lay a role in
	5913	of Healthc are Organi zations (J CAHO)
	5914	certifying these org anizations complianc e with the HIPAA A/S requireme nts.
	5915	J-Codes
	5916	Previously HCPCS Lev el II has contained a set of c odes with a high-ord er value o f "J" to i dentify so me drugs a nd some ot her items. The final HIPAA tra nsactions and code s et rule st ates that any J-code s identify ing drugs will be dr opped from the HCPCS and NDC c odes will be used to identify all drug p roducts.
	5917	Maintain o r Maintena nce
	5918	Under HIPA A, this is "…activit ies necess ary to sup port the u se of a st andard ado pted by th e Secretar y, includi ng technic al correct ions to an implement ation spec ification, and enhan cements or expansion of a code set. This term excl udes the a ctivities related to the adopt ion of a n ew standar d or imple mentation specificat ion, or mo dification to an ado pted stand ard or imp lementatio n specific ation." [4 5 CFR 162. 103]
	5919	Maximum De fined Data Set
	5920	Under HIPA A, this is "… all of the requi red data e lements fo r a partic ular stand ard based on a speci fic implem entation s pecificati on." [45 C FR 162.103 ]. A frame work under HIPAA whe reby an en tity creat ing a tran saction is free to i nclude wha tever data any recei ver might want or ne ed. The re cipient of a maximum data set is free to ignore an y portion of the dat a not need ed to cond uct their part of th e associat ed busines s transact ion, unles s the none ssential d ata is nee ded for co ordination of benefi ts.
	5921	Medical Co de Sets
	5922	Codes that character ize a medi cal condit ion or tre atment. Th e code set s are usua lly mainta ined by pr ofessional societies and publi c health o rganizatio ns.
	5923	Memorandum of Unders tanding (M OU)
	5924	A document providing a general descripti on of the kinds of r esponsibil ities that are to be assumed b y two or m ore partie s in their pursuit o f some goa l(s). More specific informatio n may be p rovided in an associ ated State ment Of Wo rk (SOW).
	5925	Modify or Modificati on
	5926	Under HIPA A, refers to "a chan ge adopted by the Se cretary, t hrough reg ulation, t o a standa rd or an i mplementat ion specif ication." [45 CFR 16 0.102]
	5927	National C enter for Health Sta tistics
	5928	An adminis tration of HHS and C DC that
	5929	(NCHS)
	5930	oversees I CD coding.
	5931	National C ouncil for Prescript ion Drug
	5932	An ANSI-ac credited g roup that maintains
	5933	Programs ( NCPDP)
	5934	a number o f standard formats f or use by the retail pharmacy industry, some of wh ich are in cluded in the HIPAA mandates.
	5935	National D rug Code ( NDC)
	5936	A medical code set t hat has be en selecte d for use in the HIP AA transac tions.
	5937	National E mployer ID
	5938	A system f or uniquel y identify ing all sp onsors of health car e benefits .
	5939	National P atient ID
	5940	A system f or uniquel y identify ing all re cipients o f health c are servic es.
	5941	National P ayer ID
	5942	A system f or uniquel y identify ing all or ganization s that pay s for heal th care se rvices. Al so known a s Health P lan ID or Plan ID.
	5943	National P rovider Fi le (NPF)
	5944	The databa se envisio ned for us e in maint aining a n ational pr ovider reg istry.
	5945	National P rovider ID
	5946	A system f or uniquel y identify ing all pr oviders of health ca re service s, supplie s, and equ ipment.
	5947	National P rovider Re gistry
	5948	The organi zation env isioned fo r assignin g the Nati onal Provi der IDs.
	5949	National P rovider Sy stem (NPS)
	5950	The admini strative s ystem envi sioned for supportin g a nation al provide r registry .
	5951	National S tandard Fo rmat (NSF)
	5952	Genericall y, this ap plies to a ny nationa l standard format, b ut it is o ften used in a more limited wa y to desig nate the P rofessiona l EMC NSF, a 320-byt e flat fil e record f ormat used to submit professio nal claims .
	5953	National U niform Bil ling Commi ttee
	5954	The commit tee establ ished by t he America n
	5955	(NUBC)
	5956	Hospital A ssociation (AHA) to develop a single bil ling form and standa rd data se t that cou ld be used nationwid e by insti tutional p roviders a nd payers for handli ng health care claim s.
