4. EPMO Open Source Coordination Office Redaction File Detail Report

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4.1 Files compared

#	Location	File	Last Modified
1	ePharmacy_Bundle 12.zip	bps_1_0_p24_um.docx	Wed Sep 12 15:26:57 2018 UTC
2	ePharmacy_Bundle 12.zip	bps_1_0_p24_um.docx	Fri Sep 14 15:44:56 2018 UTC

4.2 Comparison summary

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4.5 Comparison detail

	1	ELECTRONIC CLAIMS MA NAGEMENT E NGINE (ECM E)
	2	Version 1. 0
	3
	4	USER MANUA L
	5
	6
	7
	8
	9
	10
	11	November 2 018
	12
	13
	14	Department of Vetera ns Affairs
	15	Office of Informatio n and Tech nology (OI T)
	16	Product De velopment
	17
	18
	19
	20	Revision H istory
	21
	22	Date
	23	Descriptio n (Patch # if applic able)
	24	Project Ma nager
	25	Technical Writer
	26	11/2018
	27	Updated fo r BPS124
	28	Modify RE Open CLOSE D/Resubmit Claim act ion, Chang e label on Claim Log , Modify C hange View (CV), Enh ance Claim Reports
	29	PII
	30	PII
	31	07/2018
	32	Updated fo r BPS123
	33	Update Tit le page da te, footer date
	34	Modificati on filter questions CV Change View actio n, Rx Acti vity Log t o add Date of Servic e to ECME Log, Resub mit with E dits actio n, Process Secondary /TRICARE R x to ECME option, Pa yable Clai ms Report, Rejected Claims Rep ort, Rever sal Claims Report, C laims Subm itted Not Yet Releas ed Report, Recent Tr ansactions Report, C losed Clai ms Report, View ePha rmacy Rx R eport Opti on
	35	PII
	36	PII
	37	11/2017
	38	Updated fo r BPS122
	39	Update Tit le page da te, modifi cation to Change Vie w action; change aut o-reverse parameter and auto-r eversal bu lletin; ad d Facility ID Qualif ier and Re conciliati on ID to C laim Log a nd Claim R esponse In quiry; add new actio n PR Print Reports t o VER View ePharmacy Rx.
	40	PII
	41	PII
	42	05/2017
	43	Updated fo r BPS121
	44	PII
	45	PII
	46	08/2016
	47	Updated fo r BPS120
	48	PII
	49	PII
	50	06/2016
	51	Updated Ti tle Page t o current OI&T stand ards.
	52	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)
	53	PII
	54	PII
	55	10/2015
	56	Updated fo r BPS118
	57	PII
	58	PII
	59	11/2013
	60	Updated fo r BPS115 (made num erous mino r changes throughout ; fixed de fective pa ge breaks)
	61	PII
	62	PII
	63	02/2012
	64	Updated fo r BPS111
	65	PII
	66	PII
	67	10/2011
	68	Updated fo r BPS110
	69	PII
	70	PII
	71	06/2011
	72	Updated fo r BPS110 and consi stency
	73	PII
	74	PII
	75	12/2010
	76	Reviewed a nd updated revisions ; inserted TRICARE d isclaimer
	77	PII
	78	PII
	79	10/2010
	80	Updated fo r accuracy changes p er CBO
	81	PII
	82	PII
	83	08/2010
	84	Updated fo r BPS18 and Addend um
	85	PII
	86	PII
	87	10/2009
	88	Updated fo r patch BP S1.08 eP harmacy CO B Support
	89	PII
	90	PII
	91	04/2009
	92	Updated fo r patch BP S1.07
	93	PII
	94	PII
	95	02/2007
	96	Updated fo r patch BP S1.02
	97	PII
	98	PII
	99	08/2006
	100	Updated fo r interim patch BPS* 1.0*3
	101	PII
	102	PII

	103	04/2006
	104	Initial re lease of t he ECME Us er Manual.
	105	PII
	106	PII
	107
	108	(This page included for two-si ded copyin g.)
	109
	110
	111
	112	Contents
	113
	114	1Introduct ion1
	115	2Orientati on3
	116	2.1 Workin g with the ECME User Manual3
	117	2.2 Obtain ing Online Help4
	118	2.3 Findin g Related Manuals5
	119	3ECME Menu Structure s7
	120	3.1 The Co mplete ECM E Menu Str ucture9
	121	3.2 ECME U ser Screen 11
	122	3.3 ECME P harmacy CO B Menu Str ucture11
	123	3.4 Pharma cy ECME Ma nager Menu Structure 11
	124	3.5 Pharma cy Electro nic Claims Reports M enu Struct ure12
	125	4Accessing the ECME Main Menu1 3
	126	5Accessing the ECME User Scree n15
	127	5.1 Change View20
	128	5.2 Sort L ist29
	129	5.3 Revers e Payable Claim32
	130	5.4 Resubm it Claim35
	131	5.5 Close Claim38
	132	5.5.1 Vari ations to the Close claim proc ess.41
	133	5.5.2 Spec ial Notes regarding secondary claims43
	134	5.6 Add/Vi ew Comment s43
	135	5.7 Furthe r Research Screen45
	136	5.7.1 Insu rance Deta ils46
	137	5.7.2 View Eligibili ty47
	138	5.7.3 View Prescript ion48
	139	5.7.4 Add/ View Comme nts50
	140	5.7.5 Clai ms Trackin g50
	141	5.7.6 Thir d Party In quiry52
	142	5.7.7 On H old Copay Listing53
	143	5.7.8 Rele ase Copay5 4
	144	5.7.9 IB ( Integrated Billing) Events Rep ort56
	145	5.7.10 Gro up Plan Me nu60
	146	5.7.11 Eli gibility I nquiry Opt ion61
	147	5.8 Print Claim Log (hidden ac tion)63
	148	5.09 Send to Worklis t66
	149	5.10 Reope n Closed C laims (hid den action )69
	150	5.11 Resub mit with E dits (hidd en action) 71
	151	5.12 OPEC C Reject I nformation (hidden a ction)76
	152	5.13 Resu bmit Claim Without R eversal (h idden acti on)77
	153	5.14 Open /Close Non Billable Entry (hid den action )79
	154	5.15 Displ ay Update (hidden ac tion)80
	155	5.16 Exit (from ECME User Scre en)82
	156	6.Accessin g the ECME Pharmacy COB Menu83
	157	6.1 Potent ial Second ary Rx Cla ims Report 83
	158	6.2 Potent ial Claims Report fo r Dual Eli gible85
	159	6.3 Proces s Secondar y/TRICARE Rx to ECME 87
	160	6.3.1Submi tting Seco ndary Clai ms88
	161	6.3.2Submi tting Prim ary Claims for TRICA RE and Dua l Eligibil ity Patien ts89
	162	7Accessing the Pharm acy ECME M anager Men u91
	163	7.1 ECME T ransaction Maintenan ce Options 92
	164	7.1.1 View /Unstrand Submission s Not Comp leted92
	165	7.1.2 Re O pen CLOSED /Resubmit Claim 94
	166	7.2 Pharma cy ECME Se tup Menu97
	167	7.2.1 Edit Basic ECM E Paramete rs97
	168	7.2.2 Edit ECME Phar macy Data1 00
	169	7.2.3 Regi ster Pharm acy with A ustin Info rmation Te chnology C enter103
	170	7.3 Statis tics Scree n106
	171	7.3.1 Upda te Continu ously108
	172	7.3.2 Disp lay Update 109
	173	7.3.3 Zero (clear) S tatistics1 09
	174	7.3.4 Exit ing the St atistics S creen111
	175	8Accessing the Pharm acy Electr onic Claim s Reports1 13
	176	8.1 Claim Results an d Status11 4
	177	8.1.1 Paya ble Claims Report117
	178	8.1.2 Reje cted Claim s Report12 3
	179	8.1.3 CMOP /ECME Acti vity Repor t130
	180	8.1.4 Reve rsal Claim s Report13 2
	181	8.1.5 Clai ms Submitt ed, Not Ye t Released 136
	182	8.1.6 Rece nt Transac tions138
	183	8.1.7 Tota ls by Date 143
	184	8.1.8 Clos ed Claims Report144
	185	8.1.9 Non- Billable S tatus Repo rt148
	186	8.1.10 Spe nding Acco unt Report 155
	187	8.2 Other Reports161
	188	8.2.1 ECME Claims-Re sponse Inq uiry Optio n161
	189	8.2.2 Paye r Sheet De tail Repor t Option16 4
	190	8.2.3 ECME Setup – P harmacies Report169
	191	8.2.4 Turn -around ti me statist ics171
	192	8.2.5 View ePharmacy Rx172
	193	8.2.6 OPEC C Producti vity Repor t183
	194	9BPS Night ly Backgro und Job190
	195	10Glossary 192
	196	11Acronyms 208
	197	12Index209
	198
	199
	200
	201	1Introduct ion
	202
	203
	204	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:
	205
	206	Allows pha rmacy clai ms process ing staff to submit, resubmit, and rever se electro nic claims ;
	207
	208	Provides r eports for end users and manag ement on c laims stat us, transa ction hist ory, and s ystem conf iguration standings;
	209
	210	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.
	211
	212	Allows Eli gibility I nquiry and Verificat ion transa ctions for verificat ion of val id patient pharmacy insurance.
	213
	214	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.
	215
	216	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.
	217
	218
	219	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.
	220
	221	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.
	222
	223	The ECME U ser Manual consists of the fol lowing sec tions.
	224
	225	ECME Intro duction: Outlines t he history , use, and intent of the ECME software.
	226
	227	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.
	228
	229	ECME Menu Structures : Lists t he complet e ECME men u structur e. It also lists the ECME User , Manager, and Repor ts menus.
	230
	231	Accessing the ECME M enu: Desc ribes how to gain ac cess to th e ECME mai n Menu.
	232
	233	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.
	234
	235	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.
	236
	237	Accessing the Pharma cy ECME Ma nager Menu : Describ es electro nic claims managemen t features that requ ire manage ment level decisions .
	238
	239	Accessing the Pharma cy Electro nic Claims Reports: Describes the repor ts generat ed by ECME .
	240
	241	ECME Backg round Jobs : Describ es the tas ks perform ed by the Nightly Ba ckground J ob.
	242
	243	Glossary: Defines c ommon ECME -related t erms.
	244
	245	Acronyms: Lists ECM E-related acronyms.
	246
	247	Index: Li sts subjec ts, option s, and men us alphabe tically.
	248
	249
	250	2Orientati on
	251	2.1 Workin g with the ECME User Manual
	252	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.
	253
	254	The ECME U ser Manual uses the following methods to enhance r eadability .
	255
	256	Menu optio ns and scr een action s are ital icized.
	257	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.
	258
	259	Screen pro mpts are d enoted wit h quotatio n marks ar ound them.
	260	Example: The “Selec t Action:” prompt wi ll display next.
	261
	262	Variable n ames, form al name of options, field and file names , and secu rity keys are comple tely upper case.
	263	Example: The BPS US ER key.
	264
	265	Screen cap tures/dial ogues are shaded and shown in a non-prop ortional f ont.
	266
	267	User respo nses to on line promp ts are in boldface t ype.
	268	Example:
	269	Select Pha rmacy ECME User Menu Option: R PT
	270
	271	<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.
	272
	273	Example:
	274	Select Pha rmacy ECME Manager M enu Option : ?<Enter>
	275
	276	The follow ing symbol s alert yo u to speci al informa tion.
	277
	278	Symbol
	279	Descriptio n
	280
	281	Cautions y ou to noti ce critica l informat ion.
	282
	283	Indicates especially important or helpfu l informat ion.
	284
	285	Indicates that you m ust hold a particula r security key to pe rform a sp ecific tas k.
	286	Example: You must hold the BPS MANAGE R and BPS MENU keys to access the Pharma cy ECME Ma nager Menu options.
	287
	288	2.2 Obtain ing Online Help
	289	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.
	290
	291	To retriev e Online H elp in any VistA cha racter-bas ed product :
	292
	293	Enter a si ngle quest ion mark ( ?) at a fi eld/prompt to obtain a brief d escription :
	294
	295	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.
	296	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.
	297
	298	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.
	299
	300	Enter thre e question marks (?? ?) at a fi eld/prompt to invoke any addit ional Help text stor ed in Help Frames.
	301	2.3 Findin g Related Manuals
	302	To learn m ore about the ECME V . 1.0 soft ware, plea se consult the follo wing:
	303
	304	Electronic Claims Ma nagement E ngine (ECM E) V. 1.0 Technical Manual/Sec urity Guid e
	305
	306	All ECME V . 1.0 docu mentation can be fou nd at the VistA Docu mentation Library at http:// URL .
	307
	308	VHA-orient ed HIPAA ( Health Ins urance Por tability a nd Account ability Ac t) informa tion can b e found at http:// URL .
	309	(This page included for two-si ded copyin g.)
	310
	311
	312	3ECME Menu Structure s
	313	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.
	314
	315	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.
	316
	317	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.
	318
	319	Table 3-1: List of U sers with Suggested ECME Menus and Secur ity Keys
	320	Type of Us er
	321	*ECME Menu
	322	ECME Secur ity Keys
	323	OPECC
	324	All ECME M enus
	325	ECME Ma in Menu
	326	ECME Us er Screen
	327	ECME Ph armacy COB
	328	Pharmac y ECME Man ager Menu
	329	Pharmac y Electron ic Claims Reports
	330	BPSMENU
	331	BPS USER
	332	BPS MANA GER
	333	BPS REPO RTS
	334	Pharmacist , Pharmacy Technicia n
	335	ECME Ma in Menu
	336	ECME Us er Screen
	337	Pharmac y Electron ic Claims Reports
	338	BPSMENU
	339	BPS USER
	340	BPS REPO RTS
	341	ePharmacy Site Manag er and bac k-up
	342	ECME Ma in Menu
	343	ECME Us er Screen
	344	Pharmac y ECME Man ager Menu
	345	Pharmac y Electron ic Claims Reports
	346	BPSMENU
	347	BPS USER
	348	BPS MANA GER
	349	BPS MAST ER
	350	BPS REPO RTS
	351	ADPAC
	352	(Autom ated Data
	353	Proce ssing Appl ication
	354	Coord inator)
	355	ECME Ma in Menu
	356	ECME Ph armacy COB
	357	Pharmac y ECME Man ager Menu
	358	Pharmac y Electron ic Claims Reports
	359	BPSMENU
	360	BPS MANA GER
	361	(BPS MA STER is al so
	362	requir ed to acce ss certain
	363	MGR me nu options )
	364	BPS REPO RTS
	365	IRMS
	366	(Inform ation Reso urces
	367	Manage ment Servi ce)
	368	ECME Main Menu
	369	Pharmac y ECME Man ager Menu
	370	Pharmac y Electron ic Claims Reports
	371	BPSMENU
	372	BPS MANA GER
	373	(BPS MA STER is al so
	374	requir ed to acce ss certain
	375	MGR me nu options )
	376	BPS REPO RTS
	377	OPECC Supe rvisor
	378	Pharmacy E lectronic Claims Rep orts
	379	BPS SUPERV ISOR
	380	BPS REPORT S
	381	3.1 The Co mplete ECM E Menu Str ucture
	382
	383	The comple te list of ECME menu options i s shown be low. The O PECC needs to access all ECME options.
	384
	385
	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.
	387
	388	UECME User Screen
	389	COBECME Ph armacy COB ...
	390	SECPotenti al Seconda ry Rx Clai ms Report
	391	TRIPotenti al Claims Report for Dual Elig ible
	392	PROProcess Secondary /TRICARE R x to ECME
	393	MGRPharmac y ECME Man ager Menu . .
	394	MNTECME tr ansaction maintenanc e options …
	395	UNSView/Un strand Sub missions N ot Complet ed
	396	ROCRe Open CLOSED/Re submit Cla im
	397	SETPharmac y ECME Set up Menu .. .
	398	BASEdit Ba sic ECME P arameters
	399	PHAREdit E CME Pharma cy Data
	400	REGRegiste r Pharmacy with Aust in Informa tion Techno logy Cente r
	401	STATStatis tics Scree n
	402	RPTPharmac y Electron ic Claims Reports . .
	403	CLAClaim R esults and Status . .
	404	PAYPayable Claims Re port
	405	REJRejecte d Claims R eport
	406	ECMPCMOP/E CME Activi ty Report
	407	REVReversa l Claims R eport
	408	NYRClaims Submitted, Not Yet R eleased
	409	RECRecent Transactio ns
	410	DAYTotals by Date
	411	CLOClosed Claims Rep ort
	412	NBSNon-Bil lable Stat us Report
	413	SPASpendin g Account Report
	414	OTHOther R eports . .
	415	CRIECME Cl aims-Respo nse Inquir y
	416	PAYPayer S heet Detai l Report
	417	PHARECME S etup - Pha rmacies Re port
	418	TATTurn-ar ound time statistics
	419	VERView eP harmacy Rx
	420	OPROPECC P roductivit y Report
	421
	422	3.2 ECME U ser Screen
	423	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.
	424
	425
	426	You must h old the BP S MENU and BPS USER keys to vi ew the ECM E User Scr een option .
	427
	428	UECME User Screen
	429
	430	3.3 ECME P harmacy CO B Menu Str ucture
	431	The ECME P harmacy CO B Menu opt ion struct ure is lis ted below. OPECCs mu st be able to access this menu .
	432
	433
	434	You must h old the BP SMENU keys to view t he ECME Ph armacy COB option.
	435
	436
	437	COBECME Ph armacy COB . .
	438	SEC Pot ential Sec ondary Rx Claims Rep ort
	439	TRI Potential Claims Re port for D ual Eligib le
	440	PRO Process Se condary/TR ICARE Rx t o ECME
	441	3.4 Pharma cy ECME Ma nager Menu Structure
	442
	443	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.
	444
	445
	446	You must h old the BP SMENU and BPS MANAGE R keys to view the P harmacy EC ME Manager Menu opti on.
	447
	448	MGRPharmac y ECME Man ager Menu . .
	449	MNTECME tr ansaction maintenanc e options …
	450	UNSView/Un strand Sub missions N ot Complet ed
	451	ROCRe Open CLOSED/Re submit Cla im
	452	SETPharmac y ECME Set up Menu .. .
	453	BASEdit Ba sic ECME P arameters
	454	PHAREdi t ECME Pha rmacy Data
	455	REGRegi ster Pharm acy with A ustin Auto mation Cen ter
	456	STATStatis tics Scree n
	457	3.5 Pharma cy Electro nic Claims Reports M enu Struct ure
	458
	459	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.
	460
	461
	462	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.
	463
	464	RPTPharmac y Electron ic Claims Reports . .
	465	CLAClaim R esults and Status . .
	466	PAYPayable Claims Re port
	467	REJRejecte d Claims R eport
	468	ECMPCMOP/E CME Activi ty Report
	469	REVReversa l Clams Re port
	470	NYRClaims Submitted, Not Yet R eleased
	471	RECRecent Transactio ns
	472	DAYTotals by Date
	473	CLOClosed Claims Rep ort
	474	NBS Non -Billable Status Rep ort
	475	SPA Spe nding Acco unt Report
	476
	477	OTHOther R eports . .
	478	CRIECME Cl aims-Respo nse Inquir y
	479	PAYPayer S heet Detai l Report
	480	PHARECME S etup - Pha rmacies Re port
	481	TATTurn-ar ound time statistics
	482	VERView eP harmacy Rx
	483	OPROPECC P roductivit y Report
	484
	485
	486
	487
	488	4Accessing the ECME Main Menu
	489
	490	The Electr onic Claim s Manageme nt Engine Main Menu option is usually ac cessed thr ough the C ore Applic ations Men u.
	491
	492
	493	You must h old the BP SMENU key to view th e Electron ic Claims Management Engine (E CME) Main Menu.
	494
	495	Example 4- 1: Access ing the El ectronic C laims Mana gement Eng ine Main M enu
	496	Select Cor e Applicat ions Optio n: ?
	497
	498	Laboratory ...
	499	PIMS MAS MANAGE R ...
	500	Mental Hea lth ...
	501	Military R etirees .. .
	502	Patient Da ta Log
	503	Informatio n Manageme nt Systems (SWIMS) . ..
	504	Voluntary Services' Menu ...
	505	AR Finance AR Manager M enu ...
	506	BPS ECME ...
	507	EN Engineerin g Main Men u ...
	508	FEE Fee Basis Main Menu ...
	509	HL7 HL7 Main M enu ...
	510	IB Integrated Billing M aster Menu ...
	511	NS Nursing Sy stem Manag er's Menu ...
	512	PSO Outpatient Pharmacy Manager .. .
	513	VOL Voluntary Service Ma ster Menu ...
	514
	515	Select Cor e Applicat ions Optio n: BPS EC ME
	516
	517
	518	(This page included for two-si ded copyin g.)
	519
	520	5Accessing the ECME User Scree n
	521
	522	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 .
	523
	524	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.
	525
	526
	527	You must h old the BP SMENU AND BPS USER k ey to view the ECME User Scree n option.
	528
	529	This scree n is acces sed by sel ecting the U (ECME U ser Screen ) option o n the ECME Main Menu screen.
	530
	531
	532	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 .
	533
	534	Example 5- 1: Access ing the EC ME User Sc reen Optio n
	535	*** ****** ****** ****** ****** **
	536	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	537	* XXXXX V AMC *
	538	* Main M enu *
	539	*** ****** ****** ****** ****** **
	540
	541
	542	U ECME User Screen
	543	COB ECME Pharm acy COB .. .
	544	MGR Pharmacy E CME Manage r Menu ...
	545	RPT Pharmacy E lectronic Claims Rep orts ...
	546
	547
	548	Select ECM E Option: U ECME Us er Screen
	549	Please wai t...
	550	Example 5- 2: Displa ying the E CME User S creen Opti on
	551	PHARMACY E CME Jul 03, 20 10@14:55:0 1 Page : 1 of 30
	552	SELECTED D IVISION(S) : ALL
	553	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	554	Sorted b y: Transac tion date by default
	555	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# STATUS /LOC/TYP/R XINF
	556	1 ECMEPa tient,FIVE (XXXX) I BINSUR1/ VET Pb: 0 Rj:1 AcR v:3 RjRv:0
	557	1.1 CO LCHICINE 0 .6MG 0007 4-3781-01 06/24 1012 97$ 1/ 0000000016 53 M RT DS/N
	558	10/1 9/10 - Cla rification Code 8 su bmitted.
	559	(OPP USER,TWO)
	560	p-Re versal acc epted
	561	Enter ?? f or more ac tions
	562	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	563	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	564	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	565	Select Act ion: Next Screen//
	566
	567	This secti on diagram s and desc ribes the different elements o f your ECM E User Scr een.
	568
	569	PHARMACY E CME Jul 03, 20 10@14:55:0 1 Page : 1 of 30
	570	SELECTED D IVISION(S) : ALL
	571	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	572	Sorted b y: Transac tion date by default
	573
	574	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/FILL/RX# /ECME# STATU S/LOC/TYP/ RXINF
	575	1 ECMEPa tient,FIVE (XXXX) I BINSUR1/ Vet Pb: 0 Rj:1 AcR v:3 RjRv:0
	576	1.1 CO LCHICINE 0 .6MG 0007 4-3781-01 06/24 1012 97$ 1/ 0000000016 53 M RT DS/N
	577	10/1 9/10 - Cla rification Code 8 su bmitted.
	578	(OPP USER,TWO)
	579	p-Re versal acc epted
	580
	581	Enter ?? f or more ac tions
	582
	583
	584
	585
	586	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	587	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	588	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	589	Select Act ion: Next Screen//
	590
	591
	592	PHARMACY E CME Jul 03, 20 10@14:55:0 1 Page : 1 of 30
	593	SELECTED D IVISION(S) : ALL
	594	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	595	Sorted b y: Transac tion date by default
	596
	597	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/FILL/RX# /ECME# STATU S/LOC/TYP/ RXINF
	598	1 ECMEPa tient,FIVE (XXXX) I BINSUR1/ Vet Pb: 0 Rj:1 AcR v:3 RjRv:0
	599	1.1 CO LCHICINE 0 .6MG 0007 4-3781-01 06/24 1012 97$ 1/ 0000000016 53 M RT DS/N
	600	10/1 9/10 - Cla rification Code 8 su bmitted.
	601	(OPP USER,TWO)
	602	p-Re versal acc epted
	603
	604	Enter ?? f or more ac tions
	605
	606
	607
	608
	609	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	610	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	611	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	612	Select Act ion: Next Screen//
	613
	614	Dia gram 5-1: ECME User Screen Ar eas
	615
	616	Header
	617	Area
	618	Header
	619	Area
	620
	621
	622
	623
	624	Patient/
	625	Rx
	626	Area
	627	Patient/
	628	Rx
	629	Area
	630
	631
	632
	633
	634
	635	Message
	636	Window
	637
	638	Message
	639	Window
	640
	641
	642
	643
	644	Action
	645	Area
	646	Action
	647	Area
	648
	649
	650	The table below desc ribes the four areas of the EC ME User Sc reen.
	651	Table 5-1: Descript ion of ECM E User Scr een Areas
	652	Screen Are a
	653	Descriptio n
	654	Header Are a
	655	Displays t he date/ti me the scr een was bu ilt, page status, se lected div ision(s), user and a ctivity da te range.
	656	Patient/
	657	Rx Area
	658	Displays i nformation about the patient a nd prescri ption:
	659
	660	#
	661	Line Numbe r. Sequent ial line n umber for each patie nt and ass ociated pr escription line(s).
	662
	663	Patient Li nes
	664
	665	# PATIEN T (Pati ent ID) IN SURANCE/ E ligIndicat or Summar yStatus
	666
	667	ECMEPatien t,FIVE (X XXX) IBINS UR1/ VET Pb:0 Rj:1 AcRv:3 Rj Rv:0
	668
	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
	675	Exam ple: VET Pb :17 Rj:4 A cRv:0 RjRv :0.
	676
	677	Claim/ Pre scription Informatio n Line
	678	The Prescr iption lin e(s) follo w the pati ent inform ation line s sequenti ally. For each fill, an ECME c laim is se nt to the payer and each of th ese claims is displa yed as a s eparate li ne on the User Scree n (ECME Us er Screen) .
	679
	680	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
	681
	682	LOC /BillT YPE /RXSta tus /Rele ase Status
	683	M/ RT/ DS /N
	684
	685	These show for each claim:
	686	Drug Name
	687	NDC (Natio nal Drug C ode)
	688	Date of Se rvice
	689	Rx#
	690	$ Patient Copay (if applicable )
	691	Refill#
	692	ECME#
	693	Fill Locat ion
	694	C = Consol idated Mai l Outpatie nt Pharmac y (CMOP)
	695	M = LO CAL MAIL
	696	W = WI NDOW FILL
	697	Bill Type
	698	BB = B ackbill
	699	P2 = PRO option
	700	RS = Res ubmission
	701	RT = Rea l Time Fil l
	702	RX Status
	703	AC = Acti ve
	704	NV = Non-v erified
	705	HL = Hold
	706	SU = Suspe nd
	707	EX = Expir ed
	708	DS = Disco ntinued
	709	DL = Delet ed
	710	?? = Unkno wn
	711	Release St atus
	712	N = Rx NOT Released
	713	R = Rx Rel eased
	714	Coordinati on of Bene fits Indic ator
	715	p- primary claim
	716	s- seconda ry claim
	717	s-Payable (p-Payable )
	718	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 "*".
	719
	720	User-Input Comments
	721	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. If a claim ha s been res ubmitted s ince the m ost recent comment, a message displays i n place of the most recent com ment: “Pr ior commen ts suppres sed – use CMT action for all c omments”.
	722
	723	Payer Retu rned Respo nses
	724	The Payer Returned R esponse in formation is display ed beneath the user- input comm ents or be neath the patient in formation line, if n o comments were ente red. Each response w ill begin on a separ ate line.
	725	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 e -Pharmacy Training H ome Page, with addit ional line s of descr iptive err or message s), Payabl e, Reversa l Accepted , Reversal Rejected, Stranded, Stranded reversal, Captured, Duplicate, Other, Ca ncelled, C orrupt, Un known stat us and In Progress. If a claim is closed , “Closed” is added to the sta tus, e.g., “Reversal accepted/ Closed”.
	726	Message Wi ndow
	727	This secti on display s a plus ( +) sign, m inus (-) s ign or inf ormational text (i.e ., Enter ? ? for more actions). The plus and minus signs, ent ered at th e action p rompt, are used to j ump forwar d or back a screen.
	728	Action Are a
	729	A list of Claims Dat a Entry op tions is a vailable t o you as d escribed i n Section 5 of this manual. A double que stion mark (??) may be entered at the "S elect Acti on" prompt for a lis t of all L ist Manage r options available.
	730
	731
	732	An option chosen at the patien t informat ion level is perform ed on all claim item s for that patient.
	733
	734	The ECME U ser Screen also disp lays non-b illable en tries in a ddition to billable claims. T RICARE and CHAMPVA p rescriptio ns with ps eudo-rejec tion codes of eT and eC displa y with a f ew differe nces. The display fo r non-bill able entri es does no t include date of se rvice or a n ECME num ber. Also, an open/c losed indi cator disp lays for e ach pseudo -rejection entry and the open/ closed sta tus is onl y for disp lay purpos es. The us er is able to filter based on the status by using the Change View acti on.
	735
	736	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).
	737	Example 5- 2: List of all ECME User Scree n Actions
	738	+ Enter ?? f or more ac tions
	739	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	740	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	741	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	742
	743	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.
	744
	745	Example 5- 3: Display ing List M anager Act ions by En tering “?? ”
	746	Select Act ion: Next Screen// ? ?
	747
	748	The follow ing action s are also available :
	749	+ Next Screen
	750	- Previ ous Screen
	751	UP Up a Line
	752	DN Down a Line
	753	> Shift View to R ight
	754	< Shift View to L eft
	755	FS First Screen
	756	LS Last Screen
	757	GO Go to Page
	758	RD Re Di splay Scre en
	759	PS Print Screen
	760	PL Print List
	761	SL Searc h List
	762	ADPL Auto Display(On /Off)
	763	QQuit
	764
	765	Press RETU RN to cont inue or '^ ' to exit:
	766
	767	ROC Reope n Closed C laims
	768	OCN Open/ Close Non Billable E ntry
	769	DV Print Developer Claim Log
	770	REJ OPECC Reject In formation
	771	RER Resub mit Claim w/o Revers al
	772	EX Exit
	773	LOG Print Claim Log
	774	RED Resub mit Claim w/EDITS
	775	UD Displ ay Update
	776
	777	Enter RETU RN to cont inue or '^ ' to exit:
	778
	779	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).A fter selec ting an ac tion, a pr ompt may d isplay for the user to select an item fr om the ECM E User scr een. If t he action requires t he user to select a patient li ne, the sy stem will default a value of 1 for the i tem prompt if there is only on e patient displayed. If the a ction requ ires the u ser to sel ect a clai m line, th e system w ill defaul t a value of 1.1 for the promp t if there is only o ne claim d isplayed.
	780	5.1 Change View
	781	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.
	782
	783	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”.
	784
	785
	786	(This page included for two-si ded copyin g.)
	787
	788	Example 5. 1-1: Acce ssing the Change Vie w Action
	789	PHARMACY E CME Apr 26, 20 06@11:44:4 5 Page : 1 of 2
	790	SELECTED D IVISION(S) : ALL
	791	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	792	Sor ted by: Pa tient Name
	793	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	794	6 ECMEpa tient,Two (XXXX) W EBMD TE/ VET Pb:1 Rj:0 AcRv:0 RjR v:1
	795	6.1 FU ROSEMIDE 1 0MG/M 006 41-2312-25 04/18 100 004065$ 0 /000000504 691 W RT A C/R
	796	p-Pa yable
	797	6.2 CH OLESTYRAMI NE 4G 000 87-0580-01 04/19 100 004066$ 0 /000000504 692 W RT A C/R
	798	p-Re versal rej ected
	799	NN:T ransaction Rejected At Switch Or Interme diary
	800	NC16 -The clear inghouse d id not rep ly in time .
	801	7 ECMEpa tient,One (XXXX) W EBMD TE/ VET ALL payabl e
	802	7.1 AL BUTEROL IN HALER 555 55-4444-22 04/26 100 003744$ 0 /000000504 304 W RT A C/R
	803	p-Pa yable
	804	7.2 AC ETYLCYSTEI NE 20 000 87-0570-09 04/21 100 004054$ 0 /000000504 677 W RT A C/N
	805	p-Pa yable
	806	8 ECMEpa tient,Thre e (XXXX) W EBMD TE/ VET ALL payabl e
	807	+ Enter ?? f or more ac tions
	808	The screen has been updated on APR 26,20 06@14:50:4 7. Press " Q" to quit .
	809	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	810	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	811	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	812	Select Act ion: Next Screen//CV Change Vi ew
	813
	814
	815	(This page included for two-si ded copyin g.)
	816
	817
	818
	819	View data by divisio n(s) or al l division s.
	820	Example 5. 1-2: Sele cting View s by Divis ion
	821	Selec t one of t he followi ng:
	822
	823	D DIVISION
	824	A ALL
	825
	826	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: A// DIVISION
	827
	828	Selected :
	829	Select ECM E Pharmacy Division( s): BAY PI NES
	830	BAY PINES
	831
	832
	833	View data by Eligibi lity Type of the cla im.
	834	Example 5. 1-3: Sele cting View s by Eligi bility Typ e
	835	Selec t one of t he followi ng:
	836
	837	V VETERAN
	838	T TRICARE
	839	C CHAMPVA
	840	A ALL
	841
	842	Select One or Many E ligibility Types or (A)ll: A// ?
	843
	844	Enter a si ngle respo nse or mul tiple resp onses sepa rated by c ommas.
	845	Example:
	846	T
	847	T,C
	848
	849
	850	View data for one EC ME user, m any ECME u sers or al l users. T he ECME us er is defi ned as the person wh o last pro cessed/fin ished/resu bmitted, e tc., the p rescriptio n fill.
	851	Example 5. 1-4: Sele cting View s from Ent ries by On e User
	852	Selec t one of t he followi ng:
	853
	854	U USER
	855	A ALL
	856
	857	Display On e or Many ECME (U)se rs or (A)L L: A// USE R
	858
	859	Enter a us er to sele ct.
	860	Once all u sers are s elected, h it enter w ithout mak ing a sele ction.
	861
	862	Select Use r: USER
	863	1 E CMEuser,On e UO PHARMA CIST
	864	2 E CMEuser,Tw o UTW PHARMA CIST
	865	3 E CMEuser,Th ree UTH PHARMA CIST
	866	CHOOSE 1-3 : 1 ECMEu ser,One UO PHARMA CIST
	867	Selected :
	868	ECMEuser,O ne
	869	Select Use r:
	870
	871
	872	View data from one p atient, ma ny patient s or all p atients.
	873	Example 5. 1-5: Sele cting View s from Ent ries for O ne Patient
	874	Se lect one o f the foll owing:
	875
	876	P PATIENT
	877	A ALL
	878
	879	Display On e or Many (P)atients or (A)LL: A// PATIE NT
	880
	881	Enter a pa tient to s elect.
	882	Once all p atients ar e selected , hit ente r without making a s election.
	883
	884	Select Pat ient: ECME patient,ON E// ECME
	885	1 ECM Epatient,O ne 1-1-65 666443333 NO NSC VET ERAN
	886
	887	2 ECM Epatient,T wo 1-1-65 666443444 NO NSC VET ERAN
	888
	889	3 ECM Epatient,T hree 1-1-68 666773333 YES SC VET ERAN
	890
	891
	892	ENTER '^' TO STOP, O R
	893	CHOOSE 1-3 : 2 ECMEp atient,Two 1- 1-65 66 6443444 NO NSC VETER AN
	894	Enrollmen t Priority : GROUP 8g Categor y: NOT ENR OLLED End Date: 08/ 01/2005
	895	Selecte d:
	896	ECMEpatie nt,Two
	897	Select Pat ient:
	898
	899	Note: If selecting one or man y patients , data may be viewed for up to 366 days. If selec ting all p atients, d ata may be viewed fo r up to 18 0 days.
	900
	901	View data about one prescripti on, many p rescriptio ns or all prescripti ons.
	902	Example 5. 1-6: Sele cting View s from Ent ries for O ne Prescri ption
	903	Se lect one o f the foll owing:
	904
	905	R RX
	906	A ALL
	907
	908	Display On e or Many (R)x or (A )LL: A// R RX
	909
	910	Enter a pr escription to select .
	911	Once all p rescriptio ns are sel ected, hit enter wit hout makin g a select ion.
	912
	913	Select RX: 123456
	914	Selecte d:
	915	123456
	916	Select RX:
	917
	918
	919	Choose dat a for a da te range o r timefram e of days or hours.
	920	Example 5. 1-7: Sele cting View s by Timef rame of th e Default of Days
	921	Sele ct one of the follow ing:
	922
	923	D Date Range
	924	T Timeframe
	925
	926	Display Ac tivity (D) ate Range or (T)imef rame: T// ?
	927
	928	Date Range will allo w a user t o specify an activit y beginnin g and endi ng date.
	929	Timeframe will allow a user to specify t he activit y by days or hours.
	930
	931	Selec t one of t he followi ng:
	932
	933	D Date Range
	934	T Timeframe
	935
	936	Display Ac tivity (D) ate Range or (T)imef rame: Date Range
	937
	938	Note: If selecting one or man y patients , data may be viewed for up to 366 days. If selec ting all p atients, d ata may be viewed fo r up to 18 0 days.
	939
	940	(IF BY DAT E RANGE) C hoose a be ginning an d ending d ate.
	941	Example 5. 1-8: Sele cting View s by Date Range
	942	Display Ac tivity (D) ate Range or (T)imef rame: T// d Date Ra nge
	943	Activity B eginning D ate: T ( JAN 11,200 8)
	944	Activity E nding Date : ?
	945
	946	Enter a da te which i s no more than 180 d ays after the Beginn ing Date.
	947
	948	Activity E nding Date :
	949
	950
	951	(IF BY TIM EFRAME) Ch oose data for a peri od of days or hours.
	952	Example 5. 1-9: Sele cting View s by Timef rame of th e Default of Days
	953	Selec t one of t he followi ng:
	954
	955	D DAYS
	956	H HOURS
	957
	958	Activity T imeframe ( H)ours or (D)ays: D/ / <Enter> AYS
	959
	960	(IF BY TIM EFRAME) En ter a numb er for the timeframe value for the numbe r of days, or number of hours, to view.
	961	Example 5. 1-10: Sel ecting Vie ws by Time frame Numb er of Days or Hours
	962	Activity T imeframe V alue: (1-1 80): 40// 10
	963
	964
	965	Choose whi ch types o f claims w ill displa y on the U ser Screen .
	966	Example 5. 1-11: Sel ecting Typ es of Clai ms
	967	Selec t one of t he followi ng:
	968
	969	O OPEN CLAIM S
	970	C CLOSED CLA IMS
	971	A ALL
	972
	973	Select Ope n/Closed o r All Clai ms: A// <E nter> LL
	974
	975
	976	Choose whi ch types o f non-bill able entri es will di splay on t he User Sc reen.
	977	Example 5. 1-12: Sel ecting Typ es of Entr ies
	978	Selec t one of t he followi ng:
	979
	980	O Open Non-B illable En tries
	981	C Closed Non -Billable Entries
	982	A ALL
	983
	984	Please note this question only appli es to
	985	TRICAR E or CHAMP VA Non-Bil lable Entr ies.
	986
	987	Display (O )pen or (C )losed or (A)ll Non- Billable E ntries: A/ /
	988
	989
	990	Choose whi ch types o f payer re quests wil l display on the Use r Screen.
	991
	992	Example 5. 1-13: Sel ecting Typ es of Requ ests
	993	Selec t one of t he followi ng:
	994
	995	B BILLING RE QUESTS
	996	R REVERSALS
	997	A ALL
	998
	999	Select Sub mission Ty pe: A// <E nter> LL
	1000
	1001
	1002	View rejec ted claims , payable claims or all claims .
	1003	Example 5. 1-14: Sel ecting Vie ws of Clai m Status
	1004	Selec t one of t he followi ng:
	1005
	1006	R REJECTS
	1007	P PAYABLES
	1008	U UNSTRANDED
	1009	A ALL
	1010
	1011	Display (R )ejects or (P)ayable s or (U)ns tranded or (A)LL: A/ /?
	1012
	1013	Enter a si ngle respo nse or mul tiple resp onses sepa rated by c ommas.
	1014	Example:
	1015	P
	1016	P,R
	1017
	1018
	1019	View relea sed claims , non-rele ased claim s or all c laims.
	1020	Example 5. 1-15: Sel ecting Vie ws of Rele ased Claim s
	1021	Selec t one of t he followi ng:
	1022
	1023	R RELEASED
	1024	N NON-RELEAS ED
	1025	A ALL
	1026
	1027	Display (R )eleased R xs or (N)o n-Released Rxs or (A )LL: A// R ELEASED
	1028
	1029
	1030	View CMOP, Mail, Win dow or all claims.
	1031	Example 5. 1-16: Sel ecting Vie ws of CMOP Claims
	1032	Selec t one of t he followi ng:
	1033
	1034	C CMOP
	1035	M MAIL
	1036	W WINDOW
	1037	A ALL
	1038	Display (C )MOP or (M )ail or (W )indow or (A)LL: A// ?
	1039
	1040	Enter a si ngle respo nse or mul tiple resp onses sepa rated by c ommas.
	1041	Example:
	1042	C
	1043	C,M
	1044
	1045
	1046	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.
	1047	Example 5. 1-17: Sel ecting Vie ws of Bill Types
	1048	Select one of the fo llowing:
	1049
	1050	R REALTIME
	1051	B BACKBILLS
	1052	P PRO OPTION
	1053	S RESUBMISSI ON
	1054	A ALL
	1055
	1056	Display (R )ealTime, (B)ackbill s, (P)RO O ption, Re( S)ubmissio n or (A)ll : A// ?
	1057	Enter a si ngle respo nse or mul tiple resp onses sepa rated by c ommas.
	1058	Example:
	1059	B
	1060	B,P
	1061
	1062
	1063	View one r eject code , multiple reject co des or all reject co des if the option “R EJECTS” wa s chosen f or types o f claims t o view in (G) Reject ed Claims, above. W hen select ing reject Code, the prompt co ntinues to repeat un til the us er presses ‘Enter’ w ithout a r esponse.
	1064	Example 5. 1-18: Sel ecting Vie ws of One Reject Cod e
	1065	Selec t one of t he followi ng:
	1066
	1067	R REJECT COD E
	1068	A ALL
	1069
	1070	Display Sp ecific (R) eject Code or (A)LL: A// REJEC T CODE
	1071	Select Rej ect Code: 29 M /I Number Refills Au thorized
	1072	Selected :
	1073	29 M /I Number Refills Au thorized
	1074	Select Rej ect Code:
	1075
	1076
	1077	View data for a spec ific insur ance compa ny or all insurance companies.
	1078	Example 5. 1-19: Sel ecting Vie ws by a Sp ecific Ins urance Com pany
	1079	Selec t one of t he followi ng:
	1080
	1081	I SPECIFIC I NSURANCE(S )
	1082	A ALL
	1083
	1084	Select Cer tain (I)NS URANCE or (A)LL): I/ / <Enter> SPECIFIC INSURANCE( S)
	1085	Selected : OPINSUR2
	1086
	1087	Select INS URANCE: DE VELOPMENT INS 123 HERE S TREET SAN FR ANCISCO
	1088	CALIFORN IA Y
	1089	Selected : DEVELOPM ENT INS
	1090	OPINSUR2
	1091
	1092	Select INS URANCE: OP INSUR2 25 INS WAY BIRM ALABAMA Y
	1093
	1094
	1095	Selec t one of t he followi ng:
	1096
	1097	Y YES
	1098	N NO
	1099
	1100	Delete OPI NSUR2 from your list ?: NO// y YES
	1101	Selected : DEVELOPM ENT INS
	1102
	1103	Select INS URANCE:
	1104
	1105	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.
	1106	Example 5. 1-20: Ent ering “Y” to Save Se lections a s User’s P referred V iew
	1107	DO YOU WAN T TO SAVE THIS VIEW AS YOUR PR EFERRED VI EW (Y/N)?: YES
	1108	Updating s creen...
	1109
	1110	If a user accesses Change Vie w and they are not c urrently v iewing the saved pre ferred vie w, the use r is asked if they w ant to Res tore the P referred V iew. You must answe r Y or N w hen asked to restore the prefe rred view.
	1111	A response of Y will automatic ally resto re the vie w of the E CME User S creen to t he previou sly saved view witho ut the use r answerin g all of t he Change View filte rs.
	1112	A response of N, wil l prompt t he user wi th all of the Change View filt ers.
	1113	Example 5. 1-21: Ent ering “Y” to Restore User’s Pr eferred Vi ew
	1114	Restore yo ur Preferr ed View an d exit Cha nge View ( Y/N)? Y//
	1115	Updating s creen...
	1116
	1117	5.2 Sort L ist
	1118	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.