	5957	NCPDP Batc h Standard
	5958	An NCPDP s tandard de signed for use by lo w-volume d ispensers of pharmac euticals, such as nu rsing home s. Version 1.0 of th is standar d has been mandated under HIPA A.
	5959	NCPDP Tele communicat ion Standa rds
	5960	An NCPDP s tandard de signed for use by hi gh-volume dispensers of pharma ceuticals, such as r etail phar macies. Ve rsion D0 i s the tran saction st andard und er HIPAA.
	5961	Non-Formul ary Drugs
	5962	The medica tions, whi ch are def ined as co mmercially available drug prod ucts not i ncluded in the VA Na tional For mulary.
	5963	Notice of Intent (NO I)
	5964	A document that desc ribes a su bject area for which the Feder al Governm ent is con sidering d eveloping regulation s. It may describe w hat the go vernment c onsiders t o be the r elevant co nsideratio ns and inv ite commen ts from in terested p arties. Th ese commen ts can the n be used in develop ing a Noti ce of Prop osed Rulem aking (NPR M) or a fi nal regula tion.
	5965	Notice of Proposed R ulemaking (NPRM)
	5966	A document that desc ribes and explains r egulations that the Federal Go vernment p roposes to adopt at some futur e date, an d invites interested parties t o submit c omments re lated to t hem. These comments can then b e used in developing the final rules.
	5967	Office of Management & Budget (OMB)
	5968	A Federal Government agency th at has a m ajor role in reviewi ng propose d Federal regulation s.
	5969	Open Syste m Intercon nection (O SI)
	5970	A multi-la yer ISO da ta communi cations st andard. Le vel Seven of this st andard is industry-s pecific, a nd HL7 is responsibl e for spec ifying the level sev en OSI sta ndards for the healt h industry .
	5971	Outpatient Pharmacy Electronic Claims
	5972	This is a designated individua l at each site
	5973	Coordinato r (OPECC)
	5974	who will b e responsi ble for mo nitoring N CPDP claim s using th e ECME mod ule. The O PECC will resolve cl aim reject ion issues with the appropriat e parties, make data correctio ns, and re submit cla ims.
	5975	Orderable Item
	5976	An Orderab le Item na me and dos age form t hat has no strength attached t o it (e.g. , Acetamin ophen). Th e name wit h a streng th attache d is the D ispense Dr ug name (e .g., Aceta minophen 3 25mg).
	5977	Payer
	5978	In health care, an e ntity that assumes t he risk of paying fo r medical treatments . This can be an uni nsured pat ient, a se lf-insured employer, or a heal th care pl an or Heal th Mainten ance Organ ization (H MO).
	5979	DNS D
	5980	HCFA’s ter m for thei r National Payer ID initiative .
	5981	PBM
	5982	A Pharmacy Benefit M anager (PB M) is a th ird party administra tor of pre scription drug progr ams. They are primar ily respon sible for processing and payin g prescrip tion drug claims.
	5983	Placeholde rs
	5984	Physical a nd/or logi cal data e lements th at are ref erenced an d placed w ithin a da ta structu re that ha ve a data definition but may o r may not currently exist with in the sys tem. The v alue of th ese data e lements ar e not curr ently main tained by the softwa re but are establish ed for fut ure iterat ions of sy stem devel opment rel ated to Bi lling Awar e.
	5985	Potentiall y Billable Event
	5986	A service, which has all requi red data e lements as sociated w ith it. Th ese data e lements ar e collecte d in the V istA Clini cal Applic ation.
	5987	Profession al Compone nt
	5988	Charges fo r physicia n services . Examples include p hysician w ho reads t he Electro cardiogram (EKG) and an Emerge ncy Room p hysician w ho provide s treatmen t.
	5989	Provider T axonomy Co des
	5990	A code set for ident ifying the provider type and a rea of spe cializatio n for all health car e provider s. A given provider can have s everal Pro vider Taxo nomy Codes . The BCBS A maintain s this cod e set.
	5991	Secretary
	5992	Under HIPA A, this re fers to th e Secretar y of the U S Departme nt of Heal th and Hum an Service s or his/h er designa ted repres entatives. [45 CFR 1 60.103].