	1119
	1120	Sort Order (Defaults );
	1121	TTransacti on Date/Ti me(descend ing)
	1122	DDivision (ascendin g)
	1123	IInsurance Company(a scending)
	1124	CReject Co de(ascendi ng)
	1125	PPatient N ame(ascend ing)
	1126	NDrug Name (ascending )
	1127	BBill Type [BB/P2/RT ](ascendin g)
	1128	LFill Loca tion (asce nding)
	1129	RReleased/ Non-Releas e(ascendin g)
	1130	AActive/Di scontinued Rx (asce nding)
	1131
	1132
	1133
	1134	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.
	1135	Active/Dis continued Rx option sorts clai ms by the Rx status.
	1136
	1137	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”.
	1138	Example 5. 2-1: Acce ssing the Sort List Option
	1139	PHARMACY E CME Apr 30, 20 05@09:10:1 8 Page: 1 of 2
	1140	SELECTED D IVISION(S) : ALL
	1141	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1142	Sor ted by: Pa tient Name
	1143	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	1144	6 ECMEpa tient,Two (XXXX) WEB MD / 89% Pb: 5 Rj:0 AcR v:0 RjRv:0
	1145	6.1 FU ROSEMIDE 1 0MG/M 006 41-2312-25 04/21 100 004065$ 0 /000000504 691 W RT A C/R
	1146	p-Pa yable
	1147	6.2 CH OLESTYRAMI NE 4G 000 87-0580-01 04/21 100 004066$ 0 /000000504 692 W RT A C/R
	1148	p-Re versal rej ected
	1149	NN:T ransaction Rejected At Switch Or Interme diary
	1150	NC16 -The clear inghouse d id not rep ly in time .
	1151	7 ECMEpa tient,One (XXXX) WEBMD TE/ VET ALL payab le
	1152
	1153	+ Enter ?? f or more ac tions
	1154	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1155	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1156	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1157	Select Act ion: Next Screen//SO Sort Li st
	1158
	1159	Example 5. 2-2: Choo sing Patie nt as the User’s Sor t Preferen ce
	1160	Selec t one of t he followi ng:
	1161
	1162	T TRANSACTIO N DATE
	1163	D DIVISION
	1164	I INSURANCE
	1165	C REJECT COD E
	1166	P PATIENT NA ME
	1167	N DRUG NAME
	1168	B BILL TYPE (BB/P2/RT)
	1169	L FILL LOCAT ION
	1170	R RELEASED/N ON-RELEASE D
	1171	A ACTIVE/DIS CONTINUED
	1172
	1173	ENTER SORT TYPE: P// PATIENT N AME
	1174
	1175
	1176	Example 5. 2-3: Choo sing User’ s Sort Pre ference as the Prefe rred View
	1177	Selec t one of t he followi ng:
	1178
	1179	Y YES
	1180	N NO
	1181
	1182	DO YOU WAN T TO SAVE THIS VIEW AS YOUR PR EFERRED VI EW (Y/N)?: YES
	1183	Updating s creen...
	1184
	1185	5.3 Revers e Payable Claim
	1186	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.
	1187
	1188	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. ”
	1189
	1190	Access the action by entering REV at the “Select A ction:” pr ompt on th e ECME Use r Screen.
	1191	Example 5. 3-1: Acce ssing and Executing the Revers e Payable Claim Acti on
	1192	PHARMACY E CME Aug 10, 20 05@10:31:2 2 Page: 1 8 of 42
	1193	SELECTED D IVISION(S) : ALL
	1194	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1195	Sor ted by: Pa tient Name
	1196	+# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	1197	7 ECMEpa tient,One (XXXX) WE BMD TE/ VET A LL payable
	1198	7.1 AL BUTEROL IN HALER 555 55-4444-22 08/08 100 003744$ 0 /000000504 304 W RT A C/R
	1199	p-Pa yable
	1200	7.2 AC ETYLCYSTEI NE 20 000 87-0570-09 08/01 100 004054$ 0 /000000504 677 W RT A C/N
	1201	p-Pa yable
	1202	+ Enter ?? f or more ac tions
	1203	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1204	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1205	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1206	Select Act ion: Next Screen// R EV Rever se Payable Claim
	1207
	1208
	1209	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.
	1210	Example 5. 3-2: Ente ring the L ine Item f or a Claim with a Pa yable Seco ndary Clai m
	1211	1.12 FLU RAZEPAM 15 MG C 00140 -0065-14 0 3/04 10232 2$ 2/00000 0113596 W RT AC/R
	1212	cannot be Reversed i f the seco ndary clai m is payab le.
	1213	Please rev erse the s econdary c laim first .
	1214
	1215
	1216	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.
	1217	Example 5. 3-3: Ente ring the L ine Item f or the Cla im Reversa l Request
	1218	Enter the line numb ers for th e Payable claim(s) t o be Rever sed.
	1219	Select: 7 .1
	1220
	1221
	1222	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.
	1223	Example 5. 3-4: Typi ng Text fo r Required Reversal Reason
	1224
	1225	You've cho sen to REV ERSE the f ollowing p rescriptio n for ECME patient,Si x
	1226	7.1 AL BUTEROL IN HALER 555 55-4444-22 02/28 100 003744$ 0 /000000504 304 W RT A C/R
	1227
	1228	Enter REQU IRED REVER SAL REASON : RX IS FO R SC CONDI TION
	1229
	1230	This respo nse must h ave at lea st 0 chara cters and no more
	1231	than 60 ch aracters a nd must no t contain embedded u parrow
	1232
	1233
	1234
	1235	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.
	1236	Example 5. 3-5: Ente ring “Y” t o Continue Claim Rev ersal Requ est
	1237	Enter REQU IRED REVER SAL REASON : Drug is only billa ble throug h CMOP
	1238	Are you su re?(Y/N)? YES
	1239
	1240
	1241	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.
	1242
	1243	Example 5. 3-6: Ente ring “Y” t o Mark the Claim as Non-billab le
	1244	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
	1245
	1246	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: ??
	1247
	1248	Choose from:
	1249	1 NOT INSURED
	1250	2 SC T REATMENT
	1251	3 AGEN T ORANGE
	1252	4 IONI ZING RADIA TION
	1253	5 SOUT HWEST ASIA
	1254	7 COVE RAGE CANCE LED
	1255	10 INVA LID PRESCR IPTION ENT RY
	1256	12 PRES CRIPTION D ELETED
	1257	13 PRES CRIPTION N OT RELEASE D
	1258	14 DRUG NOT BILLA BLE
	1259	21 MILI TARY SEXUA L TRAUMA
	1260	29 HEAD /NECK CANC ER
	1261	30 COMB AT VETERAN
	1262	33 90 D AY RX FILL NOT COVER ED
	1263	34 NOT A CONTRACT ED PROVIDE R
	1264	35 INVAL ID MULTIPL ES PER DAY SUPP
	1265	36 REFI LL TOO SOO N
	1266	37 INVA LID NDC FR OM CMOP
	1267	38 PRO JECT 112/S HAD
	1268	39 NON COVERED D RUG PER PL AN
	1269	40 FIL ING TIMEFR AME NOT ME T
	1270	61 NO PHARMACY C OVERAGE
	1271	85 NPI /TAXONOMY ISSUES
	1272	86 RX DUR REJECT
	1273	87 RX PRIOR AUTH NOT OBTAI NED
	1274	88 RX MEDICARE P ART D
	1275	89 RX DISCOUNT C ARD
	1276	91 DAT E OF BIRTH MISMATCH
	1277	999 OTH ER
	1278
	1279	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: 2 SC TREA TMENT
	1280	Comment : RX IS FOR SC CONDIT ION
	1281	Are you su re (Y/N)? YES
	1282
	1283	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.
	1284
	1285	The system submits a claim rev ersal requ est to the payer for each sele cted claim .
	1286	Example 5. 3-7: Clai m Reversal Request i s Submitte d
	1287	Processing Primary c laim...
	1288
	1289	Claim Stat us:
	1290	Reversing. ..
	1291	IN PROGRES S-Building the trans action
	1292	IN PROGRES S-Transmit ting
	1293	IN PROGRES S-Parsing response
	1294	E REVERSAL ACCEPTED
	1295
	1296
	1297	Reversal A ccepted
	1298	1 claim re versal sub mitted.
	1299	Enter RETU RN to cont inue or '^ ' to exit:
	1300
	1301
	1302	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.
	1303	Example 5. 3-8: Acce pted Payab le Claim R eversal Re quest
	1304	PHARMACY E CME Aug 10, 20 05@10:31:2 2 Page: 1 8 of 42
	1305	SELECTED D IVISION(S) : ALL
	1306	Transmitte d by ALL u sers Activity Date Rang e: within the past X X day(s)
	1307	Sor ted by: Pa tient Name
	1308	+# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	1309	7 ECMEPa tient,Six (XXXX) WE BMD TE/ VET A LL payable
	1310	7.1 AL BUTEROL IN HALER 555 55-4444-22 02/28 100 003744$ 0 /000000504 304 W RT D S/R
	1311	p-Re versal Acc epted
	1312	5.4 Resubm it Claim
	1313	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:
	1314
	1315	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.
	1316
	1317	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.
	1318
	1319	The Resubm it action is accesse d by enter ing RES at the “Sele ct Action: ” prompt o n the ECME User Scre en.
	1320
	1321	Example 5. 6-1: Acces sing and E xecuting t he Resubmi t Claim Ac tion
	1322	PHARMACY E CME Jul 22, 20 08@14:41:5 5 Page : 1 of 29
	1323	SELECTED D IVISION(S) : ALL
	1324	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1325	Sorted by: Transa ction Date
	1326	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/TYP R XINF
	1327	1 ECMEpa tient,One (XXXX) OP INSUR1/ VE T Pb:2 Rj: 4 AcRv:4 R jRv:0
	1328	1.1 RE SERPINE 0. 1MG S 000 83-0035-40 07/19 100 598$ 1 /000000000 520 W RT A C/N
	1329	p-In progress- Waiting t o start
	1330	1.2 LI DOCAINE 0. 5% W/ 001 86-0140-01 07/19 100 704$ 1 /000000000 623 W RT A C/N
	1331	p-In progress- Transmitt ing
	1332	1.3 IM IPRAMINE 2 5MG T 007 79-0588-30 07/19 100 820$ 1 /000000000 740 W RT * */N
	1333	p-Re jected
	1334	07:M /I Cardhol der ID
	1335	1.4 FL URAZEPAM 1 5MG C 007 81-2806-05 07/18 100 948$ 0 /000000000 870 W RT * */N
	1336	p-Re jected
	1337	07:M /I Cardhol der ID
	1338	1.5 DA CARBAZINE 100MG 000 26-8151-10 07/21 100 958$ 2 /000000000 880 W RT * */N
	1339	p-Re versal acc epted
	1340	+ Enter ?? f or more ac tions
	1341	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1342	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1343	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1344	Select Act ion: Next Screen// r es Resub mit Claim
	1345
	1346	You are pr ompted for the line item(s) of the claim to be res ubmitted.
	1347
	1348	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” ).
	1349
	1350	Example 5. 4-2: Enter ing the Li ne Item fo r the Clai m Resubmis sion Reque st
	1351	Enter the line numbe rs for the claim(s) to be resu bmitted.
	1352	Select ite m(s): 1.5
	1353
	1354	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.
	1355
	1356	Example 5. 4-3: Resu bmitting a Closed Cl aim
	1357
	1358	You've cho sen to RES UBMIT the following prescripti on
	1359	1.2 AM ITRIPTYLIN E HCL 006 03-2212-32 10/11 205 6098 0 /000001616 051 M RT D S/N
	1360	Are you su re?(Y/N)? y YES
	1361
	1362	>> Cannot Resubmit
	1363	1.2 AM ITRIPTYLIN E HCL 006 03-2212-32 10/11 205 6098 0 /000001616 051 M RT D S/N
	1364	because t he claim i s Closed. Reopen the claim and try again .
	1365
	1366	0 claims h ave been r esubmitted .
	1367
	1368
	1369	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.
	1370
	1371	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.
	1372	Example 5. 4-4: Enter ing the Li ne Item fo r a Claim that has a Payable S econdary C laim
	1373	The claim:
	1374	1.12 FLU RAZEPAM 15 MG C 00140 -0065-14 0 3/04 10232 2$ 2/00000 0113596 W RT AC/R
	1375	cannot be Resubmitte d if the s econdary c laim is pa yable.
	1376	Please rev erse the s econdary c laim first .
	1377
	1378	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.
	1379
	1380	Example 5. 4-5: Enter ing “Y” to Continue Claim Resu bmission R equest
	1381
	1382	You've cho sen to RES UBMIT the following prescripti on for ECM Epatient,O ne
	1383	100MG 000 26-8151-10 06/26 100 958$ 2 /000000000 880 W RT * */N
	1384	Are you su re?(Y/N)? y YES
	1385
	1386	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.
	1387	Example 5. 4-6: Ente ring “Y” t o Place Mu ltiple Sub missions i n the Queu e
	1388	The claim is in prog ress. The request wi ll be sche duled and processed after
	1389	the previo us request (s) are co mpleted. P lease be a ware that the result of
	1390	the resubm it depends on the pa yer's resp onse to th e prior in complete r equests.
	1391	Do you wan t to proce ed?(Y/N)? y YES
	1392
	1393
	1394	The claim resubmissi on request is submit ted and th e progress is displa yed.
	1395	Example 5. 4-7: Disp laying a S uccessfull y Resubmit ted Claim
	1396	Claim Stat us:
	1397	IN PROGRES S-Waiting to start
	1398	IN PROGRES S-Building the claim
	1399	IN PROGRES S-Transmit ting
	1400	E PAYABLE
	1401
	1402	Veteran Pr escription 100958 su ccessfully submitted to ECME f or claim g eneration.
	1403	1 claim ha s been res ubmitted.
	1404
	1405
	1406	Enter RETU RN to cont inue or '^ ' to exit: <ENTER>
	1407
	1408	Updating s creen for resubmitte d claims.. .
	1409
	1410
	1411	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.
	1412
	1413	Example 5. 4-8: Displ aying the Claim Stat us after a Resubmiss ion
	1414	PHARMACY E CME Jul 12, 20 08@14:42:4 6 Page : 1 of 29
	1415	SELECTED D IVISION(S) : ALL
	1416	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1417	Sorted by: Transa ction Date
	1418	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/TYP R XINF
	1419	1 ECMEpa tient,One (XXXX) OP INSUR1/ VE T Pb:2 Rj: 4 AcRv:4 R jRv:0
	1420	1.1 RE SERPINE 0. 1MG S 000 83-0035-40 07/09 100 598$ 1 /000000000 520 W RT A C/N
	1421	p-In progress- Waiting t o start
	1422	1.2 LI DOCAINE 0. 5% W/ 001 86-0140-01 07/09 100 704$ 1 /000000000 623 W RT A C/N
	1423	p-In progress- Waiting t o start
	1424	1.3 IM IPRAMINE 2 5MG T 007 79-0588-30 07/09 100 820$ 1 /000000000 740 W RT * */N
	1425	p-Re jected
	1426	07:M /I Cardhol der ID
	1427	1.4 FL URAZEPAM 1 5MG C 007 81-2806-05 07/08 100 948$ 0 /000000000 870 W RT * */N
	1428	p-Re jected
	1429	07:M /I Cardhol der ID
	1430	1.5 DA CARBAZINE 100MG 000 26-8151-10 07/06 100 958$ 2 /000000000 880 W RS * */N
	1431	p-Pa yable
	1432	+ Enter ?? f or more ac tions
	1433	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1434	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1435	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1436	Select Act ion: Next Screen//
	1437	5.5 Close Claim
	1438	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” .
	1439
	1440	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.”
	1441
	1442	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.
	1443
	1444
	1445	PHARMACY E CME Jul 15, 20 14@18:43:0 2 Page: 1 of 1
	1446	SELECTED D IVISION(S) : GENERIC CITY
	1447	Transmitte d by Trans mitter, Pe rson Ac tivity Dat e Range: w ithin the past 365 d ay(s)
	1448	Sorted b y: Transac tion date by default
	1449	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# STATUS/LOC /TYP/RXINF
	1450	1
	1451	1.1 AB ACAVIR SUL FATE 0017 3066101 07 /15 ###### #0/00000## #7412 M RT SU/N
	1452	07/1 5/14 - IGN ORED - tes t of cmop
	1453	p-Re jected
	1454	NN:T ransaction Rejected At Switch Or Interme diary
	1455	NC16 -The clear inghouse d id not rep ly in time .
	1456
	1457
	1458	Enter ?? f or more ac tions
	1459	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1460	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1461	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1462	Select Act ion: Quit/ /CLO
	1463	Enter the line numbe rs for the claim(s) to be clos ed.
	1464	Select ite m(s): 1.1
	1465
	1466	You've cho sen to clo se the fol lowing pre scription( s) for
	1467	Oppatient, ONE :
	1468	1.1 AB ACAVIR SUL FATE 0017 3066101 07 /15 ###### #0/00000## #7412 M RT SU/N
	1469	NN:T ransaction Rejected At Switch Or Interme diary
	1470	NC16 -The clear inghouse d id not rep ly in time .
	1471
	1472	ALL Select ed Rxs wil l be CLOSE D using th e same inf ormation g athered in the
	1473	following prompts.
	1474
	1475	Are you su re?(Y/N)? y YES
	1476
	1477	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.
	1478
	1479	PHARMACY E CME Jul 15, 20 14@18:43:0 2 Page: 1 of 1
	1480	SELECTED D IVISION(S) : GENERIC CITY
	1481	Transmitte d by Trans mitter, Pe rson Ac tivity Dat e Range: w ithin the past 365 d ay(s)
	1482	Sorted b y: Transac tion date by default
	1483	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# STATUS/LOC /TYP/RXINF
	1484	1
	1485	1.1 AB ACAVIR SUL FATE 0017 3066101 07 /15 ###### #0/00000## #7412 M RT SU/N
	1486	07/1 5/14 - IGN ORED - tes t of cmop
	1487	p-Re jected
	1488	NN:T ransaction Rejected At Switch Or Interme diary
	1489	NC16 -The clear inghouse d id not rep ly in time .
	1490
	1491
	1492	Enter ?? f or more ac tions
	1493	CU Contin uous Updat e REV Reverse Pa yable Clai m FR Furt her Resear ch
	1494	UD Displa y Update RES Resubmit C laim LOG Prin t Claim Lo g
	1495	CV Change View CLO Close Clai m WRK Send to Workli st
	1496	SO Sort L ist CMT Add/View C omments EX Exit
	1497	Select Act ion: Quit/ /
	1498
	1499
	1500	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.
	1501
	1502	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.
	1503	Example 5. 5-1: Enter ing a Pres cription L ine Item t o Close On e Rejected Claim
	1504	PHARMACY E CME Aug 02, 20 05@12:19 Page: 1 of 7 0
	1505	SELECTED D IVISION(S) : ALL
	1506	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1507	Sor ted by: Pa tient Name
	1508	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	1509	7 ECMEpa tient,Two (XXXX) WEB MD / VET Pb :3 Rj:1 Ac Rv:0 RjRv: 0
	1510	7.1 DE SIPRAMINE 25MG T 000 68-0011-10 08/02 100 003962$ 0 /000000504 559 W RT * */N
	1511	p-Re jected
	1512	07:M /I Cardhol der ID Num ber
	1513	22:M /I Dispens e As Writt en(DAW)/Pr oduct Sele ction Code
	1514	34:M /I Submiss ion Clarif ication Co de
	1515	7.2 CO DEINE SULF ATE 30 000 02-1010-02 08/02 100 82$ 0 /000000504 561 W RT E X/N
	1516	p-Re jected
	1517	07:M /I Cardhol der ID Num ber
	1518	23:M /I Ingredi ent Cost S ubmitted
	1519	8 ECMEpat ient,Two (XXXX) WEB MD / VET AL L payable
	1520	8.1 TE STOSTERONE ENTH. 000 03-0328-40 07/30 90 9238$ 0/00000110 5472 M RT AC/N
	1521	p-Pa yable
	1522	+ Enter ?? f or more ac tions
	1523	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1524	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1525	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1526	Select Lin e Item(s): Next Scre en// CLO Close Cla im
	1527	Enter the line numbe rs for the claim(s) to be clos ed.
	1528	Select Lin e Item(s): 7.1
	1529
	1530
	1531	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.
	1532	Example 5. 5-2: Ente ring “Y” t o Continue Close Cla im Request
	1533	You've cho sen to clo se the fol lowing pre scription( s) for
	1534	ECMEpatien t,Two:
	1535	7.1 DE SIPRAMINE 25MG T 000 68-0011-10 03/20 100 003962$ 0 /000000504 559 W RT * */N
	1536	07:M /I Cardhol der ID Num ber
	1537	22:M /I Dispens e As Writt en(DAW)/Pr oduct Sele ction Code
	1538	34:M /I Submiss ion Clarif ication Co de
	1539
	1540	ALL Select ed Rxs wil l be CLOSE D using th e same inf ormation g athered in the follo wing promp ts.
	1541
	1542	Are you su re?(Y/N)? YES
	1543
	1544	You are pr ompted for a non-bil lable reas on code.
	1545	Example 5. 5-3: List ing Non-Bi llable Rea son Codes
	1546	PHARMACY E CME Aug 12, 20 05@12:19 Pa ge: 1 o f 70
	1547	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: ??
	1548
	1549	Choose from:
	1550	1 NOT INSURED
	1551	2 SC T REATMENT
	1552	3 AGEN T ORANGE
	1553	4 IONI ZING RADIA TION
	1554	5 SOUT HWEST ASIA
	1555	7 COVE RAGE CANCE LED
	1556	10 INVA LID PRESCR IPTION ENT RY
	1557	12 PRES CRIPTION D ELETED
	1558	13 PRES CRIPTION N OT RELEASE D
	1559	14 DRUG NOT BILLA BLE
	1560	21 MILI TARY SEXUA L TRAUMA
	1561	29 HEAD /NECK CANC ER
	1562	30 COMB AT VETERAN
	1563	33 90 D AY RX FILL NOT COVER ED
	1564	34 NOT A CONTRACT ED PROVIDE R
	1565	35 INVA LID MULTIP LES PER DA Y SUPP
	1566	36 REFI LL TOO SOO N
	1567	37 INVA LID NDC FR OM CMOP
	1568	38 PROJ ECT 112/SH AD
	1569	39 NON COVERED DR UG PER PLA N
	1570	40 FILI NG TIMEFRA ME NOT MET
	1571	61 NO P HARMACY CO VERAGE
	1572	85 NPI/ TAXONOMY I SSUES
	1573	86 RX D UR REJECT
	1574	87 RX P RIOR AUTH NOT OBTAIN ED
	1575	88 RX M EDICARE PA RT D
	1576	89 RX D ISCOUNT CA RD
	1577	91 DATE OF BIRTH MISMATCH
	1578	999 OTHE R
	1579
	1580	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: 61 NO PHA RMACY COVE RAGE
	1581
	1582
	1583	You are p rompted fo r a commen t (explana tion), and again whe ther you w ant to con tinue.
	1584
	1585	Example 5. 5-4: Ente ring a Com ment and A nswering ‘ Are You Su re?’ Quest ion
	1586	Comment : ECME Rejec t: Insuran ce does no t cover Rx s
	1587	Are you su re?(Y/N)? YES
	1588
	1589	Closing Cl aim VA2006 =1712884=0 00010=0006 693...OK
	1590	1 claim ha s been clo sed.
	1591
	1592
	1593	Enter RETU RN to cont inue or '^ ' to exit: <Enter>
	1594
	1595	Updating s creen for closed cla ims...
	1596
	1597	5.5.1 Vari ations to the Close claim proc ess.
	1598	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”.
	1599	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.
	1600	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.
	1601	Example 5. 5.1-1: Cl osing a Pr escription
	1602	You've cho sen to clo se the fol lowing pre scription( s) for
	1603	ECMEPatien t,FIVE :
	1604	4.1 CO LCHICINE 0 .6MG 0007 4378101 06 /24 101297 $ 1/00 0000001653 M RT DS/N
	1605
	1606	ALL Select ed Rxs wil l be CLOSE D using th e same inf ormation g athered in the
	1607	following prompts.
	1608
	1609	Are you su re?(Y/N)? YES
	1610
	1611	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: OTHER
	1612
	1613	Selec t one of t he followi ng:
	1614
	1615	N NON-BILLAB LE
	1616	D DROP TO PA PER
	1617
	1618	Treat as ( N)on-Billa ble Episod e or (D)ro p Bill to Paper?: NO N-BILLABLE
	1619	Comment : Insurance does not cover Rxs
	1620	Release Pa tient CoPa y(Y/N)? YE S
	1621	Are you su re?(Y/N)? NO
	1622
	1623
	1624	Example 5. 5.1-2: En tering Non -Billable Episode fo r Reason C ode 31
	1625	Select CLA IMS TRACKI NG NON-BIL LABLE REAS ONS NAME: 31 90 DAY RX FILL N OT COVERED
	1626
	1627	Selec t one of t he followi ng:
	1628	N NON-BILLA BLE
	1629	D DROP TO P APER
	1630
	1631	Treat as ( N)on-Billa ble Episod e or (D)ro p Bill to Paper?: Se lect: N No n-billable
	1632
	1633
	1634	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 (^ ).
	1635	Example 5. 5.1-3: En tering a C omment
	1636	Comment : ECME Rejec t: Plan do es not cov er 90-day fills
	1637
	1638
	1639	You can e nter Y or N to choos e to conti nue the cl ose claim request or not.
	1640	Example 5. 5.1-4: Ent ering “Y” to Continu e Close Cl aim Reques t
	1641	Are you su re?(Y/N)? Y YES
	1642
	1643	If the Rx# display i s followed by a “$”, the ECME user is gi ven the fo llowing pr ompt to an swer wheth er the pat ient copay can be re leased als o or not. If you sel ect Y, the patient c opay bill will be au tomaticall y removed from hold status for ALL selec ted claims .
	1644	Example 5. 5.1-5: Rel easing Pat ient Copay
	1645	Release Pa tient CoPa y(Y/N)? Y YES
	1646
	1647
	1648
	1649	When the c laim is su ccessfully closed, t he display shows tha t the tran saction we nt through “OK” and states tha t the clai m was clos ed.
	1650	Example 5. 5.1-6: Di splaying S ystem Clos ing the Cl aim
	1651	Closing Cl aim VA2005 -1111111-1 23456-0000 501...OK
	1652	1 claim ha s been clo sed.
	1653
	1654	Enter RET URN to con tinue or ' ^' to exit :/ <Enter>
	1655
	1656	Updating s creen for closed cla ims...
	1657
	1658	The closed claim tra nsaction m ay no long er be disp layed with the patie nt’s other prescript ion line i tems depen ding on th e filters set in Cha nge View. The system will noti fy Integra ted Billin g of the c losed clai m so that Claims Tra cking can be updated .
	1659	Example 5. 5.1-7: Clo sed Item i s No Longe r Displaye d
	1660	PHARMACY E CME Aug 12, 20 05@13:13:1 5 Page : 1 of 69
	1661	SELECTED D IVISION(S) : ALL
	1662	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1663	Sor ted by: Pa tient Name
	1664	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	1665	7 ECMEpa tient,Two (XXXX) WEB MD / VET P b:3 Rj:1 A cRv:0 RjRv :0
	1666	7.1 CO DEINE SULF ATE 30 000 02-1010-02 08/03 100 82$ 0 /000000504 561 W RT E X/N
	1667	p-Re jected
	1668	07:M /I Cardhol der ID Num ber
	1669	23:M /I Ingredi ent Cost S ubmitted
	1670	8 ECMEpat ient, Thre e (XXXX ) WEBMD / VET A LL payable
	1671	8.1 TE STOSTERONE ENTH. 000 03-0328-40 08/03 90 9238$ 0/00000110 5472 M RT AC/N
	1672	p-Pa yable
	1673	9 ECMEpat ient,22 (XXXX) WE BMD / VET A LL payable
	1674	9.1 HY DROCODONE 5/ACET 557 78-8998-88 08/12 909 254$ 1 /000001105 496 C RT A C/N
	1675	+ Enter ?? f or more ac tions
	1676
	1677	5.5.2 Spec ial Notes regarding secondary claims
	1678	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.
	1679
	1680	Example 5. 5.2-1: Sec ondary Ins urance Not ification
	1681	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.
	1682
	1683	Patient: EC MEpatient, One
	1684	Date of se rvice: JU N 29, 2010
	1685	Insurance: EC MEInsuranc e,One
	1686	Group numb er: 10 001
	1687	BISOPROL OL 2.5MG/ 51285-004 7-02 06/29 2055810$ 0/00000 1615758 W RT AC/R
	1688
	1689	Do you wan t to print the infor mation (ab ove) conce rning addi tional ins urance?
	1690	(Y/N)? n NO
	1691	5.6 Add/Vi ew Comment s
	1692	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. I f a claim has been r esubmitted , a messag e displays in place of the mos t recent c omment: “ Prior comm ents suppr essed – us e CMT acti on for all comments” . The mes sage indic ating the prior comm ents were suppressed is not ca ptured in CMT Add/Vi ew Comment s.
	1693
	1694	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 .
	1695
	1696	Example 5. 6-1: Enter ing a Pres cription L ine Item t o Add a Co mment
	1697	PHARMACY E CME Jul 02, 20 05@22:19 Page: 1 of 7 0
	1698	SELECTED D IVISION(S) : ALL
	1699	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1700	Sor ted by: Pa tient Name
	1701	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	1702	1 ECMEpa tient,Two (XXXX) WEB MD / VET Pb :3 Rj:1 Ac Rv:0 RjRv: 0
	1703	1.1 TA MOXIFEN CI TRATE 000 93-0784-86 07/01 909 392$ 0 /000001105 634 W ** D S/R
	1704	p-Re jected
	1705	NN:T ransaction Rejected At Switch Or Interme diary
	1706	NC40 -Request f rom an unk nown site. Registrat ion is req uired
	1707	1.2 DE SIPRAMINE HCL 25 000 68-0011-10 07/01 909 393$ 0 /000001105 635 W ** A C/R
	1708	p-Pa yable
	1709	1.3 DI AZEPAM 5MG /ML IN 001 40-1933-06 07/01 909 394$ 0 /000001105 636 W ** A C/N
	1710	p-Pa yable
	1711
	1712
	1713	+ Enter ?? f or more ac tions
	1714	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1715	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1716	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1717	Select Act ion: Next Screen// C MT Add/V iew Commen ts
	1718	Enter the line numbe r for whic h you wish to Add/Vi ew comment s.
	1719	Select: 1. 2
	1720
	1721	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
	1722	Example 5. 6-2: Displ aying the Prescripti on Line It em to Add a Comment or Quit
	1723	O Add OP ECC Commen t EX Exit
	1724	P Add Ph armacy/OPE CC Comment
	1725	Select act ion: Next Screen// O Add OPE CC Comment
	1726	Enter the line numbe r for whic h you wish to Add co mments.
	1727
	1728	Select ite m: 12.1//
	1729
	1730	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.
	1731	Example 5. 6-3: Addin g a commen t to a Pre scription Line Item
	1732
	1733	Enter Comm ent: This shows a te st comment line for a prescrip tion line item.
	1734
	1735	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.
	1736	Example 5. 6-4: Displ aying the Added Comm ent and Pr ompting fo r Another
	1737	ADD/VIEW C OMMENTS Jul 02, 20 05@22:19 Page: 1 of 1
	1738	PHARMACY E CME
	1739	SELECTED D IVISION(S) : ALL
	1740	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1741	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	1742	1.1 DE SIPRAMINE HCL 25 000 68-0011-10 07/01 909 393$ 0 /000001105 635 W ** A C/R
	1743	08/1 5/05 - Thi s shows a test comme nt line fo r a prescr iption lin e item.
	1744	(LAS T,FIRST NA ME)
	1745	p-Payable
	1746	07/ 11/15 (Pha rm) - TEST COMMENT F OR PHARMAC Y/OPECC CO MMENT
	1747	(LAS T,FIRST NA ME)
	1748	p-P ayable
	1749
	1750
	1751
	1752
	1753
	1754	Enter ?? f or more ac tions
	1755	O Add OP ECC Commen t EX Exit
	1756	P Add Ph armacy/OPE CC Comment
	1757	Select act ion: Next Screen//
	1758
	1759	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”.
	1760	5.7 Furthe r Research Screen
	1761	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.
	1762
	1763	Enter FR a t the “Sel ect Action :” prompt on the ECM E User Scr een.
	1764	Example 5. 7-1: Acces sing the F urther Res earch Acti on
	1765	PHARMACY E CME July 26, 2 005@11:31: 22 Page: 18 of 42
	1766	SELECTED D IVISION(S) : ALL
	1767	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1768	Sor ted by: Pa tient Name
	1769	+# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	1770	16 ECMEpa tient,One (XXXX ) WEBMD / VE T ALL pay able
	1771	16.1 ET ANERCEPT 2 5MG/VI 584 06-0425-34 07/22 909 504$ 0 /000001105 747 M RT A C/N
	1772	p-Pa yable
	1773	16.2 ET ANERCEPT 2 5MG/VI 584 06-0425-34 07/22 909 504$ 1 /000001105 747 M RT A C/N
	1774	p-Pa yable
	1775	16.3 DI VALPROEX 1 25MG T 000 74-6212-13 07/22 909 505$ 0 /000001105 748 M RT A C/N
	1776	p-Pa yable
	1777	16.4 CO LLAGENASE OINT 504 84-0527-30 07/22 909 506$ 0 /000001105 749 M RT A C/N
	1778	p-Pa yable
	1779	16.5 NA FCILLIN 1 GM. IN 002 09-6950-22 07/22 909 507$ 0 /000001105 750 M RT A C/N
	1780	p-Pa yable
	1781	+ Enter ?? for more actions
	1782	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	1783	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	1784	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	1785
	1786	Select Act ion: Next Screen// F R Further Research
	1787	The system re-displa ys the ECM E User Scr een with m ultiple ne w “Researc h” options .
	1788	Example 5. 7-2: Displ aying Mult iple Furth er Researc h Menu Opt ions
	1789	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1790	SELECTED D IVISION(S) : ALL
	1791	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1792	Sorted b y: Transac tion date by default
	1793	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1794	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1795	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1796	p-Re jected
	1797	85:C laim Not P rocessed
	1798	NN:T ransaction Rejected At Switch Or Interme diary
	1799	02:M /I Version /Release N umber
	1800	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1801	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1802	p-Re versal Oth er
	1803	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1804	p-Re versal Oth er
	1805	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1806	p-Pa yable
	1807	+ Enter ?? f or more ac tions
	1808	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1809	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1810	VP View Prescripti on OH On Hold C opay List EX Exi t
	1811	CMT Add/V iew Commen ts RH Release C opay
	1812	Select act ion:Next S creen//
	1813
	1814
	1815	5.7.1 Insu rance Deta ils
	1816	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.
	1817
	1818	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.
	1819	Example 5. 7.1-1: Acc essing Ins urance Det ails Optio n
	1820	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1821	SELECTED D IVISION(S) : ALL
	1822	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1823	Sorted b y: Transac tion date by default
	1824	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1825	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1826	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1827	p-Re jected
	1828	85:C laim Not P rocessed
	1829	NN:T ransaction Rejected At Switch Or Interme diary
	1830	02:M /I Version /Release N umber
	1831	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1832	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1833	p-Re versal Oth er
	1834	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1835	p-Re versal Oth er
	1836	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1837	p-Pa yable
	1838	+ Enter ?? f or more ac tions
	1839	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1840	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1841	VP View Prescripti on OH On Hold C opay List EX Exi t
	1842	CMT Add/V iew Commen ts RH Release C opay
	1843	Select act ion:Next S creen// IN S Insuran ce details
	1844	Please sel ect a SING LE Patient Line item for viewi ng Insuran ce
	1845	Select ite m: 1.4
	1846
	1847	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.
	1848	Example 5. 7.1-2: Di splaying I nsurance D etails Act ions
	1849	Patient In surance In formation Aug 09, 20 06@12:56:4 9 Page: 1 of 1
	1850	Insurance Management for Patie nt: ECMEpa tient,One 0000
	1851
	1852	Insura nce Co. Ty pe of Poli cy Group Ho lder Eff ect. Expir es
	1853	1 WEBMD PRESCRIPT ION 10 000 SELF 01/01/00
	1854
	1855	Enter ?? f or more ac tions >>>
	1856	VP View P olicy Info BU Benefits U sed EX Exit
	1857	AB Annual Benefits INS View Insur ance Co.
	1858	Select Act ion:Quit// QUIT
	1859
	1860
	1861	5.7.2 View Eligibili ty
	1862	The View E ligibility action al lows you t o view the Patient E ligibility Screen.
	1863
	1864
	1865	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.
	1866
	1867	Enter VE t o view eli gibility i nformation for a sin gle patien t.
	1868	Example 5. 7.2-1: Acc essing Vie w Eligibil ity Option
	1869	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1870	SELECTED D IVISION(S) : ALL
	1871	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1872	Sorted b y: Transac tion date by default
	1873	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1874	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1875	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1876	p-Re jected
	1877	85:C laim Not P rocessed
	1878	NN:T ransaction Rejected At Switch Or Interme diary
	1879	02:M /I Version /Release N umber
	1880	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1881	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1882	p-Re versal Oth er
	1883	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1884	p-Re versal Oth er
	1885	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1886	p-Pa yable
	1887	+ Enter ?? f or more ac tions
	1888	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1889	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1890	VP View Prescripti on OH On Hold C opay List EX Exi t
	1891	CMT Add/V iew Commen ts RH Release C opay
	1892	Select act ion:Next S creen// VE View El igibility
	1893	Please sel ect a SING LE Patient Line item for viewi ng Eligibi lity
	1894	Select ite m: 1.4
	1895
	1896	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.
	1897	Example 5. 7.2-2: Di splaying V iew Eligib ility Opti ons.
	1898	Patient El igibility Aug 15, 20 05@11:14:1 2 Page: 1 of 1
	1899	ECMEPat ient,Six 5959 DOB: 01/02/66
	1900
	1901	Means T est: YES Ins ured: Yes
	1902	Date of T est: 07/29 /05 A/O Expo sure:
	1903	Co-pay E xemption T est: Rad. Expo sure:
	1904	Date of T est:
	1905	Patient ha s agreed t o pay dedu ctible
	1906
	1907	Prima ry Elig. C ode: NSC
	1908
	1909	Serv ice Connec ted: No
	1910	Rated Disabilit ies: None
	1911	Enter ?? f or more ac tions
	1912	EX Exit
	1913	Select Act ion: Quit/ /
	1914
	1915
	1916	5.7.3 View Prescript ion
	1917	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.
	1918
	1919	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.
	1920	Example 5. 7.3-1: Acc essing Vie w Prescrip tion Actio n
	1921	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	1922	SELECTED D IVISION(S) : ALL
	1923	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	1924	Sorted b y: Transac tion date by default
	1925	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	1926	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	1927	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	1928	p-Re jected
	1929	85:C laim Not P rocessed
	1930	NN:T ransaction Rejected At Switch Or Interme diary
	1931	02:M /I Version /Release N umber
	1932	EV11 7-D0 IS IN VALID VERS ION NUMBER
	1933	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	1934	p-Re versal Oth er
	1935	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	1936	p-Re versal Oth er
	1937	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	1938	p-Pa yable
	1939	+ Enter ?? f or more ac tions
	1940	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	1941	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	1942	VP View Prescripti on OH On Hold C opay List EX Exi t
	1943	CMT Add/V iew Commen ts RH Release C opay
	1944	Select act ion:Next S creen// VP View Pr escription
	1945	Please sel ect a SING LE Rx Line item for viewing a Prescripti on
	1946	Select ite m: 1.4
	1947
	1948	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 .
	1949	Example 5. 7.3-2: Di splaying V iew Prescr iption Opt ions.
	1950	Rx Activit y Log Nov 03, 20 XX@15:27:5 4 Page: 1 of 5
	1951	ECMEPatie nt,Six
	1952	PID: XXX X Ht(cm): _______ ( ______)
	1953	DOB: MAY X,XXXX (X X) Wt(kg): _ ______ (__ ____)
	1954	Rx # : XXXXXX$
	1955	Orde rable Item : TRIAMTER ENE 50MG
	1956
	1957	CMOP Drug : TRIAMTER ENE 50MG T AB
	1958	*Dosage : 50MG
	1959	Verb : TAKE
	1960	Disp ense Units : 1
	1961	Noun : TABLET
	1962	*Route : ORAL
	1963	*Schedule : 2X
	1964	Patient In structions
	1965
	1966	SIG : TAKE ONE TABLET BY MOUTH 2X
	1967	Pati ent Status : OPT NSC
	1968	Issue Date : 10/07/XX Fil l Date: 10 /07/XX
	1969	Last Fill Date : 10/07/XX (Window)
	1970	Last Re lease Date : Lot #:
	1971	Expires : 10/08/XX MFG:
	1972	D ays Supply : 90 QTY (TAB) : 11
	1973	# of Refills : 3 Rem aining: 3
	1974	Provider : OPINSUR2
	1975	Routing: W indow
	1976	Copies : 1
	1977	Method of Pickup :
	1978	Clinic : Not on F ile
	1979	Division : XXXXXXXX XX
	1980	Pharmacist :
	1981	Patient Counseling : NO
	1982	Remarks :
	1983	F inished By : PSOuser, Two
	1984	Entry B y: PSOuser ,Two Entry Date: 10/ 6/XX 11:45 :57
	1985
	1986	Original F ill Releas ed: Routing: W indow
	1987	Refill Log :
	1988	# Log Dat e Refill Date Qty Routi ng Lot # Phar macist
	1989	========== ========== ========== ========== ========== ========== ========== =========
	1990	There are NO Refills For this Prescripti on
	1991
	1992	Partial Fi lls:
	1993	# Log Da te Date Qty Routing Lot # Pharm acist
	1994	========== ========== ========== ========== ========== ========== ========== =========
	1995	There are NO Partial s for this Prescript ion
	1996
	1997	Activity L og:
	1998	# Date Reas on Rx Ref Init iator Of A ctivity
	1999	========== ========== ========== ========== ========== ========== ========== =========
	2000	1 08/03/ XX EDIT ORIGINAL PSOu ser,Two
	2001	Comments: FILL DATE (3050801),
	2002
	2003	Copay Acti vity Log:
	2004	# Date Reas on Rx Ref Initiato r Of Activ ity
	2005	========== ========== ========== ========== ========== ========== ========== =========
	2006	There's NO Copay act ivity to r eport
	2007	Label Log:
	2008	# Date Rx R ef Printed By
	2009	========== ========== ========== ========== ========== ========== ========== =========
	2010	1 08/01/ XX ORIG INAL PSOuser, Three
	2011	Comments: From RX nu mber XXXXX X
	2012	2 08/03/ 05 ORIG INAL PSOuser, Three
	2013	Comments: From RX nu mber XXXXX X (Reprint )
	2014
	2015
	2016	Rx Activit y Log Nov 03, 20 10@15:27:5 4 Page: 5 of 5
	2017	ECMEPatie nt,Six
	2018	PID: XXX X Ht(cm) : _______ (______)
	2019	DOB: JAN X, XXXX ( XX) Wt(kg): _______ (_ _____)+
	2020	ECME Log:
	2021	# Date Rx R ef Initiator Of Activi ty
	2022	========== ========== ========== ========== ========== ========== ========== =========
	2023	1 5/22/0 6@19:00:24 ORIGIN AL PSOuser,Th ree
	2024	Comments: Submitted to ECME:CM OP TRANSMI SSION(NDC: 00049-3980 -60)
	2025	2 7/6/06 @19:01:04 REFILL 1 PSOuser,Th ree
	2026	Comments: Submitted to ECME:CM OP TRANSMI SSION(NDC: 00049-3980 -60)
	2027	3 7/7/06 @14:39:19 REFILL 1 PSOuser,Th ree
	2028	Comments: Submitted to ECME:RE JECT WORKL IST-DUR OV ERRIDE COD ES(DD/M0/1 B)-E
	2029	PAYABLE-p MEDCO
	2030	4 7/8/06 @12:48:02 REFILL 1 PSOuser,Th ree
	2031	Comments: CHAMPVA-EC ME RED Res ubmit Clai m w/Edits: Date of S ervice
	2032	(7/6/2006) -pMEDCO
	2033
	2034	ECME REJEC T Log:
	2035	# Date/Ti me Rcvd Rx Ref Reject Ty pe STA TUS Da te/Time Re solved
	2036	========== ========== ========== ========== ========== ========== ========== =========
	2037	1 7/6/06@ 19:02:08 REFILL 1 DUR RES OLVED 7/ 7/06@14:39 :19
	2038	Comments: AUTOMATICA LLY CLOSED (CLAIM RE -SUBMITTED )
	2039
	2040	Enter ?? f or more ac tions
	2041
	2042	Selec t Action:Q uit//
	2043
	2044
	2045	5.7.4 Add/ View Comme nts
	2046	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.
	2047
	2048
	2049	5.7.5 Clai ms Trackin g
	2050	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.