	5993	Segment
	5994	Under HIPA A, this is "…a group of relate d data ele ments in a transacti on”. [45 C FR 162.103 ]
	5995	Service
	5996	Medical ca re and ite ms such as medical d iagnosis a nd treatme nt, drugs and biolog icals, sup plies, app liances, a nd equipme nt, medica l social s ervices, a nd use of hospital R egional Pr imary Care Hospital (RPCH) or Skilled Nu rsing Faci lity (SNF) facilitie s.
	5997	Standard
	5998	Under HIPA A, this is "… a pres cribed set of rules, condition s, or requ irements d escribing the follow ing inform ation for products, systems, s ervices or practices (1) Class ification of compone nts, (2) S pecificati on of Mate rials, per formance o r operatio ns, (3) De lineation of procedu res. [45 C FR 160.103 ]
	5999	Standard S etting Org anization (SSO)
	6000	Under HIPA A, this is "…an orga nization a ccredited by ANSI th at develop s and main tains stan dards for informatio n transact ions or da ta element s, or any other stan dard that is necessa ry for, or will faci litate the implement ation of t his part." [45 CFR 1 60.103]
	6001	Standard T ransaction
	6002	Under HIPA A, this is "… a tran saction th at complie s with the applicabl e standard adopted u nder this part." [45 CFR 162.1 03]
	6003	Statement of Work (S OW)
	6004	A document describin g the spec ific tasks and metho dologies t hat will b e followed to satisf y the requ irements o f an assoc iated cont ract or MO U.
	6005	Third Part y Administ rator (TPA )
	6006	An entity that proce sses healt h care cla ims and pe rforms rel ated busin ess functi ons for a health pla n.
	6007	Third (3rd ) Party Cl aims
	6008	Health car e insuranc e claims s ubmitted t o an
	6009	Transactio n
	6010	entity for reimburse ment of he alth care bills. Und er HIPAA, this is "… the exchan ge of info rmation be tween two parties to carry out financial or admini strative a ctivities related to health ca re." [45 C FR 160.103 ]
	6011	TRICARE Pa tient
	6012	A TRICARE patient is a patient that is r eceiving s ervices du e to being covered b y TRICARE . His/her TRICARE in surance wi ll be bill ed for the prescript ion.
	6013	UB-92
	6014	A uniform institutio nal claim form devel oped by th e National Uniform B illing Com mittee (NU BC) that h as been in use since 1993.
	6015	Unstructur ed Data
	6016	This term usually re fers to da ta that is represent ed as free -form text , as an im age, etc., where it is not pra ctical to predict ex actly what data will appear wh ere.
	6017	‘Verify’ a Prescript ion
	6018	After a pr escription order has been ‘Fin ished’ the prescript ion must b e ‘Verifie d’ by an a uthorized VistA user , through the admini stration o f the syst em securit y key SOP. This is a critical step in th e process of generat ing an ele ctronic cl aim.
	6019	Veterans H ealth Info rmation Sy stems
	6020	Acronym fo r Veterans Health In formation
	6021	and Techn ology Arch itecture ( VistA)
	6022	Systems an d Technolo gy Archite cture, the new name for Decent ralized Ho spital Com puter Prog ram (DHCP) .
	6023	Workgroup for Electr onic Data
	6024	A health c are indust ry group t hat lobbie d
	6025	Interchang e (WEDI)
	6026	for HIPAA A/S, and t hat has a formal con sultative role under the HIPAA legislati on.
	6027	(This page included for two-si ded copyin g.)