	2051
	2052	Enter the CT action and then e nter a sin gle prescr iption lin e item to track a cl aim.
	2053	Example 5. 7.5-1: Acc essing Cla ims Tracki ng Option
	2054	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	2055	SELECTED D IVISION(S) : ALL
	2056	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 1 day(s)
	2057	Sorted b y: Transac tion date by default
	2058	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	2059	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	2060	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	2061	p-Re jected
	2062	85:C laim Not P rocessed
	2063	NN:T ransaction Rejected At Switch Or Interme diary
	2064	02:M /I Version /Release N umber
	2065	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2066	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /06 110033 6$ 0/00 0000003120 W RT DS/R
	2067	p-Re versal Oth er
	2068	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /07 110033 7$ 0/00 0000003122 W RT DS/R
	2069	p-Re versal Oth er
	2070	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /07 110033 9$ 0/00 0000003124 W RT AC/R
	2071	p-Pa yable
	2072	+ Enter ?? f or more ac tions
	2073	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	2074	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	2075	VP View Prescripti on OH On Hold C opay List EX Exi t
	2076	CMT Add/V iew Commen ts RH Release C opay
	2077	Select act ion:Next S creen// C T Claims Tracking
	2078	Please sel ect a SING LE Rx Line item when accessing Claims Tr acking.
	2079	Select ite m: 1.1.... ...
	2080
	2081	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.
	2082	Example 5. 7.5-2: Di splaying C laims Trac king Optio ns
	2083	CLAIMS TRA CKING EDIT Nov 03, 20 10@15:27:5 4 Page: 1 of 3
	2084	Expanded C laims Trac king Info for: ECME Patient, T wo ROI:
	2085	For: PRESC RIPTION RE FILL on 11 /04/05
	2086	+
	2087	Visit Type: PRE SCRIPTION REFILL Author ization #:
	2088	Prescript ion #: XXX XXXX No . Days App roved: 0
	2089	Fill Date: Nov 04, 2005 Second Opinion R equired:
	2090	Drug: ALL OPURINOL 3 00MG, 30'S Second Opinion O btained:
	2091	Qua ntity: 1
	2092	Days S upply: 1 Review In formation
	2093	2 NDC#: 510 79-0206-20 Insuranc e Claim: Y ES
	2094	Phys ician: ECM EProvider, Two Follow- up Type:
	2095	Random Sample:
	2096	Special Co ndition:
	2097	Local A ddition:
	2098	Ins. R eviewer:
	2099	Hospital R eviewer:
	2100	Billing Informatio n
	2101	+ Enter ?? f or more ac tions
	2102	BI Billin g Info Edi t TA Treatment Auth. EX Exit
	2103	RI Review Info SE Submit Cla im to ECME
	2104	Select Act ion:Next S creen// <E nter>
	2105
	2106	CLAIMS TRA CKING EDIT Nov 03, 20 10@15:27:5 4 Page: 2 of 3
	2107	Expanded C laims Trac king Info for: ECMEp atient,Two ROI:
	2108	For: PRESC RIPTION RE FILL on 11 /04/05
	2109	+
	2110	Episo de Billabl e: NO Total Cha rges: $ 0
	2111	Non-Bill able Reaso n: PRESCRI PTION NOT REL Estima ted Recv ( Pri): $
	2112	Nex t Bill Dat e: Estima ted Recv ( Sec): $
	2113	Work. Com p/OWCP/Tor t: Estima ted Recv ( ter): $
	2114	I nitial Bil l: Mean s Test Cha rges: $
	2115	Bill Statu s: Amount Paid: $ 0
	2116
	2117
	2118	Hospital Reviews E ntered
	2119
	2120	Insuranc e Reviews Entered
	2121
	2122	Service Connected Conditions :
	2123	Service C onnected: NO
	2124	+ Enter ?? f or more ac tions
	2125	BI Billin g Info Edi t TA Treatment Auth. EX Exit
	2126	RI Review Info SE Submit Cla im to ECME
	2127	Select Act ion:Next S creen//<En ter>
	2128
	2129
	2130	CLAIMS TRA CKING EDIT Nov 03, 20 10@15:27:5 4 Page: 3 of 3
	2131	Expanded C laims Trac king Info for: ECMEp atient,Two ROI:
	2132	For: PRESC RIPTION RE FILL on 11 /04/05
	2133	+
	2134	NONE STAT ED
	2135
	2136
	2137
	2138
	2139
	2140	Enter ?? f or more ac tions
	2141	BI Billin g Info Edi t TA Treatment Auth. EX Exit
	2142	RI Review Info SE Submit Cla im to ECME
	2143	Select Act ion:Quit//
	2144
	2145	5.7.6 Thir d Party In quiry
	2146	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 .
	2147
	2148
	2149	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.
	2150
	2151	Example 5. 7.6-1: Acc essing Thi rd Party ( Joint) Inq uiry Optio n
	2152	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	2153	SELECTED D IVISION(S) : ALL
	2154	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2155	Sorted b y: Transac tion date by default
	2156	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	2157	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	2158	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	2159	p-Re jected
	2160	85:C laim Not P rocessed
	2161	NN:T ransaction Rejected At Switch Or Interme diary
	2162	02:M /I Version /Release N umber
	2163	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2164	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	2165	p-Re versal Oth er
	2166	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	2167	p-Re versal Oth er
	2168	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	2169	p-Pa yable
	2170	+ Enter ?? f or more ac tions
	2171	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	2172	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	2173	VP View Prescripti on OH On Hold C opay List EX Exi t
	2174	CMT Add/V iew Commen ts RH Release C opay
	2175	Select act ion:Next S creen// T PJI Thir d Party In quiry
	2176	Please sel ect a SING LE Patient Line item when acce ssing TPJI
	2177	Select ite m:
	2178
	2179	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.
	2180	Example 5. 7.6-2: Di splaying T hird Party (Joint) I nquiry Opt ions.
	2181	Third Part y Active B ills Nov 03, 20 10@15:27:5 4 Page: 1 of 1
	2182	ECMEPatien t,SIX (XXX X)NSC
	2183	Bill # From To MT? Type Stat Rate Insure r Orig Am t Curr Amt
	2184	1 K400K9C e 06/15/0 5 06/15/05 YES OP A REIM IN WEBMD 45.00 45.00
	2185	2 K400K9D e 06/15/0 5 06/15/05 YES OP A REIM IN WEBMD 45.00 45.00
	2186	…
	2187	\|r Referre d \|* MT on Hold \|+ M ulti Carri ers \|
	2188	CI Claim Informatio n IL Inactive B ills PI Pati ent Insura nce
	2189	CP Change Patient HS Health Sum mary EL Pati ent Eligib ility
	2190	Select Act ion: Quit/ /
	2191
	2192
	2193	5.7.7 On H old Copay Listing
	2194	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.
	2195
	2196
	2197	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.
	2198
	2199	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.
	2200	Example 5. 7.7-1: Acc essing On Hold Copay Listing O ption
	2201	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	2202	SELECTED D IVISION(S) : ALL
	2203	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2204	Sorted b y: Transac tion date by default
	2205	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	2206	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	2207	1.1 SI METHICONE 40MG 0258 7542934 10 /26 110033 5$ 0/00 0000003119 W RT AC/R
	2208	p-Re jected
	2209	85:C laim Not P rocessed
	2210	NN:T ransaction Rejected At Switch Or Interme diary
	2211	02:M /I Version /Release N umber
	2212	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2213	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	2214	p-Re versal Oth er
	2215	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	2216	p-Re versal Oth er
	2217	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	2218	p-Pa yable
	2219	+ Enter ?? f or more ac tions
	2220	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	2221	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	2222	VP View Prescripti on OH On Hold C opay List EX Exi t
	2223	CMT Add/V iew Commen ts RH Release C opay
	2224	Select act ion:Next S creen// O H On Hol d Copay Li sting
	2225	Please sel ect a SING LE Patient Line item when acce ssing On H old Copay Listing
	2226	Select ite m: 1
	2227
	2228
	2229	You are pr ompted for a start a nd end dat e for the report.
	2230	Example 5. 7.7-2: Ent ering On H old Copay Report Sta rt and End Dates
	2231	Start with DATE: T-3 (AUG 14, 2005)
	2232	Go to DATE: T (AUG 17, 2 005)
	2233
	2234
	2235	You are pr ompted to choose whe ther to in clude Phar macy Co-pa y charges or not.
	2236	Example 5. 7.7-3: En tering “Y” to Includ e Pharmacy Co-pay Ch arges on R eport
	2237	Include Ph armacy Co- pay charge s on this report? NO // YES
	2238
	2239	*** Margin width of this outpu t is 132 * **
	2240	* This o utput shou ld be queu ed *
	2241	DEVICE: HO ME// 132 PRINTER
	2242
	2243
	2244	Print the report at 132 charac ters.
	2245	Example 5. 9.7-4: Pr inted On H old Copay Listing Re port
	2246	List of al l HELD bil ls for EC MEPatient, SIX (XXXX) AUG 8,200 6 PAGE 1
	2247	PATIENT CH ARGES C ORRESPONDI NG THIRD P ARTY BILLS
	2248	========== ========== ========== ========== ========== ========== ========== =======\|\|= ========== ========== ========== =========
	2249	From/ Date AR IB \|\| AR
	2250	Action ID Type Bill# Fill Dt to AR Charge Status Status\|\| Bill# Cla ssf($Typ) ST Charg e % Paid
	2251	========== ========== ========== ========== ========== ========== ========== =======\|\|= ========== ========== ========== =========
	2252	'* ' = outpt visit on s ame day as Rx fill d ate \|\|
	2253	========== ========== ========== ========== ========== ========== ========== =======\|\|= ========== ========== ========== =========
	2254	5002877 NSC R X Rx #: 100003994 ECME # 0 0000123457 9 \|\|
	2255	12/30/0 5 8.00 ON HOLD\|\|
	2256
	2257
	2258	Enter RETU RN to cont inue or '^ ' to exit:
	2259
	2260
	2261
	2262	5.7.8 Rele ase Copay
	2263	This actio n accesses the Relea se Charges 'On Hold' option, l ocated on the On Hol d Menu (wh ich is loc ated on th e Automate d Means Te st Billing Menu) in the Integr ated Billi ng softwar e. If you select a s ingle Rx L ine item, the system defaults the to the REF# of t he selecte d Rx.
	2264
	2265	Enter RH t o access t he Release Copay opt ion. You m ay select a single P atient lin e item or a single R x line ite m.
	2266	Example 5. 7.8-1: Acc essing Rel ease Copay Option
	2267	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	2268	SELECTED D IVISION(S) : ALL
	2269	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2270	Sorted b y: Transac tion date by default
	2271	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	2272	1 ECMEPa tient,SIX (XXXX) OPI NSUR2/2055 557898 VET Pb:10 Rj:2 AcRv :0 RjRv:1
	2273	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	2274	p-Re jected
	2275	85:C laim Not P rocessed
	2276	NN:T ransaction Rejected At Switch Or Interme diary
	2277	02:M /I Version /Release N umber
	2278	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2279	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	2280	p-Re versal Oth er
	2281	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	2282	p-Re versal Oth er
	2283	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	2284	p-Pa yable
	2285	+ Enter ?? f or more ac tions
	2286	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	2287	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	2288	VP View Prescripti on OH On Hold C opay List EX Exi t
	2289	CMT Add/V iew Commen ts RH Release C opay
	2290	Select act ion:Next S creen// RH Relea se Copay
	2291	Please sel ect a SING LE Patient Line item or a SING LE Rx Line item when accessing
	2292	Release C opay from Hold.
	2293	Select ite m: 9
	2294
	2295	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.
	2296	Example 5. 7.8-2: Lis ting On Ho ld Copay C harges for Release C opay Optio n
	2297	ECMEPatien t,,SIX Pt ID: 000-00 -0000
	2298	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	2299
	2300	The follow ing IB Act ions for t his patien t are ON H OLD:
	2301	========== ========== ========== ========== ========== ========== ========== ==========
	2302	REF Act ion ID Bi ll Type Bill # Fr/Fl Dt To/Rls Dt Charge
	2303	========== ========== ========== ========== ========== ========== ========== ==========
	2304	1 000 596570 Rx #: 909708 08/01/05 08/01/05 21.00
	2305	EC ME #: 0000 00000000
	2306	2 000 596574 Rx #: 909693 08/01/05 08/01/05 21.00
	2307	EC ME #: 0000 00000000
	2308	3 000 596575 Rx #: 909694 08/01/05 08/01/05 21.00
	2309	EC ME #: 0000 00000000
	2310	4 000 596580 Rx #: 909728 08/01/05 08/01/05 21.00
	2311	EC ME #: 0000 00000000
	2312	5 000 596581 Rx #: 909703 08/01/05 08/01/05 21.00
	2313	EC ME #: 0000 00000000
	2314	6 000 596601 Rx #: 909698 08/01/05 08/03/05 21.00
	2315	EC ME #: 0000 00000000
	2316
	2317	Select IB Actions (R EF #) to r elease (or '^' to ex it): 2
	2318	OK to pass this char ge to Acco unts Recei vable? YES
	2319
	2320
	2321	Passing ch arges to A ccounts Re ceivable.. .
	2322
	2323	========== ========== ========== ========== ========== ========== ========== ==========
	2324	REF Act ion ID Bi ll Type Bill # Fr/Fl Dt To/Rls Dt Charge
	2325	========== ========== ========== ========== ========== ========== ========== ==========
	2326	2 000 596574 Rx #: 909693 K400KDC 08/01/05 08/01/05 21.00
	2327	EC ME #: 0000 00000000
	2328
	2329	The charge listed ab ove has be en passed to Account s Receivab le.
	2330
	2331	Enter RETU RN to cont inue or '^ ' to exit:
	2332
	2333
	2334	5.7.9 IB ( Integrated Billing) Events Rep ort
	2335	The “EVNT” action al lows you t o access t he IB e-Ph armacy Men u Option, ECME Billi ng Events Report.
	2336
	2337	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.
	2338	Example 5. 7.9-1: Acc essing IB Events Rep ort Option
	2339	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	2340	SELECTED D IVISION(S) : ALL
	2341	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2342	Sorted b y: Transac tion date by default
	2343	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	2344	1 ECMEPa tient,,SIX (XXXX) OP INSUR2/205 5557898 VET Pb:1 0 Rj:2 AcR v:0 RjRv:1
	2345	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	2346	p-Re jected
	2347	85:C laim Not P rocessed
	2348	NN:T ransaction Rejected At Switch Or Interme diary
	2349	02:M /I Version /Release N umber
	2350	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2351	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	2352	p-Re versal Oth er
	2353	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	2354	p-Re versal Oth er
	2355	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	2356	p-Pa yable
	2357	+ Enter ?? f or more ac tions
	2358	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	2359	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	2360	VP View Prescripti on OH On Hold C opay List EX Exi t
	2361	CMT Add/V iew Commen ts RH Release C opay
	2362	Select act ion:Next S creen// EVNT IB Ev ents Repor t
	2363	Please sel ect a SING LE Patient Line item or a SING LE Rx Line item when accessing
	2364	The IB Ev ents Repor t.
	2365	Select ite m: 2
	2366
	2367
	2368	You are p rompted fo r a start and end da te for thi s report.
	2369	Example 5. 7.9-2: Ent ering Date s to Inclu de in IB E vents Repo rt Listing
	2370	START WITH DATE: TOD AY//T-60 (JUN 23, 2 005)
	2371	GO TO DATE : TODAY//T (AUG 22, 2005)
	2372
	2373
	2374	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.
	2375
	2376	Example 5. 7.9-3: Cho osing Defa ult ‘All’ for Types of Events for IB Eve nts Report
	2377	Selec t one of t he followi ng:
	2378
	2379	M MAIL
	2380	W WINDOW
	2381	C CMOP
	2382	A ALL
	2383
	2384	(M)AIL, (W )INDOW, (C )CMOP, (A) LL: ALL// <Enter> ALL
	2385
	2386
	2387	You are pr ompted to select S ( SUMMARY RE PORT) or D (DETAILED REPORT) a nd a print device.
	2388	Example 5. 7.9-4: Sel ecting Sum mary Type for IB Eve nts Report
	2389	S SUMMARY RE PORT
	2390	D DETAILED R EPORT
	2391
	2392	(S)UMMARY REPORT, (D )ETAILED R EPORT: SUM MARY REPOR T// <Ente r> SUMMARY REPORT
	2393
	2394	DEVICE: HO ME//
	2395
	2396	PAGE 1
	2397	BILLI NG ECME EV ENTS ON 06 /23/05 TO 08/22/05 (SUMMARY)
	2398
	2399	RX# FILL DAT E PA TIENT NAME DRUG
	2400	========== ========== ========== ========== ========== ========== ========== ==========
	2401	1 909693 0 08/0 1/05 EC MEPatient, SIX EPOETI N ALFA,REC OMB 20,000 UNT/
	2402	FINI SH 08/0 1/05 11:32 a Status:E CME Billab le
	2403	SUBM IT 08/0 1/05 11:34 a Status:O K
	2404	REVE RSAL 08/0 1/05 3:19p Status:E CME Claim reversed, no Bill to cancel
	2405	FINI SH 08/0 1/05 3:20p Status:E CME Billab le
	2406	SUBM IT 08/0 1/05 3:20p Status:O K
	2407	RELE ASE 08/0 1/05 3:20p Status:O K
	2408	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	2409	2 909694 0 08/0 1/05 EC MEPatient, Seven CYCL OPHOSPHAMI DE 1000MG INJ
	2410	FINI SH 08/0 1/05 11:44 a Status:E CME Billab le
	2411	SUBM IT 08/0 1/05 11:45 a Status:O K
	2412	REVE RSAL 08/0 1/05 3:37p Status:E CME Claim reversed, no Bill to cancel
	2413	FINI SH 08/0 1/05 3:38p Status:E CME Billab le
	2414	SUBM IT 08/0 1/05 3:38p Status:O K
	2415	RELE ASE 08/0 1/05 3:38p Status:O K
	2416	BILL ING 08/0 1/05 3:38p Status:B ill# K400K BC created
	2417	REVE RSAL 08/0 5/05 3:09p Status:B ill# K400K BC cancell ed
	2418	Press RETU RN to cont inue, '^' to exit:
	2419
	2420
	2421	Example 5. 7.9-5: Sel ecting a D etailed Ty pe for IB Events Rep ort
	2422	S SUMMARY RE PORT
	2423	D DETAILED R EPORT
	2424
	2425	(S)UMMARY REPORT, (D )ETAILED R EPORT: SUM MARY REPOR T// DETAIL ED REPORT
	2426
	2427	DEVICE: HO ME//
	2428
	2429
	2430	PAGE 1
	2431	BILLING EC ME EVENTS ON 07/06/1 1 TO 09/04 /11 (DETAI LED) for X XXXXX VAMC DIVISIO
	2432
	2433	RX# FILL DAT E PA TIENT NAME DRUG
	2434	========== ========== ========== ========== ========== ========== ========== ==========
	2435	1 205478 9 0 06/0 8/11 EC MEPATIENT, SIX C LONAZEPAM 1MG TAB
	2436	FINI SH 08/1 0/11 6:35p Status:E CME Billab le
	2437	ELIGIBILIT Y:
	2438	DRUG:CLONA ZEPAM 1MG TAB
	2439	NDC:57664- 0274-08, B ILLED QTY: 30, COST:. 024, DEA:4 CPR
	2440	PLAN: INS URANCE: WE BMD COB: S
	2441	BIN:123456 , PCN:1123 456789, PA YER SHEET B1:WBTESTB 1
	2442	PAYER SHEE T B2:WBTES TB2, PAYER SHEET B3: WBTESTB1
	2443	DISPENSING FEE:11.40 , BASIS OF COST DETE RM:COST CA LCULATIONS
	2444	COST:12.12 , GROSS AM T DUE:12.1 2, ADMIN F EE:0.00
	2445	USER:ECMEu ser,Two
	2446	SUBM IT 08/1 0/11 6:35p Status:O K
	2447	ECME#:0000 01614656, FILL DATE :06/08/11, RELEASE DATE:06/08 /11
	2448	PAYER RESP ONSE: PAYA BLE
	2449	PLAN:, INS URANCE: WE BMD
	2450	USER:ECMEu ser,Three
	2451	BILL ING 08/1 0/11 6:35p Status:B ill K10004 V created with ERROR s
	2452	Press RETU RN to cont inue, '^' to exit:
	2453
	2454	PAGE 2
	2455	BILLING EC ME EVENTS ON 07/06/1 1 TO 09/04 /11 (DETAI LED) for X XXXXX VAMC DIVISIO
	2456
	2457	RX# FILL DAT E PA TIENT NAME DRUG
	2458	========== ========== ========== ========== ========== ========== ========== ==========
	2459	ERROR DESC RIPTION: C annot esta blish rece ivable in AR (second ary ins).
	2460	ECME#:0000 01614656, FILL DATE :06/08/11, RELEASE DATE:06/08 /11
	2461	DRUG:CLONA ZEPAM 1MG TAB
	2462	NDC:57664- 0274-08, B ILLED QTY: 30, DAYS S UPPLY:30
	2463	BILLED:12. 12, PAID:6 8.32
	2464	PLAN:, INS URANCE: WE BMD
	2465	USER:ECMEu ser,One
	2466	REVE RSAL 08/1 1/11 1:18p Status:
	2467	ECME#:0000 01614656, FILL DATE :06/08/11, RELEASE DATE:06/08 /11
	2468	PAYER RESP ONSE: ACCE PTED
	2469	PLAN:, INS URANCE: WE BMD
	2470	USER:ECMEu ser,Two
	2471	REVERSAL R EASON:TST
	2472	FINI SH 08/1 1/11 1:20p Status:E CME Billab le
	2473	ELIGIBILIT Y:
	2474	DRUG:CLONA ZEPAM 1MG TAB
	2475	NDC:57664- 0274-08, B ILLED QTY: 30, COST:. 024, DEA:4 CPR
	2476	Press RETU RN to cont inue, '^' to exit:
	2477
	2478
	2479	PAGE 3
	2480	BILLING EC ME EVENTS ON 07/06/1 1 TO 09/04 /11 (DETAI LED) for C HEYENNE VA MC DIVISIO
	2481
	2482	RX# FILL DAT E PA TIENT NAME DRUG
	2483	========== ========== ========== ========== ========== ========== ========== ==========
	2484	PLAN: INS URANCE: WE BMD COB: S
	2485	BIN:123456 , PCN:1123 456789, PA YER SHEET B1:WBTESTB 1
	2486	PAYER SHEE T B2:WBTES TB2, PAYER SHEET B3: WBTESTB1
	2487	DISPENSING FEE:11.40 , BASIS OF COST DETE RM:COST CA LCULATIONS
	2488	COST:12.12 , GROSS AM T DUE:12.1 2, ADMIN F EE:0.00
	2489	USER:ECMEu ser,Two
	2490	SUBM IT 08/1 1/11 1:20p Status:O K
	2491	ECME#:0000 01614656, FILL DATE :06/08/11, RELEASE DATE:06/08 /11
	2492	PAYER RESP ONSE: REJE CTED
	2493	PLAN:, INS URANCE: WE BMD
	2494	USER:ECMEu ser,One
	2495	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	2496	2 205480 3 0 05/0 6/11 EC MEPATIENT, SIX L IDOCAINE 0 .5% (5MG/M L) 50ML M
	2497	FINI SH 08/1 0/11 6:07p Status:E CME Billab le
	2498	ELIGIBILIT Y:
	2499	DRUG:LIDOC AINE 0.5% (5MG/ML) 5 0ML MDV
	2500	NDC:00409- 4278-01, B ILLED QTY: 30, COST:1 .486, DEA: 6P
	2501	Press RETU RN to cont inue, '^' to exit:
	2502
	2503
	2504
	2505	5.7.10 Gro up Plan Me nu
	2506	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).
	2507
	2508	Enter GRP L to acces s the Grou p Plan Men u option.
	2509
	2510	Example 5. 7.10-1: Ac cessing Gr oup Plan M enu
	2511	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	2512	SELECTED D IVISION(S) : ALL
	2513	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2514	Sorted b y: Transac tion date by default
	2515	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	2516	1 ECMEPa tient,,SIX (XXXX) OP INSUR2/205 5557898 VET Pb:1 0 Rj:2 AcR v:0 RjRv:1
	2517	1.1 SI METHICONE 40MG 0258 7542934 10 /26 110033 5$ 0/00 0000003119 W RT AC/R
	2518	p-Re jected
	2519	85:C laim Not P rocessed
	2520	NN:T ransaction Rejected At Switch Or Interme diary
	2521	02:M /I Version /Release N umber
	2522	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2523	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	2524	p-Re versal Oth er
	2525	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	2526	p-Re versal Oth er
	2527	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	2528	p-Pa yable
	2529	+ Enter ?? f or more ac tions
	2530	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	2531	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	2532	VP View Prescripti on OH On Hold C opay List EX Exi t
	2533	CMT Add/V iew Commen ts RH Release C opay
	2534	Select act ion:Next S creen// GRPL Gr oup Plan M enu
	2535
	2536
	2537	- -- Group P lan Menu - --
	2538
	2539	EPLA Edit PLAN APPLI CATION Sub file
	2540	MGP Match Group Pla n to a Pha rmacy Plan
	2541	MMGP Match Multiple Group Plan s to a Pha rmacy Plan
	2542
	2543	Select Ite m(s):
	2544
	2545
	2546	5.7.11 Eli gibility I nquiry Opt ion
	2547	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.
	2548	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 .
	2549
	2550	You can ed it the Rel ationship Code, Pers on Code, a nd Insuran ce Effecti ve Date.
	2551
	2552	Example 5. 7.11-1: Ac cessing El igibility Inquiry Op tion
	2553
	2554	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	2555	SELECTED D IVISION(S) : ALL
	2556	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2557	Sorted b y: Transac tion date by default
	2558	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	2559	1 ECMEPa tient,,SIX (XXXX) OP INSUR2/205 5557898 VET Pb:1 0 Rj:2 AcR v:0 RjRv:1
	2560	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	2561	p-Re jected
	2562	85:C laim Not P rocessed
	2563	NN:T ransaction Rejected At Switch Or Interme diary
	2564	02:M /I Version /Release N umber
	2565	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2566	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	2567	p-Re versal Oth er
	2568	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	2569	p-Re versal Oth er
	2570	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	2571	p-Pa yable
	2572	+ Enter ?? f or more ac tions
	2573	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	2574	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	2575	VP View Prescripti on OH On Hold C opay List EX Exi t
	2576	CMT Add/V iew Commen ts RH Release C opay
	2577	Select act ion:Next S creen// EL IG ELIG
	2578	Enter the line numbe r for the claim to b e submitte d for Elig ibility Ve rification
	2579	Select ite m: 1.1
	2580
	2581
	2582	You've cho sen to VER IFY Eligib ility of t he followi ng prescri ption for ECMEPATIEN T,
	2583	SIX
	2584	1.1 SI METHICONE 40MG 0258 7542934 10 /26 110033 5$ 0/00 0000003119 W RT AC/R
	2585	Are you su re?(Y/N)? YES
	2586	Relationsh ip Code: 1 // CARDHOLDER
	2587	Person Cod e: 01//
	2588	Effective Date: 10/ 06/2010// 11/3/2010
	2589
	2590	Are you su re?(Y/N)? YES
	2591
	2592	Not submit table: Eli gibility P ayer Sheet Not Found .
	2593
	2594	Enter RETU RN to cont inue or '^ ' to exit:
	2595
	2596	When you e nter QUIT, the syste m will ret urn you to the Furth er Researc h Screen.
	2597
	2598	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 .
	2599
	2600	Example 5. 7.11-2: En tering the EXIT Acti on from Fu rther Rese arch Scree n
	2601	FURTHER RE SEARCH SCR EEN Nov 03, 20 10@15:27:5 4 Page: 1 of 30
	2602	SELECTED D IVISION(S) : ALL
	2603	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2604	Sorted b y: Transac tion date by default
	2605	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# S TATUS/LOC/ TYP/RXINF
	2606	1 ECMEPa tient,,SIX (XXXX) OP INSUR2/205 5557898 VET Pb:1 0 Rj:2 AcR v:0 RjRv:1
	2607	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	2608	p-Re jected
	2609	85:C laim Not P rocessed
	2610	NN:T ransaction Rejected At Switch Or Interme diary
	2611	02:M /I Version /Release N umber
	2612	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2613	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /26 110033 6$ 0/00 0000003120 W RT DS/R
	2614	p-Re versal Oth er
	2615	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /27 110033 7$ 0/00 0000003122 W RT DS/R
	2616	p-Re versal Oth er
	2617	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /27 110033 9$ 0/00 0000003124 W RT AC/R
	2618	p-Pa yable
	2619	+ Enter ?? f or more ac tions
	2620	INS Insur ance detai ls CT Claims Tr acking EVNT IB Events Rep ort
	2621	VE View Eligibilit y TPJI Third Par ty Inquiry GRPL Gro up Plan Me nu
	2622	VP View Prescripti on OH On Hold C opay List EX Exi t
	2623	CMT Add/V iew Commen ts RH Release C opay
	2624	Select act ion:Next S creen// E X Exit
	2625
	2626
	2627	5.8 Print Claim Log (hidden ac tion)
	2628	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.
	2629
	2630	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.
	2631	Example 5. 10-1: Acc essing the Print Cla im Log Opt ion
	2632	PHARMACY E CME Aug 12, 20 05@02:40:3 4 Page: 1 of 81
	2633	SELECTED D IVISION(S) : ALL
	2634	Transmitte d by ALL u sers Activity Date Rang e: within the past 3 0 day(s)
	2635	Sor ted by: Pa tient Name
	2636	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	2637	1 ECMEPa tient,,SIX (XXXX) OP INSUR2/205 5557898 VET Pb:1 0 Rj:2 AcR v:0 RjRv:1
	2638	1.1 SI METHICONE 40MG 0258 7542934 10 /06 110033 5$ 0/00 0000003119 W RT AC/R
	2639	p-Re jected
	2640	85:C laim Not P rocessed
	2641	NN:T ransaction Rejected At Switch Or Interme diary
	2642	02:M /I Version /Release N umber
	2643	EV11 7-D0 IS IN VALID VERS ION NUMBER
	2644	1.2 TR IAMTERENE 50MG, 0048 4359030 10 /06 110033 6$ 0/00 0000003120 W RT DS/R
	2645	p-Re versal Oth er
	2646	1.3 AM YL NITRITE 0.3M 0022 3700212 10 /07 110033 7$ 0/00 0000003122 W RT DS/R
	2647	p-Re versal Oth er
	2648	1.4 TR IAMTERENE 50MG, 0048 4359030 10 /07 110033 9$ 0/00 0000003124 W RT AC/R
	2649	p-Pa yable
	2650	+ Enter ?? f or more ac tions
	2651	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2652	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2653	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2654	Select Act ion: Next Screen// L OG Print Claim Log
	2655
	2656	Enter the line numbe r for whic h you wish to print claim logs .
	2657	Select ite m: 5.1
	2658
	2659
	2660	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>) .
	2661	Example 5. 8-2: Disp laying Cla im Log Dat a for a Se lected Pre scription Line Item
	2662	PHARMACY E CME A ug 22, 200 5@13:58:50 Page: 1 of 7
	2663	Claim Log informatio n
	2664
	2665	Pharmacy E CME Log
	2666
	2667	Rx #: 9093 93/0 EC ME#: 00000 1105635
	2668	Drug: AMOX ICILLIN 25 0MG CAP
	2669	Pat ient: ECME patient,On e (0000) S ex: M DOB: J AN 1, 1954 (57)
	2670	Submi tted: JUN 15,2005@15 :19:11
	2671	By: ECME user,One
	2672	VA Cla im #: VA20 05=1234567 893=123456 =0000502
	2673
	2674
	2675	+ Enter ?? f or more ac tions
	2676	PR Print Data EX Exit
	2677	Select act ion:Next S creen// <E nter>
	2678
	2679	PHARMACY E CME Sep 11, 20 05@11:36:1 4 Page: 2 of 7
	2680	Claim Log informatio n
	2681	+
	2682	Transactio n Informat ion (#661) ---------- ---------- ---------- ---------- ---------
	2683	Created on : JUN 15,2 005@16:25: 48
	2684	Submitted By: ECMEUS ER,FOUR
	2685	Transactio n Type: RE QUEST
	2686	Date of Se rvice: 06/ 15/2005
	2687	NDC Code: 00068-0011 -10
	2688	Quantity S ubmitted o n Claim: 6 0 ( )
	2689	Days Suppl y: 30
	2690	Division : ALBANY IS C
	2691	NPI#: 4000 000016
	2692	ECME Pharm acy: XXXXX XXXX
	2693	Rx Qty: 90 (EA) U nit Cost: .752 G ross Amt D ue: 79.08
	2694	Ingredient Cost: 67. 68 Dispe nsing Fee: 11.40
	2695	U&C Charge : 79.08 A dmin Fee: 0.00
	2696
	2697	Insurance Name: WEBM D
	2698	Rx Coordin ation of B enefits: P RIMARY
	2699	BIN: 12345 6
	2700	PCN: 11234 56789
	2701	Group ID: WEBMDTEST
	2702	Cardholder ID:
	2703	Patient Re lationship Code: CAR DHOLDER
	2704	Cardholder First Nam e: One
	2705	Cardholder Last Name : ECMEpati ent
	2706	Facility I D Qualifie r:
	2707	+ Enter ?? f or more ac tions
	2708	PR Print Data EX Exit
	2709	Select act ion:Next S creen// <E nter>
	2710
	2711	PHARMACY E CME Sep 11, 20 05@11:39:0 7 Page: 3 of 7
	2712	Claim Log informatio n
	2713	+
	2714	Plan ID: 8 729
	2715	Payer Shee t IEN: WBT ESTB1
	2716	B2 Payer S heet IEN: WBTESTB2
	2717	B3 Rebill Payer Shee t: WBTESTB 1
	2718	Certify Mo de:
	2719	Cert IEN:
	2720
	2721	+ Enter ?? f or more ac tions
	2722	PR Print Data EX Exit
	2723	Select act ion:Next S creen// <E nter>
	2724
	2725	PHARMACY E CME Sep 11, 20 05@11:39:5 1 Page: 4 of 7
	2726	Claim Log informatio n
	2727	+
	2728	Response I nformation (#661)--- ---------- ---------- ---------- ---------- ---------
	2729	Response R eceived: J UN 15,2005 @16:25:49
	2730	Date of Se rvice: 06/ 15/2005
	2731	Transactio n Response Status: P aid
	2732	Total Amou nt Paid: $ 40.00
	2733	Ingredient Cost Paid : $48.00 Dispensin g Fee Paid : $1.00
	2734	Patient Re sp (INS): ($9.00)
	2735	Reconcilia tion ID:
	2736	Reject cod e(s):
	2737	Payer Mess age:
	2738	Payer Addi tional Mes sage:
	2739	Reason for Service C ode: AD
	2740	DUR Text: AMOXICILLI N 250MG CA P
	2741	DUR Additi onal Text: The text would disp lay here
	2742	+ Enter ?? f or more ac tions
	2743	PR Print Data EX Exit
	2744	Select act ion:Next S creen// <E nter>
	2745
	2746	PHARMACY E CME Sep 11, 20 05@11:39:5 1 Page: 5 of 7
	2747	Claim Log informatio n
	2748	+
	2749	Transactio n Informat ion (#659) ---------- ---------- ---------- ---------- ---------
	2750	Created on : JUN 15,2 005@15:07: 34
	2751	Transactio n Type: RE QUEST
	2752	Date of Se rvice: 06/ 15/2005
	2753	NDC Code: 00068-0011 -10
	2754	Quantity S ubmitted o n Claim: 6 0 ( )
	2755	Days Suppl y: 30
	2756	Division : ALBANY IS C
	2757	NPI#: 4000 000016
	2758	ECME Pharm acy: BAY P INES
	2759	Rx Qty: 90 (EA) Unit Cost: .752 Gross Amt Due: 79.08
	2760	Ingredient Cost: 67. 68 Dispe nsing Fee: 11.40
	2761	U&C Charge : 79.08 A dmin Fee: 0.00
	2762
	2763	Insurance Name: WEBM D
	2764	Rx Coordin ation of B enefits: P RIMARY
	2765	BIN: 12345 6
	2766	PCN: 11234 56789
	2767	Group ID: WEBMDTEST
	2768	Cardholder ID:
	2769	Patient Re lationship Code: CAR DHOLDER
	2770	Cardholder First Nam e: One
	2771	Cardholder Last Name : ECMEpati ent
	2772	Facility I D Qualifie r:
	2773
	2774	+ Enter ?? for more a ctions
	2775	PR Print Data EX Exit
	2776	Select act ion:Next S creen// <E nter>
	2777
	2778	PHARMACY E CME Sep 11, 20 05@11:42:4 1 Page: 6 of 7
	2779	Claim Log informatio n
	2780	+
	2781	Plan ID: 8 729
	2782	Payer Shee t IEN: WBT ESTB1
	2783	B2 Payer S heet IEN: WBTESTB2
	2784	B3 Rebill Payer Shee t: WBTESTB 1
	2785	Certify Mo de:
	2786	Cert IEN:
	2787
	2788	+ Enter ?? f or more ac tions
	2789	PR Print Data EX Exit
	2790	Select act ion:Next S creen// <E nter>
	2791
	2792	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.
	2793
	2794	PHARMACY E CME Sep 11, 20 05@11:43:0 1 Page: 7 of 7
	2795	Claim Log informatio n
	2796	+
	2797	Response I nformation (#659)--- ---------- ---------- ---------- ---------- ---------
	2798	Response R eceived: J UN 15,2005 @15:18:30
	2799	Date of Se rvice: 06/ 15/2005
	2800	Transactio n Response Status: R ejected
	2801	Total Amou nt Paid: $ 0
	2802	Ingredient Cost Paid : Dispe nsing Fee Paid:
	2803	Patient Re sp (INS):
	2804	Reconcilia tion ID:
	2805	Reject cod e(s):
	2806	NN:Transa ction Reje cted At Sw itch Or In termediary
	2807	Payer Mess age: NC40- Request fr om an unkn own site. Registrat ion is req uired
	2808	Payer Addi tional Mes sage:
	2809	Reason for Service C ode: AD
	2810	DUR Text: AMOXICILLI N 250MG CA P
	2811	DUR Additi onal Text: The text would disp lay here
	2812	Enter ?? f or more ac tions
	2813	PR Print Data EX Exit
	2814	Select act ion:Quit// <Enter> QUIT
	2815
	2816	5.09 Send to Worklis t
	2817	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.
	2818
	2819	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”.
	2820
	2821	Enter WRK at the Sel ect Action prompt, a nd a singl e line ite m for the claim you wish to se nd.
	2822	Example 5. 09-1: Acc essing the Send to W orklist Op tion, and Entering a Line Item .
	2823	PHARMACY E CME Jul 03, 20 08@12:04:0 2 Page: 1 of 41
	2824	SELECTED D IVISION(S) : ALL
	2825	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2826	Sorted b y: Transac tion date by default
	2827	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/ TYP RXINF
	2828	1 ECMEpa tient,One (XXXX) NON TRIC/ V ET Pb:0 Rj :6 AcRv:3 RjRv:2
	2829	1.1 AL BUTEROL 0. 5% IN 503 83-0741-20 07/03 205 4905$ 1 /000001614 782 W RT * */R
	2830	p-Re jected
	2831	07:M /I Cardhol der ID
	2832	1.2 JA PANESE ENC EPHAL 492 81-0680-30 06/27 205 5040$ 0 /000001614 918 W RT * */N
	2833	p-In progress- Parsing r esponse
	2834	1.3 JA PANESE ENC EPHAL 492 81-0680-30 07/03 205 5040$ 1 /000001614 918 W RT D IS/N
	2835	p-In progress- Parsing r esponse
	2836	1.4 OL ANZAPINE 1 0MG T 000 02-4117-30 06/29 205 5048$ 0 /000001614 926 W RT D IS/N
	2837	p-In progress- Parsing r esponse
	2838	1.5 OL ANZAPINE 1 0MG T 000 02-4117-30 06/29 205 5049$ 0 /000001614 927 W RT * */N
	2839	p-Re versal acc epted/Clos ed
	2840	1.6 OL ANZAPINE 1 0MG T 000 02-4117-30 07/03 205 5049$ 1 /000001614 927 W RT A C/N
	2841	+ Enter ?? f or more ac tions
	2842	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2843	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2844	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2845	Select Act ion: Next Screen// w rk Send to Worklis t
	2846
	2847	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2848	Select ite m(s): 1.1
	2849	You've cho sen to sen d to Pharm acy Work L ist the fo llowing:
	2850	1.1 AL BUTEROL 0. 5% IN 503 83-0741-20 06/03 205 4905$ 1 /000001614 782 W RT * */R
	2851	Comment fo r Pharmacy : Needs t o be resol ved in Pha rmacy.
	2852
	2853	Eligible c laim(s) wi ll be sent to the Ph armacy Wor klist...
	2854
	2855	Are you su re?(Y/N)? y YES
	2856	1.1 AL BUTEROL 0. 5% IN 503 83-0741-20 07/03 205 4905$ 1 /000001614 782 W RT * */R
	2857	has been s ent to the Pharmacy Work List.
	2858
	2859	Enter RETU RN to cont inue or '^ ' to exit:
	2860
	2861	Updating s creen...
	2862
	2863
	2864	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.
	2865
	2866	Example 5. 09-2: The Updated U ser Screen
	2867	PHARMACY E CME Jul 03, 20 08@12:04:4 8 Page: 1 of 41
	2868	SELECTED D IVISION(S) : ALL
	2869	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2870	Sorted b y: Transac tion date by default
	2871	# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/ TYP RXINF
	2872	1 ECMEpa tient,One (XXXX) NON TRIC/ V ET Pb:0 Rj :6 AcRv:3 RjRv:2
	2873	1.1 AL BUTEROL 0. 5% IN 503 83-0741-20 06/03 205 4905$ 1 /000001614 782 W RT * */R
	2874	07/2 3/08 - Sen t to Pharm acy: Needs to be res olved in P harmacy.
	2875	(ECM EUSER,FOUR )
	2876	p-Re jected
	2877	07:M /I Cardhol der ID
	2878	1.2 JA PANESE ENC EPHAL 492 81-0680-30 06/27 205 5040$ 0 /000001614 918 W RT * */N
	2879	p-In progress- Parsing r esponse
	2880	1.3 JA PANESE ENC EPHAL 492 81-0680-30 07/03 205 5040$ 1 /000001614 918 W RT D S/N
	2881	p-In progress- Parsing r esponse
	2882	1.4 OL ANZAPINE 1 0MG T 000 02-4117-30 06/29 205 5048$ 0 /000001614 926 W RT D S/N
	2883	p-In progress- Parsing r esponse
	2884	1.5 OL ANZAPINE 1 0MG T 000 02-4117-30 06/29 205 5049$ 0 /000001614 927 W RT * */N
	2885	+ Enter ?? f or more ac tions
	2886	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2887	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2888	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2889	Select Act ion: Next Screen//
	2890
	2891
	2892	If an inva lid claim is selecte d, other m essages ma y appear.
	2893
	2894	Example 5. 09-3: Sel ected Clai m Already on the Pha rmacy Work list
	2895	1.15 TAZAROTENE 0.1% T 0 0023-0042- 03 07/15 2 055208$ 0/0000016 15107 W RT AC/N
	2896	07/1 5/08 - Sen t to Pharm acy:testin g
	2897	+ Enter ?? f or more ac tions
	2898	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2899	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2900	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2901	Select Act ion: Next Screen// w rk Send to Worklis t
	2902
	2903	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2904	Select ite m(s): 1.15
	2905	You've cho sen to sen d to Pharm acy Work L ist the fo llowing:
	2906	1.15 TA ZAROTENE 0 .1% T 000 23-0042-03 07/15 205 5208$ 0 /000001615 107 W RT A C/N
	2907	was ALREAD Y sent to the Pharma cy Work Li st.
	2908
	2909	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2910	Select ite m(s):
	2911	Example 5. 09-4: Sel ected Clai m Doesn’t Have an El igible Rej ect Code
	2912
	2913	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2914	Select ite m(s):
	2915	You've cho sen to sen d to Pharm acy Work L ist the fo llowing:
	2916	1.11 ALLOP URINOL 100 MG 00364- 0632-02 02 /18 788538 $ 0/00 0001459640 W RT AC/N
	2917	doesn't ha ve eligibl e reject c ode to be sent to th e Pharmacy Work List .
	2918
	2919	Example 5. 09-5: Sel ected Clai m Has Not Been Rejec ted
	2920
	2921	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2922	Select ite m(s):
	2923	You've cho sen to sen d to Pharm acy Work L ist the fo llowing:
	2924	1.11 ACARB OSE 25MG T AB 00026- 2863-51 03 /03 788628 $ 0/00 0001459751 W RT DS/N
	2925	was not re jected and cannot be sent to t he Pharmac y Work Lis t.
	2926
	2927
	2928	Example 5. 09-6: Sel ected Clai m is Close d
	2929	1.22 ERYT HRITYL TET RAN 00223 -0916-01 0 4/03 10202 8$ 3/0 0000000240 3 W RT DL/ N
	2930	04/0 6/09 - RX DELETED
	2931	(ECM Eemployee, One)
	2932	p-Re jected/Clo sed
	2933	88:D UR Reject Error
	2934	1.23 ME THANTHELIN E 50M 000 14-1501-31 03/13 102 029$ 0 /000000002 404 W RT A C/N
	2935	p-Re jected
	2936	79:R efill Too Soon
	2937	+--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ----------
	2938	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2939	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2940	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2941	Select Act ion: Next Screen// W RK Send to Worklis t
	2942
	2943	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2944	Select ite m(s): 1.22
	2945	You've cho sen to sen d to Pharm acy Work L ist the fo llowing:
	2946	1.22 ER YTHRITYL T ETRAN 002 23-0916-01 04/03 102 028$ 3 /000000002 403 W RT D E/N
	2947	is closed and cannot be sent t o the Phar macy Work List.