	6028	11
	6029	Acronyms X E "Acronym s"
	6030	AcronymDes criptionAI TC Austin Informatio n Technolo gy CenterA DPACAutoma ted Data P rocessing Applicatio n Coordina torAMAAmer ican Medic al Associa tionANSAme rican Nati onal Stand ardsANSIAm erican Nat ional Stan dards Inst ituteA/SAd ministrati ve Simplif icationASC Accredited Standards Committee ASTMAmeric an Society for Testi ng and Mat erialsBCBS ABlue Cros s and Blue Shield As sociationC DESECME Us er ScreenC MOPConsoli dated Mail Outpatien t Pharmacy CMSCenters for Medic are & Medi caidCOBCoo rdination of Benefit sDDData Di ctionaryDE ADrug Enfo rcement Ad ministrati onDHHSDepa rtment of Health and Human Ser vicesDURDr ug Utiliza tion Revie wECMEElect ronic Clai ms Managem ent Engine ECommElect ronic Comm erceEDIEle ctronic Da ta Interch angeFILEMA NVistA Fil eManGUIGra phical Use r Interfac eHCFAHealt h Care Fin ancing Adm inistratio nHCPCSHCFA Common Pr ocedural C oding Syst emHFMAHeal thcare Fin ancial Man agement As sociationH HSDepartme nt of Heal th and Hum an Service sHIAAHealt h Insuranc e Associat ion of Ame ricaHIPAAH ealth Insu rance Port ability an d Accounta bility Act HL7Health Level Seve nIBIntegra ted Billin gICDIntern ational Cl assificati on of Dise aseICD-9-C MInternati onal Class ification of Disease , 9th revi sion, Clin ical Modif icationICD -9-PCSInte rnational Classifica tion of Di sease, 9th revision, Procedure Coding Sy stemIGImpl ementation GuideIRMS Informatio n Resource s Manageme nt Service ISOInterna tional Sta ndards Org anizationJ CAHOJoint Commission on Accred itation of Healthcar e Organiza tionsAcron ymDescript ionMOUMemo randum of Understand ingNCHSNat ional Cent er for Hea lth Statis ticsNCPDPN ational Co uncil for Prescripti on Drug Pr ogramsNDCN ational Dr ug CodeNDF National D rug FileNO INotice of IntentNPF National P rovider Fi leNPINatio nal Provid er Identif ierNPRMNot ice of Pro posed Rule makingNPSN ational Pr ovider Sys temNSFNati onal Stand ard Format NUBCNation al Uniform Billing C ommitteeOM BOffice of Managemen t and Budg etOPECCOut patient Ph armacy Ele ctronic Cl aims Coord inatorOSIO pen System Interconn ectionOTCO ver the Co unterPOSPo int of Sal eSOWStatem ent of Wor kSSOStanda rd Setting Organizat ionTPAThir d Party Ad ministrati onVADepart ment of Ve terans Aff airsVAMCDe partment o f Veterans Affairs M edical Cen terVHAVete rans Healt h Administ rationVist AVeterans Health Inf ormation S ystems and Technolog y Architec tureWEDIWo rkgroup fo r Electron ic Data In terchange1 2
	6031	Index
	6032
	6033	A
	6034	Accessing Pharmacy E CME Manage r Menu, 87
	6035	Accessing the ECME P harmacy CO B Menu, 79
	6036	Acronyms, 199
	6037	Add/View C omments, 4 0, 47
	6038	B
	6039	BPS Nightl y Backgrou nd Job, 18 1
	6040	C
	6041	Change Vie w, 19
	6042	Claim Resu lts and St atus, 108
	6043	Claims Sub mitted, No t Yet Rele ased, 128
	6044	Claims Tra cking, 47
	6045	Close Clai m, 35
	6046	Closed Cla ims Report , 135
	6047	CMOP/ECME Activity R eport, 122
	6048	D
	6049	Display Up date, 76
	6050	Display Up date, 103
	6051	E
	6052	ECME Claim s-Response Inquiry, 152
	6053	ECME Main Menu, 12
	6054	ECME Menu Options, 8
	6055	ECME Menu Structures , 7
	6056	ECME Setup - Pharmac ies, 160
	6057	ECME Trans action Mai ntenance O ptions, 87
	6058	ECME User Screen, 14
	6059	Edit Basic Pharmacy ECME Param eters, 92
	6060	Edit ECME Pharmacy D ata, 94
	6061	Exit from ECME User Screen, 78
	6062	F
	6063	Further Re search Scr een, 42
	6064	G
	6065	Glossary, 183
	6066	Group Plan Menu, 57
	6067	I
	6068	IB (Integr ated Billi ng) Events Report, 5 3