	2948
	2949	Enter the line numbe rs for the claim(s) to send to the Pharm acy Workli st.
	2950	Select ite m(s):
	2951
	2952	5.10 Reope n Closed C laims (hid den action )
	2953	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.
	2954	Enter ROC at the “Se lect Actio n:” prompt to access the optio n, and sel ect a line item.
	2955	Example 5. 10-1: Acc essing the Reopen Cl osed Claim s Option
	2956	PHARMACY E CME Mar 27, 20 09@16:26:5 0 Page: 1 of 41
	2957	SELECTED D IVISION(S) : ALL
	2958	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	2959	Sorted b y: Transac tion date by default
	2960	-#--PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/ TYP RXINF
	2961	1 ECMEpa tient,One (XXXX) OP INSUR2/205 5557898 VET ALL pa yable
	2962	1.1 DO XEPIN 25MG CAP 008 39-7221-06 03/27 102 105$ 0 /000000002 484 W BB A C/R
	2963	p-Pa yable
	2964	1.2 ME THAZOLAMID E 50M 000 05-5470-23 03/27 102 106$ 0 /000000002 485 W BB A C/R
	2965	p-Pa yable
	2966	2 ECMEpa tient,Two (XXXX) OP INSUR1/ VET Pb:53 Rj:28 AcRv :21 RjRv:6
	2967	2.1 ME DROXYPROGE STRON 000 09-0050-02 06/20 101 171$ 0 /000000001 521 W RT D S/N
	2968	06/2 0/08 - Cla rification Code 99 s ubmitted.
	2969	(ECM Euser,One)
	2970	p-Re versal acc epted
	2971	2.2 RE SERPINE 0. 1MG S 985 21-4587-02 03/26 101 237A$ 0 /000000001 695 C RT D S/R
	2972	p- R ejected/Cl osed
	2973	2.3 FU ROSEMIDE 1 0MG/M 510 79-0935-20 03/21 101 646$ 0 /000000002 014 W RT D S/N
	2974	+--------- Enter ?? f or more ac tions----- ---------- ---------- ---------- ----------
	2975	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	2976	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	2977	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	2978	Select Act ion: Next Screen// R OC ROC
	2979	Enter the line numbe r for the claim you want to re open.
	2980	Select ite m(s): 2.2
	2981
	2982	You've cho sen to reo pen the fo llowing pr escription s(s) for
	2983	ECMEpatien t,One:
	2984	2.2 RE SERPINE 0. 1MG S 985 21-4587-02 03/26 101 237A$ 0 /000000001 695 C RT DS/R
	2985
	2986	All Select ed Rxs wil l be reope ned using the same i nformation gathered in the
	2987	following prompts.
	2988
	2989
	2990	Are you su re?(Y/N)? YES
	2991
	2992	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.
	2993
	2994	Example 5. 10-2: Ente ring Text Comment fo r Reopened Closed Cl aim
	2995	REOPEN COM MENTS: Cla im reopene d for new refill
	2996	ARE YOU SU RE YOU WAN T TO RE-OP EN THIS CL AIM? (Y/N) ? No// YES
	2997	ReOpening Claim: VA2 009=400000 0016=10522 0=0005843 ... OK
	2998
	2999	1 claim ha s been reo pened.
	3000
	3001
	3002	Enter RETU RN to cont inue or '^ ' to exit: <Enter>
	3003
	3004
	3005	Once the c laim has b een succes sfully reo pened, the screen is updated a nd re-disp layed.
	3006
	3007	Example 5. 10-3: The User Scree n is Updat ed and Re- Displayed
	3008	Updating s creen for reopened c laims...
	3009
	3010	PHARMACY E CME Mar 27, 20 09@16:28:3 2 Page: 1 of 41
	3011	SELECTED D IVISION(S) : ALL
	3012	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	3013	Sorted b y: Transac tion date by default
	3014	-#--PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# LOC/ TYP RXINF
	3015	1 ECMEpa tient,One (XXXX) OP INSUR2/205 5557898 VET ALL pa yable
	3016	1.1 DO XEPIN 25MG CAP 008 39-7221-06 03/27 102 105$ 0 /000000002 484 W BB A C/R
	3017	p-Pa yable
	3018	1.2 ME THAZOLAMID E 50M 000 05-5470-23 03/27 102 106$ 0 /000000002 485 W BB A C/R
	3019	p-Pa yable
	3020	2 ECMEpa tient,Two (XXXX) OP INSUR1/ VET Pb:53 Rj:28 AcRv :21 RjRv:6
	3021	2.1 ME DROXYPROGE STRON 000 09-0050-02 03/20 101 171$ 0 /000000001 521 W RT D S/N
	3022	06/2 0/08 - Cla rification Code 99 s ubmitted.
	3023	(ECM Euser,One)
	3024	p-Re versal acc epted
	3025	2.2 RE SERPINE 0. 1MG S 985 21-4587-02 03/26 101 237A$ 0 /000000001 695 C RT D S/R
	3026	p-Re jected
	3027	2.3 FU ROSEMIDE 1 0MG/M 510 79-0935-20 03/21 101 646$ 0 /000000002 014 W RT D S/N
	3028	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	3029	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	3030	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	3031	Select Act ion: Next Screen//
	3032
	3033
	3034	5.11 Resub mit with E dits (hidd en action)
	3035	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, Delay Rea son Code, and/or NCP DP Field N ame or Num ber. (The Date of Se rvice prom pt is only asked if the prescr iption has been rele ased.) If the claim selected is for sec ondary ins urance, th e Coordina tion of Be nefits inf ormation c an also be edited.
	3036
	3037	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.
	3038	0 Not Specified
	3039	1 Card holder
	3040	2 Spou se
	3041	3 Chil d
	3042	4 Othe r
	3043
	3044	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 .
	3045
	3046	The Submis sion Clari fication C ode cannot be edited if eithe r of these condition s exists:
	3047	An unresol ved reject is on the pharmacis ts’ workli st
	3048	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.
	3049	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.
	3050
	3051	You've cho sen to RES UBMIT the following prescripti on for ECM Epatient,f our
	3052	1.2 AL BUTEROL 0. 5% IN 2420 8034720 02 /22 000000 0 0/00 0000000003 W RT DS/N
	3053	Are you su re?(Y/N)? YES
	3054	Pharmacy R elationshi p Code: 1/ / C ARDHOLDER
	3055	Pharmacy P erson Code : 125//
	3056	Prior Auth orization Number: 00 000000000/ /
	3057	Prior Auth orization Type Code: 0// NOT SPEC IFIED
	3058	Submission Clarifica tion Code 1: 1 NO OVE RRIDE
	3059	**OPECC c annot edit Sub. Clar . Code fie ld for thi s reject - refer to Pharmacist
	3060	Patient Re sidence Co de: 1//
	3061
	3062	By answeri ng YES to Submit NCP DP Field N ot on Paye r Sheet, i t becomes possible t o submit a NCPDP fie ld that is not on th e payer sh eet. When prompted for the fi eld name o r number, enter “??” for a lis t of possi ble choice s. Fields already o n the paye r sheet ar e excluded from the list of po ssible cho ices. Als o excluded are any f ields that do not ha ve logic t o pull dat a from Vis tA (i.e. f ields that will alwa ys be <bla nk>).
	3063
	3064	Submit NCP DP Field N ot on Paye r Sheet (Y /N)? N// Y ES
	3065
	3066	Enter a va lid NCPDP Field name or number . Enter ' ??' for
	3067	a list of possible c hoices. F ields alre ady on the payer she et
	3068	are exclud ed from th e list of possible c hoices. A lso exclud ed
	3069	are any fi elds that do not hav e logic to pull data from Vist A
	3070	(i.e. fiel ds that wi ll always be <blank> ).
	3071
	3072	NCPDP Fiel d Name or Number: ? ?
	3073
	3074	Choose from:
	3075	498.12 PRE SCRIBER TE LEPHONE NU MBER
	3076	678 TIME O F SERVICE
	3077	B08 PATIEN T STREET A DDRESS LIN E 1
	3078	B09 PATIEN T STREET A DDRESS LIN E 2
	3079	B27 PRESCR IBER STREE T ADDR LIN E 1
	3080	B28 PRESCR IBER STREE T ADDR LIN E 2
	3081	B38 PATIEN T ID ASSOC COUNTRY C ODE
	3082	B41 PRES I D ASSOC CO UNTRY CODE
	3083	B42 PRESCR IBER COUNT RY CODE
	3084	B98 RECONC ILIATION I D
	3085
	3086	NCPDP Fiel d Name or Number: 6 78 T IME OF SER VICE
	3087	Value to transmi t: 085354
	3088	Transmit w ith claim (Y/N)? Y//
	3089
	3090	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.”
	3091
	3092
	3093	Enter RED at the “Se lect Actio n:” prompt to choose the presc ription li ne to resu bmit.
	3094	Example 5. 11-1: Acc essing the Resubmit with Edits Option
	3095	PHARMACY E CME Aug 12, 20 11@02:40:3 4 Page: 1 of 81
	3096	SELECTED D IVISION(S) : ALL
	3097	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	3098	Sor ted by: Pa tient Name
	3099	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	3100	5 ECMEpa tient,Two (XXXX) WE BMD / VET AL L payable
	3101	5.1 LE UCOVORIN 5 MG/ML 007 03-5140-01 08/12 109 58860$ 0 /000009378 798 W RT A C/N
	3102	p-Re versal rej ected
	3103	6 ECMEpa tient,One (XXXX) WEB MD / VET Pb: 3 Rj:1 AcR v:1 RjRv:0
	3104	6.1 GR ANULEX SPR AY 4O 005 14-0001-01 08/12 109 58847 0 /000009378 705 W RT A C/R
	3105	p-Pa yable
	3106	6.2 AC ARBOSE 100 MG TA 000 26-2862-51 08/12 525 36284 1 /000009378 782 W RT D S/N
	3107	03/2 0/06 - RX DISCONTINU ED
	3108	p-Re jected
	3109	08:M /I Person Code
	3110	+ Enter ?? f or more ac tions
	3111	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	3112	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	3113	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	3114	Select Act ion: Quit/ / RED RE D
	3115
	3116	Enter the line numbe r for the claim to b e submitte d.
	3117	Example 5. 11-2: Ent ering the Line Item for the Cl aim Resubm ission Req uest
	3118	Enter the line numbe r for the claim to b e resubmit ted:
	3119	Select ite m: 6.2
	3120
	3121
	3122	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.
	3123	Example 5. 11-3: Ente ring the L ine Item f or a Claim that has a Payable Secondary Claim
	3124	The claim:
	3125	1.12 FLU RAZEPAM 15 MG C 00140 -0065-14 0 3/04 10232 2$ 2/00000 0113596 W RT AC/R
	3126	cannot be Resubmitte d if the s econdary c laim is pa yable.
	3127	Please rev erse the s econdary c laim first .
	3128
	3129	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.
	3130	Example 5. 11-4: Ente ring Yes t o “Are You Sure” Pro mpt
	3131	You've cho sen to RES UBMIT the following prescripti on for ECM Epatient, One
	3132	1.2 LI DOCAINE 0. 5% W/ 001 86-0140-01 07/09 100 704$ 1 /000000000 623 W RT A C/N
	3133	ARE YOU SU RE? (Y/N)? No// YES
	3134
	3135	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 the con ditions ex plained ab ove are no t met), Da te of Serv ice, Patie nt Residen ce Code, P harmacy Se rvice Type Code and/ or Delay R eason Code .
	3136	Example 5. 11-5: Edit ing Prompt s
	3137
	3138	Pharmacy R elationshi p Code: <E nter>
	3139	Pharmacy P erson Code : 23
	3140	Prior Auth orization Number: 00 000000000/ /
	3141	Prior Auth orization Type Code: 0// NOT SPEC IFIED
	3142	Submission Clarifica tion Code 1: 5// THERAP Y CHANGE
	3143	Submission Clarifica tion Code 2:
	3144	Select one of the fo llowing:
	3145	1. 01/19/2 010 Curre nt Date of Service
	3146	2. 01/19/2 010 Fill Date
	3147	3. 01/20/2 010 Relea se Date
	3148
	3149	Date of Se rvice: 1// 2 01/19/2 010 Fill D ate
	3150	Patient Re sidence Co de: 1// HOME
	3151	Pharmacy S ervice Typ e Code: 1/ / R ETAIL
	3152	Delay Reas on Code:
	3153
	3154	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.
	3155
	3156	Example 5. 11-6: Ente ring the s econdary c laim infor mation wit h payment informatio n
	3157
	3158	Data for S econdary C laim
	3159	---------- ---------- ----
	3160	Insurance: ECME INS URANCE2 COB: SECON DARY
	3161	Rate Type: REIMBURS ABLE INS.
	3162	Other Cove rage Code: 02 (OTHE R COVERAGE EXISTS - PAYMENT CO LLECTED)
	3163	Other Paye r Coverage Type: 01 (PRIMARY)
	3164	Other Paye r ID Quali fier: 03 (BANK INFO RMATION NU MBER (BIN) )
	3165	Other Paye r ID: 123 456
	3166	Other Paye r Date: J un 28, 201 0
	3167	Other Paye r Paid Qua lifier: 0 8 (SUM OF ALL REIMBU RSEMENT)
	3168	Other Paye r Amount P aid: 40.0 0
	3169
	3170	Do you wan t to edit this Secon dary Claim Informati on (Y/N)? N// y YES
	3171
	3172	Insura nce CO B Subscri ber ID Gro up Ho lder Eff ective Ex pires
	3173	====== ======= == == ======= ====== === ======= == ====== === ======= == ========
	3174	1 ECME I NSURAN PRI 12340987 T-GR OUP1 PAT IENT 10/2 0/2006 06/ 00/2011
	3175	2 ECME I NSURAN SEC D-GR OUP1 PAT IENT 07/0 9/2006 06/ 00/2011
	3176
	3177
	3178	SECONDARY INSURANCE POLICY: 2/ / ECME I NSURANCE1 (SECONDARY ) - D-GROU P1
	3179	SELECT RAT E TYPE: RE IMBURSABLE INS.// Who's Re sponsible: INSURER
	3180	OTHER COVE RAGE CODE: 02// O THER COVER AGE EXISTS - PAYMENT COLLECTED
	3181	OTHER PAYE R ID: 1234 56//
	3182	OTHER PAYE R DATE: J un 28, 201 0//
	3183	Edit Paid Amounts or Reject Co des (PAID AMOUNTS/RE JECT CODES ): PAID A MOUNTS//
	3184	OTHER PAYE R AMOUNT P AID QUALIF IER: 08// SUM OF ALL REIMBU RSEMENT
	3185	OTHER PAYE R AMOUNT P AID: (0-9 99999): 40 .00// 40. 00
	3186	OTHER PAYE R PATIENT RESPONSIBI LITY AMOUN T QUALIFIE R: 06 (AMT REPORTED BY PRIOR P AYER)
	3187	OTHER PAYE R PATIENT RESPONSIBI LITY AMOUN T: 12.38
	3188
	3189
	3190	Example 5. 11-7: Ente ring the s econdary c laim infor mation wit h reject i nformation
	3191
	3192	Data for S econdary C laim
	3193	---------- ---------- ----
	3194	Insurance: DAVE INS URANCE COB: SECON DARY
	3195	Rate Type: REIMBURS ABLE INS.
	3196	Other Cove rage Code: 03 (OTHE R COVERAGE EXISTS - THIS CLAIM NOT COVER ED)
	3197	Other Paye r Coverage Type: 01 (PRIMARY)
	3198	Other Paye r ID Quali fier: 03 (BANK INFO RMATION NU MBER (BIN) )
	3199	Other Paye r ID: 610 459
	3200	Other Paye r Date: A ug 16, 201 0
	3201	Other Paye r Reject C ode: 34:M /I Submiss ion Clarif ication Co de
	3202	Other Paye r Reject C ode: 07:M /I Cardhol der ID
	3203	Other Paye r Reject C ode: JE:M /I Percent age Sales Tax Basis Submitted
	3204
	3205	Do you wan t to edit this Secon dary Claim Informati on (Y/N)? N// y YES
	3206
	3207	Insura nce CO B Subscri ber ID Gro up Ho lder Eff ective Ex pires
	3208	====== ======= == == ======= ====== === ======= == ====== === ======= == ========
	3209	1 DAVE I NSURANC SE C SI32432 D-G ROUP1 PA TIENT 05/ 09/2007
	3210
	3211
	3212	SECONDARY INSURANCE POLICY: 1/ / DAVE I NSURANCE ( SECONDARY) - D-GROUP 1
	3213	SELECT RAT E TYPE: RE IMBURSABLE INS.// Who's Re sponsible: INSURER
	3214	OTHER COVE RAGE CODE: 03// O THER COVER AGE EXISTS - THIS CL AIM NOT CO VERED
	3215	OTHER PAYE R ID: 6104 59//
	3216	OTHER PAYE R DATE: A ug 16, 201 0//
	3217	Edit Paid Amounts or Reject Co des (PAID AMOUNTS/RE JECT CODES ): REJECT CODES//
	3218	OTHER PAYE R REJECT C ODE: 34// M/I Submissio n Clarific ation Code
	3219	OTHER PAYE R REJECT C ODE: 07// M/I Cardholde r ID
	3220	OTHER PAYE R REJECT C ODE: JE// M/I Percentag e Sales Ta x Basis Su bmitted
	3221	OTHER PAYE R REJECT C ODE:
	3222
	3223
	3224	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.
	3225	Example 5. 11-8: Answ ering “Is the Claim Correct?” Prompt
	3226
	3227
	3228	IS THIS CL AIM CORREC T?(Y/N)? Y // ES
	3229	SUBMIT CLA IM TO ECME INSURANCE 1 ?(Y/N)? Y// ES
	3230
	3231	Veteran Pr escription 103689 su ccessfully submitted to ECME f or claim g eneration.
	3232
	3233	Example 5. 11-9: Answ ering “Are you sure? ” Prompt
	3234
	3235
	3236
	3237	Are you su re?(Y/N)? YES
	3238
	3239	Veteran Pr escription 100003433 A successf ully submi tted to EC ME for cla im generat ion.
	3240
	3241	Claim Stat us:
	3242	IN PROGRES S-Waiting to start
	3243	IN PROGRES S-Waiting for packet build
	3244	IN PROGRES S-Packet b eing built
	3245	IN PROGRES S-Transmit ting
	3246	E PAYABLE
	3247
	3248
	3249
	3250	Veteran Pr escription 100003433 A successf ully submi tted to EC ME for cla im generat ion.
	3251	1 claim ha s been res ubmitted.
	3252
	3253
	3254	Enter RETU RN to cont inue or '^ ' to exit: <Enter>
	3255
	3256	Updating s creen for resubmitte d claim...
	3257
	3258	5.12 OPEC C Reject I nformation (hidden a ction) The OPECC Rej ect Inform ation hidd en action allows the user to v iew detail s associat ed with a rejected c laim. This action is only avai lable for claims wit h open rej ections an d non-bill able presc riptions w ith pseudo -rejection s of eC or eT.
	3259
	3260	Access the action by entering REJ at the “Select A ction:” pr ompt on th e ECME Use r Screen.
	3261	Example 5. 12-1: Acc essing and Executing the OPECC Reject In formation Action
	3262	PHARMACY E CME Aug 10, 20 05@10:31:2 2 Page: 1 8 of 42
	3263	SELECTED D IVISION(S) : ALL
	3264	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	3265	Sor ted by: Pa tient Name
	3266	+# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC /TYP RXINF
	3267	7 ECMEpa tient,One (XXXX) WE BMD TE/ VET A LL payable
	3268	7.1 PR EDNISONE 1 MG TA 0024 2074475 09 /16 100803 0/00 0000111872 W RS AC/N
	3269	09/1 0/15 – The comment g oes here.
	3270	(USE R, ONE)
	3271	p-Re jected
	3272	79:R efill Too Soon
	3273	+ Enter ?? f or more ac tions
	3274	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	3275	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	3276	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	3277	Select Act ion: Next Screen// R EJ REJ OPECC Reje ct Informa tion
	3278
	3279
	3280	You will s ee the fol lowing mes sage, if y ou attempt to select a claim w hen there is no reje ction.
	3281	Example 5. 12-2: Ent ering the Line Item for a Clai m with no rejection
	3282	This claim is not a valid sele ction for the OPECC Reject Inf ormation s creen.
	3283	This scree n is for e ither reje cted claim s or non-b illable cl aims.
	3284
	3285	Enter RETU RN to cont inue or '^ ' to exit:
	3286
	3287
	3288	You are p rompted fo r the line item of t he rejecte d claim or non-billa ble prescr iption ent ry.
	3289	Example 5. 12-3: Ent ering the Line Item for the OP ECC Reject Informati on Action
	3290	Select Act ion: Next Screen// R EJ REJ OPECC Reje ct Informa tion
	3291	Select ite m: 7.1
	3292
	3293
	3294	The OPECC Reject Inf ormation S creen disp lays.
	3295	Example 5. 12-4: OPE CC Reject Informatio n Screen D isplay
	3296
	3297	OPECC Reje ct Informa tion Oct 28, 20 15@14:45:4 2 Page: 1 of 3
	3298	Division : XXXXXX N PI: 111009 9999 NCP DP: 531000 0XX TAX I D: XX-XXXX XXX
	3299	Patient : PATIENT,O NE(XXXP) Sex: M DOB: JUL X X,19XX(XX)
	3300	Rx# : 100XXX/0 ECME #: 0000001 11872 Da te of Serv ice: Sep 1 6, 2015
	3301	Drug : PREDNISON E 1MG TAB NDC C ode: 00242 -0744-75
	3302
	3303	REJECT Inf ormation ( Veteran) RESUBMISSI ON
	3304	Current EC ME Status: E REJECTE D
	3305	Rejects re ceived fro m Payer on 09/16/201 5 5:26:39 pm.
	3306
	3307	Code De scription
	3308	79 - Re fill Too S oon
	3309
	3310	Next Avail Fill: 10/ 31/2015
	3311	Payer Mess age : EMD 1000: CLA IM PAID
	3312	Payer Addl Msg : EMD 1000: CLA IM PAID RX :00000010X XXFILL:201 5-09-16
	3313	BIN :610144 PC N:TEST
	3314	OPECC COMM ENTS
	3315	- 09/10/15 5:17 pm – First com ment for O PECC scree n (USER,ON E)
	3316
	3317
	3318	PHARMACIST COMMENTS
	3319	- 05/12/15 8:23 am – Second co mment for Pharmacist (USER,TWO )
	3320
	3321
	3322	INSURANCE Informatio n
	3323	Insurance : VET CNF
	3324	Contact : 333 -444-5555
	3325	BIN : 610 144
	3326	PCN : TES T
	3327	Group Numb er : 246
	3328	Cardholder ID : 123 4567890
	3329	Effective Date : 01/ 25/2015
	3330
	3331
	3332	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.