	6069	Insurance Details, 4 3
	6070	Introducti on, 1
	6071	N
	6072	Non-Billab le Status Report, 13 8
	6073	O
	6074	On-Hold Co pay Listin g, 50
	6075	Online Hel p, 4
	6076	OPECC Prod uctivity?? , 174
	6077	Orientatio n, 3
	6078	Other Repo rts, 152
	6079	P
	6080	Payable Cl aims, 110
	6081	Payable Re jected Cla ims, 116
	6082	Payer Shee t Detail, 155
	6083	Pharmacy E CME Setup Menu, 91
	6084	Pharmacy E CME User S creen, 10
	6085	Pharmacy E lectronic Claims Rep orts, 107
	6086	Pharmacy E lectronic Claims Rep orts Menu Structure, 10
	6087	Potential Claims Rep ort for Du al Eligibl e, 81
	6088	Potential Secondary Rx Claims Report, 79
	6089	Print Clai m Log, 60
	6090	Process Se condary/Tr icare Rx t o ECME, 83
	6091	R
	6092	Recent Tra nsactions, 129
	6093	Related Ma nuals, 5
	6094	Release Co pay, 51
	6095	Reopen Clo sed Claims (hidden o ption), 66
	6096	Resubmit C laim, 32, 73
	6097	Resubmit w ith Edits (hidden op tion), 68
	6098	Reversal C laims Repo rt, 124
	6099	Reverse Pa yable Clai m, 29
	6100	S
	6101	Send to Wo rklist, 63
	6102	Sort List, 27
	6103	Spending A ccount Rep ort, 146
	6104	Statistics Screen, 1 00
	6105	Submitting Primary C laims for TRICARE an d Dual Eli gibility P atients, 8 5
	6106	Submitting Secondary Claims, 8 4
	6107	T
	6108	Third Part y Inquiry, 49
	6109	Totals by Date, 134
	6110	Turn-aroun d time sta tistics, 1 62
	6111	U
	6112	Update Con tinuously, 102
	6113	V
	6114	Variations to the Cl ose claim process, 3 8, 40, 90
	6115	View Eligi bility, 44
	6116	View Presc ription, 4 5, 58
	6117	View/Unstr and Claims , 88
	6118	Z
	6119	Zero (clea r) Statist ics, 103
	6120
	6121
	6122	PHARMACY E CME Jul 03, 20 10@14:55:0 1 Page : 1 of 30
	6123	SELECTED D IVISION(S) : ALL
	6124	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	6125	Sorted b y: Transac tion date by default
	6126
	6127	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/FILL/RX# /ECME# STATU S/LOC/TYP/ RXINF
	6128	1 ECMEPa tient,FIVE (XXXX) I BINSUR1/ Vet Pb: 0 Rj:1 AcR v:3 RjRv:0
	6129	1.1 CO LCHICINE 0 .6MG 0007 4-3781-01 06/24 1012 97$ 1/ 0000000016 53 M RT DS/N
	6130	10/1 9/10 - Cla rification Code 8 su bmitted.
	6131	(OPP USER,TWO)
	6132	p-Re versal acc epted
	6133
	6134	Enter ?? f or more ac tions
	6135
	6136
	6137
	6138
	6139	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	6140	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	6141	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	6142	Select Act ion: Next Screen//
	6143
	6144
	6145
	6146	Header
	6147	Area
	6148
	6149	Patient/
	6150	Rx
	6151	Area
	6152
	6153	Message
	6154	Window
	6155
	6156
	6157	Action
	6158	Area
	6159
	6160	ECME STATI STICS Nov 03, 2 010@16:50: 30 Page: 1 of 1
	6161	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	6162
	6163
	6164	* CLAIM STATUS * * CLAIM RES ULTS *
	6165	Waiting to start 0 P aid claims 2,93 4
	6166	Building the trans action 0 R ejected cl aims 2,17 1
	6167	Building the claim 0 D ropped to Paper 1 5
	6168	Building the HL7 p acket 1 D uplicate c laims 0
	6169	Preparin g for tran smit 0 C aptured cl aims 0
	6170	Transmit ting 0 A ccepted Re versals 2,06 7
	6171	Parsing response 0 R ejected Re versals 16 6
	6172	Processi ng respons e 0 A ccepted El igibility 7
	6173	R ejected El igibility 4 4
	6174	E rrors 1 4
	6175
	6176
	6177
	6178	Enter ?? f or more ac tions
	6179	UC Updat e continuo usly Z Zero (cle ar) stats
	6180	U1 Displ ay update EX Exit
	6181	Select Act ion:U1//
	6182
	6183	Header
	6184	Area
	6185
	6186	Stats
	6187	Area
	6188
	6189	Message Wi ndow
	6190
	6191
	6192	Action
	6193	Area
	6194
	6195