	3333	Example 5. 12-5: Act ions Avail able from the OPECC Reject Inf ormation S creen
	3334	+ Enter ?? f or more ac tions
	3335	VW View R x VER View E CME Rx MP Med Pr ofile PI Pat In fo
	3336	Select: Ne xt Screen/ /
	3337	5.13 Resu bmit Claim Without R eversal (h idden acti on)
	3338	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..
	3339
	3340
	3341	The action is access ed by ente ring RER a t the “Sel ect Action :” prompt on the ECM E User Scr een.
	3342	Example 5. 13-1: Acce ssing and Executing the Resubm it Claim W /O Reversa l Action
	3343	Select Act ion: Next Screen// R ER RER Resubmit C laim w/o R eversal
	3344
	3345
	3346	You are pr ompted for the line item(s) of the claim to be res ubmitted.
	3347
	3348	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” ).
	3349
	3350	Example 5. 13-2: Ente ring the L ine Item f or the Cla im Resubmi ssion Requ est
	3351	Note: This actio n will res ubmit clai ms without performin g a revers al.
	3352
	3353	This actio n should b e used in instances where the payer show s the
	3354	claim was reversed a nd VistA s hows a pay able claim . This act ion will
	3355	NOT submit a reversa l regardle ss of the current Vi stA claim status.
	3356
	3357	Enter the line numbe rs for the claim(s) to be resu bmitted w/ o reversal .
	3358	Select ite m(s):
	3359
	3360
	3361	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.
	3362
	3363	Example 5. 13-5: Ente ring “Y” t o Continue Claim Res ubmission Request
	3364
	3365	You've cho sen to RES UBMIT W/O REVERSAL t he followi ng Rx for PATIENT,TW O
	3366	1.4 PR EDNISONE 1 MG TA 0024 2074475 10 /28 100XXX 0/00 0000112XXX W RT AC/N
	3367	Are you su re?(Y/N)? YES
	3368
	3369	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.
	3370	Example 5. 13-6: Ent ering “Y” to Place M ultiple Su bmissions in the Que ue
	3371	The claim is in prog ress. The request wi ll be sche duled and processed after
	3372	the previo us request (s) are co mpleted. P lease be a ware that the result of
	3373	the resubm it depends on the pa yer's resp onse to th e prior in complete r equests.
	3374	Do you wan t to proce ed?(Y/N)? y YES
	3375
	3376
	3377	The claim resubmissi on request is submit ted and th e progress is displa yed.
	3378	Example 5. 13-7: Dis playing a Successful ly Resubmi tted Claim
	3379	Claim Stat us:
	3380	IN PROGRES S-Waiting to start
	3381	IN PROGRES S-Building the claim
	3382	IN PROGRES S-Transmit ting
	3383	E PAYABLE
	3384
	3385	Veteran Pr escription 100958 su ccessfully submitted to ECME f or claim g eneration.
	3386	1 claim ha s been res ubmitted.
	3387
	3388
	3389	Enter RETU RN to cont inue or '^ ' to exit: <ENTER>
	3390
	3391	Updating s creen for resubmitte d claims.. .
	3392
	3393
	3394	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 .
	3395
	3396	Example 5. 13-8: Disp laying the Claim Sta tus after a Resubmis sion
	3397	PHARMACY E CME Oct 28, 20 15@16:29:3 2 Page: 2 of 52
	3398	SELECTED D IVISION(S) : ALL
	3399	Transmitte d by ALL u sers Activity Date Rang e: within the past 9 99 day(s)
	3400	Sorted b y: Transac tion date by default
	3401	+# PATIEN T/DRUG/COM MENTS IN SURANCE/ND C/DOS/RX#/ ECME# STATUS/LOC /TYP/RXINF
	3402	1.4 PR EDNISONE 1 MG TA 0024 2074475 10 /28 100XXX 0/00 0000112XXX W RS AC/N
	3403	p-Pa yable
	3404
	3405	5.14 Open /Close Non Billable Entry (hid den action )
	3406	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.
	3407
	3408	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.
	3409
	3410	The action is access ed by ente ring OCN a t the “Sel ect Action :” prompt on the ECM E User Scr een.
	3411
	3412	Example 5. 14-1: Acce ssing and Executing the Open/C lose Non B illable En try Action
	3413	Select Act ion: Next Screen// O CN OCN Open/Close Non-Billa ble Entry
	3414
	3415	You are pr ompted for the line item(s) of the claim to be ope ned or clo sed.
	3416
	3417	Example 5. 14-2: Ente ring the L ine Item f or the Ope n/Close No n Billable Entry
	3418	Enter the line numbe r for the entry to b e opened o r closed.
	3419	Select ite m:
	3420
	3421
	3422	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 .
	3423
	3424	Example 5. 14-5: Answ er Prompts for Open/ Close Non Billable e ntry
	3425	You've cho sen to CLO SE the fol lowing ent ry for
	3426	PATIENT,ON E :
	3427	3.1 MI LK OF MAGN ESIA 0034 9821742 100SSS 0/ W RS EX/N
	3428	p-No n-Billable /Open
	3429	eT:T RICARE-RX NOT BILLAB LE (DRUG N OT BILLABL E)
	3430
	3431	The Select ed Entry w ill be CLO SED.
	3432
	3433	Comment : Enter a co mment now
	3434	Are you su re? (Y/N)? YES
	3435
	3436	Closing En try
	3437
	3438	Enter RETU RN to cont inue or '^ ' to exit:
	3439
	3440	5.15 Displ ay Update (hidden ac tion)
	3441	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.
	3442
	3443	This hidde n action i s accessed by enteri ng UD at t he “Select Action:” prompt on the ECME User Scree n.
	3444
	3445	Example 5. 15-1: Acc essing the Display U pdate Acti on
	3446	PHARMACY E CME Apr 26, 20 06@11:44:4 5 Page : 1 of 2
	3447	SELECTED D IVISION(S) : ALL
	3448	Transmitte d by ALL u sers Activity Date Rang e: within the past 1 0 day(s)
	3449	Sor ted by: Pa tient Name
	3450	# PATIEN T/DRUG/COM MENTS INSURANC E/NDC/RX#/ ECME# LOC/TYP RXINF
	3451	6 ECMEpa tient,Two (XXXX) WEBMD TE/ VET Pb:1 Rj:0 AcRv:0 Rj Rv:1
	3452	6.1 FU ROSEMIDE 1 0MG/M 006 41-2312-25 04/22 100 004065$ 0 /000000504 691 W RT A C/R
	3453	p-Pa yable
	3454	6.2 CH OLESTYRAMI NE 4G 000 87-0580-01 04/22 100 004066$ 0 /000000504 692 W RT A C/R
	3455	p-Re versal rej ected
	3456	NN:T ransaction Rejected At Switch Or Interme diary
	3457	NC16 -The clear inghouse d id not rep ly in time .
	3458	7 ECMEpa tient,One (XXXX) WEBMD TE/ VET ALL payab le
	3459	7.1 AL BUTEROL IN HALER 555 55-4444-22 04/26 100 003744$ 0 /000000504 304 W RT A C/R
	3460	p-Pa yable
	3461	7.2 AC ETYLCYSTEI NE 20 000 87-0570-09 04/21 100 004054$ 0 /000000504 677 W RT A C/N
	3462	s-Pa yable (p-P ayable)
	3463	8 ECMEpa tient,Thre e (XXXX) WEBMD TE/ VET ALL payab le
	3464	+ Enter ?? f or more ac tions
	3465	The screen has been updated on APR 26,20 06@14:50:4 7. Press " Q" to quit .
	3466	CV Change View REV Reverse Pa yable Clai m FR Furt her Resear ch
	3467	SO Sort L ist RES Resubmit C laim VER View ePharmacy Rx
	3468	CMT Add/Vi ew Comment s CLO Close Clai m WRK Send to Workli st
	3469	Select Act ion: Next Screen// U D Displa y Update
	3470	Updating s creen...
	3471
	3472
	3473
	3474
	3475
	3476	5.16 Exit (from ECME User Scre en)
	3477	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.
	3478
	3479	6.Accessin g the ECME Pharmacy COB Menu
	3480	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.
	3481
	3482	Example 6- 1: Accessi ng the ECM E Pharmacy COB Menu
	3483	*** ****** ****** ****** ****** **
	3484	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3485	* XXXXXX VAMC *
	3486	* Main M enu *
	3487	*** ****** ****** ****** ****** **
	3488
	3489
	3490	U ECME User Screen
	3491	COB ECME Pharm acy COB .. .
	3492	MGR Pharmacy E CME Manage r Menu ...
	3493	RPT Pharmacy E lectronic Claims Rep orts ...
	3494
	3495
	3496
	3497	Select ECM E Option: MGR Pharm acy ECME M anager Men u
	3498
	3499	Example 6- 2: Display ing the EC ME Pharmac y COB Menu
	3500	*** ****** ****** ****** ****** **
	3501	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3502	* XXXXXXX VAMC *
	3503	* Phar macy ECME Manager Me nu *
	3504	*** ****** ****** ****** ****** **
	3505
	3506	SEC Potential Secondary Rx Claims Report
	3507	TRI Potential Claims Rep ort for Du al Eligibl e
	3508	PRO Process Se condary/TR ICARE Rx t o ECME
	3509
	3510	Select ECM E Pharmacy COB Optio n:
	3511
	3512	6.1 Potent ial Second ary Rx Cla ims Report
	3513	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:
	3514	A prescrip tion where the secon dary claim is closed in ECME.
	3515	A prescrip tion where the secon dary claim is payabl e in ECME.
	3516	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 .
	3517
	3518	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.
	3519
	3520	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.
	3521	Example 6. 1-1: Acces sing the P otential S econdary R x Claims R eport
	3522	*** ****** ****** ****** ****** **
	3523	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3524	* XXXXXX VAMC *
	3525	* Pharmacy Electroni c Claims R eports *
	3526	*** ****** ****** ****** ****** **
	3527
	3528
	3529	SEC Potential Secondary Rx Claims Report
	3530	TRI Potential Claims Rep ort for Du al Eligibl e
	3531	PRO Process Se condary/TR ICARE Rx t o ECME
	3532
	3533	Select ECM E Pharmacy COB Optio n: SEC Po tential Se condary Rx Claims Re port
	3534
	3535	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.
	3536
	3537	Example 6. 1-2: Gener ating the Potential Secondary Rx Claims Report
	3538	SELECTION CRITERIA
	3539	Selec t one of t he followi ng:
	3540
	3541	D DIVISION
	3542	A ALL
	3543
	3544	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: ALL
	3545
	3546	EARLIEST D ATE: t (A PR 14, 200 9)
	3547	LATEST D ATE: T// < ENTER> (A PR 14, 200 9)
	3548	SORT CRITE RIA
	3549	Primary So rt: (N/P/ S/D): Divi sion// ??
	3550
	3551	Enter a co de from th e list to indicate t he Primary sort orde r.
	3552	Selec t one of t he followi ng:
	3553
	3554	N Patient Na me
	3555	P Payer
	3556	S Date Of Se rvice
	3557	D Division
	3558	Primary So rt: (N/P/ S/D): Divi sion// <EN TER>
	3559	Secondary Sort: (N/ P/S): <ENT ER>
	3560	DEVICE: HO ME// <ENTE R> UCX/TE LNET Ri ght Margin : 80// <EN TER>
	3561
	3562	Collecting Potential Secondary data.
	3563	Enter RETU RN to cont inue or '^ ' to exit: <ENTER>
	3564
	3565
	3566	========== ========== ========== ========== ========== ========== ========== =========
	3567	Potential Secondary Rx Claims Report 4/14/09 - 4/14/09 Page: 1
	3568	Selected D ivisions: ALL
	3569	Sorted By: Division;
	3570	Bill# RX# Fill Pati ent PatID COB Date Payers
	3571	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	3572	Division: XXXXXX
	3573	K9000LG 102179 4 ECME patient,On e 0000 p 4/14/ 09 ECME I NSURANCE1
	3574	t ECME I NSURANCE2
	3575	K0000QD 2055862 0 ECME patient,On e 0000 p 7/13/ 10 ECME I NSURANCE1
	3576	s ECME I NSURANCE2
	3577	- ECME I NSURANCE3
	3578	(P) Rej 2055865 0 ECME patient,On e 0000 p 7/13/ 10 ECME I NSURANCE1
	3579	s ECME I NSURANCE2
	3580	t ECME I NSURANCE3
	3581	(P) Rej 2055866 0 ECME patient,Tw o 4444 p 7/14/1 0 ECME IN SURANCE1
	3582	s ECME I NSURANCE2
	3583
	3584	Bill# "(P) Rej" indi cates a re jected/clo sed primar y ECME cla im
	3585	COB "-" in dicates a blank COB field in t he pt. ins . policy
	3586	6.2 Potent ial Claims Report fo r Dual Eli gible
	3587	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.
	3588
	3589	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.
	3590
	3591	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.
	3592	Example 6. 2-1: Acces sing the P otential C laims Repo rt for Dua l Eligible
	3593	*** ****** ****** ****** ****** **
	3594	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3595	* XXXXX V AMC *
	3596	* Pharmacy Electroni c Claims R eports *
	3597	*** ****** ****** ****** ****** **
	3598
	3599
	3600	SEC Potential Secondary Rx Claims Report
	3601	TRI Potential Claims Rep ort for Du al Eligibl e
	3602	PRO Process Se condary/TR ICARE Rx t o ECME
	3603
	3604	Select ECM E Pharmacy COB Optio n: TRI Po tential Cl aims Repor t for Dual Eligible
	3605
	3606	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.
	3607
	3608	Example 6. 2-2: Gener ating the Potential TRICARE Cl aims Repor t
	3609	Selec t one of t he followi ng:
	3610
	3611	D DIVISION
	3612	A ALL
	3613
	3614	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: ALL
	3615
	3616	Selec t one of t he followi ng:
	3617
	3618	T TRICARE
	3619	C CHAMPVA
	3620	A ALL
	3621
	3622	Display (T )RICARE or (C)HAMPVA or (A)LL Entries: A // LL
	3623
	3624	EARLIEST D ATE: t-10 (APR 06, 2009)
	3625	LATEST D ATE: T// (APR 16, 2009)
	3626	SORT CRITE RIA
	3627	Primary So rt: (N/P/ S/D/E): Di vision//
	3628	Secondary Sort: (N/ P/S/E):
	3629	Tertiary S ort: (N/P /S/E):
	3630
	3631	DEVICE: HO ME// ;;999 9 TELNET TERMINAL
	3632
	3633	Collecting TRICARE d ata.
	3634	Enter RETU RN to cont inue or '^ ' to exit:
	3635
	3636
	3637
	3638	========== ========== ========== ========== ========== ========== ========== ==========
	3639	Potential TRICARE Rx Claims Re port 8 /1/80 - 7/ 28/14 Page: 1
	3640	Selected D ivisions: ALL
	3641	Selected P atient Eli gibility: ALL
	3642	Sorted By: Division;
	3643	'*' indica tes the HP ID/OEID fa iled valid ation chec ks
	3644	RX# F ill Date Patient Pat ID COB Eli g Payers H PID/OEID
	3645	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	3646
	3647	Division: XXXXX VAMC
	3648	100407 2 9/9/10 OPTRICAR E,ONE 16 0P p TRI C TRICARE- 23 TEST 6 999999999*
	3649	100408 1 9/9/10 OPTRICAR E,ONE 16 0P p TRI C TRICARE- 23 TEST 6 999999999*
	3650
	3651	6.3 Proces s Secondar y/TRICARE Rx to ECME
	3652	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.
	3653
	3654	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.
	3655
	3656	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.
	3657
	3658	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.
	3659
	3660
	3661	You must h old the BP SUSER key to use the Process S econdary/T RICARE Rx to ECME op tion.
	3662
	3663	Access the Process S econdary/T RICARE Rx to ECME op tion by en tering PRO at the “E CME Pharma cy COB Opt ion:” prom pt on the ECME Pharm acy COB Me nu.
	3664	Example 6. 3-1: Acces sing the P rocess Sec ondary/TRI CARE Rx to ECME opti on
	3665	*** ****** ****** ****** ****** **
	3666	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3667	* XXXXXX V AMC *
	3668	* Pharmacy Electroni c Claims R eports *
	3669	*** ****** ****** ****** ****** **
	3670
	3671
	3672	SEC Potential Secondary Rx Claims Report
	3673	TRI Potential Claims Rep ort for Du al Eligibl e
	3674	PRO Process Se condary/TR ICARE Rx t o ECME
	3675
	3676	Select ECM E Pharmacy COB Optio n: PRO Pr ocess Seco ndary/TRIC ARE Rx to ECME
	3677
	3678
	3679	6.3.1Submi tting Seco ndary Clai ms
	3680
	3681	The Proces s Secondar y/TRICARE Rx to ECME (PRO) opt ion will p rompt for a Rx#.
	3682	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.
	3683	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.
	3684	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 ).
	3685	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
	3686
	3687	Example 6. 3.1-1: Ini tial Promp ts for the Process S econdary/T RICARE Rx to ECME op tion
	3688	Select PRE SCRIPTION RX #: 1003 0 LI DOCAINE 0. 5% W/EPI I NJ MDV
	3689
	3690	Patient RX# Dru g Name RX Stat us
	3691	ECMEPatie nt, Two 100 30 L IDOCAINE 0 .5% W/EPI INJ ACTIV E
	3692
	3693	DO YOU WAN T TO CONTI NUE?(Y/N)? Y// ES
	3694
	3695	RX #10030 has the fo llowing fi lls:
	3696
	3697	Fill Date
	3698	==== ==========
	3699	0 07/02/2010
	3700	1 10/12/2010
	3701
	3702
	3703	SELECT A F ILL TO BIL L: 07/02/2 010
	3704
	3705	Select pay er sequenc e for bill ing:
	3706
	3707	1 PRIM ARY
	3708	2 SECO NDARY
	3709
	3710
	3711	SELECT PAY ER SEQUENC E: 2 SECO NDARY
	3712	Drug name NDC Da te RX# RE F# TYPE STATUS
	3713	========== ========== ========== ========== ========== ========== ========== =========
	3714	LIDOCAINE 0. 001860 14001 09 /10 10030$ 0/00 03098 W RT **/R REJECTED
	3715
	3716	There is a n existing rejected/ reversed s econdary e -claim(s) for the RX /refill.
	3717	Do you wan t to submi t a new se condary cl aim(Y/N)? N// YES
	3718	DO YOU WIS H TO ADD/E DIT INSURA NCE COMPAN Y DATA FOR THIS PATI ENT?(Y/N)? N// O
	3719
	3720	Data for S econdary C laim
	3721	---------- ---------- ----
	3722	Insurance: INSURANC E3 COB: SECONDARY
	3723	Rate Type: REIMBURS ABLE INS.
	3724	Other Cove rage Code: 02 (OTHE R COVERAGE EXISTS - PAYMENT CO LLECTED)
	3725	Other Paye r Coverage Type: 01 (PRIMARY)
	3726	Other Paye r ID Quali fier: 03 (BANK INFO RMATION NU MBER (BIN) )
	3727	Other Paye r ID: 123 456
	3728	Other Paye r Date: O ct 15, 201 0
	3729	Other Paye r Paid Qua lifier: 0 7 (DRUG BE NEFIT)
	3730	Other Paye r Amount P aid: 40.0 0
	3731	Other Paye r Patient Responsibi lity Amoun t Qualifie r: 06 (AMT REPORTED BY PRIOR P AYER)
	3732	Other Paye r Patient Responsibi lity Amoun t: $12.38
	3733
	3734	Do you wan t to edit this Secon dary Claim Informati on (Y/N)? N// YES
	3735
	3736	Insura nce CO B Subscri ber ID Gro up Ho lder Eff ective Ex pires
	3737	====== ======= == == ======= ====== === ======= == ====== === ======= == ========
	3738	1 INSURA NC2 PR I AAA INS . PA TIENT 03/ 10/2010
	3739	2 INSURA N3 SE C 5487357 9430 GR PA TIENT 03/ 26/2010
	3740
	3741
	3742	SECONDARY INSURANCE POLICY: 2/ / INSURA NCE3 (SECO NDARY) - B RIAN'S GRP
	3743	SELECT RAT E TYPE: RE IMBURSABLE INS.// Who's Re sponsible: INSURER
	3744	OTHER COVE RAGE CODE: 02// O THER COVER AGE EXISTS - PAYMENT COLLECTED
	3745	OTHER PAYE R ID: 1234 56//
	3746	OTHER PAYE R DATE: O ct 15, 201 0//
	3747	Edit Paid Amounts or Reject Co des (PAID AMOUNTS/RE JECT CODES ): PAID A MOUNTS//
	3748	OTHER PAYE R AMOUNT P AID QUALIF IER: 07// DRUG BE NEFIT
	3749	OTHER PAYE R AMOUNT P AID: (0-9 99999): 40 .00//
	3750	OTHER PAYE R AMOUNT P AID QUALIF IER:
	3751
	3752	SUBMIT CLA IM TO INSU RANCE3 ?(Y /N)? Y// E S
	3753
	3754
	3755	Veteran Pr escription 10030 suc cessfully submitted to ECME fo r claim ge neration.
	3756
	3757	Processing Secondary claim...
	3758
	3759	Claim Stat us:
	3760	IN PROGRES S-Building the claim
	3761	IN PROGRES S-Building the HL7 p acket
	3762	IN PROGRES S-Transmit ting
	3763	E PAYABLE
	3764
	3765
	3766	6.3.2Submi tting Prim ary Claims for TRICA RE and Dua l Eligibil ity Patien ts
	3767
	3768	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.
	3769
	3770	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 .
	3771
	3772	Example 6. 3.2-1: Pro mpt for th e Process Secondary/ TRICARE Rx to ECME o ption
	3773	Select ECM E Pharmacy COB Optio n: PRO Pr ocess Seco ndary/ TRI CARE Rx to ECME
	3774	Select PRE SCRIPTION RX #: 1030 27 B ETHANECHOL 10MG TAB
	3775
	3776	Patient RX# Drug Nam e RX Status
	3777	ECMEpatie nt,One 103027 BETHANEC HOL 10MG T AB ACTIVE
	3778
	3779	DO YOU WAN T TO CONTI NUE?(Y/N)? Y// ES
	3780
	3781	RX #103027 has the f ollowing f ills:
	3782
	3783	Fill Date
	3784	==== ==========
	3785	0 10/27/2009
	3786
	3787
	3788	SELECT A F ILL TO BIL L: 0 10/2 7/2009
	3789
	3790	Select pay er sequenc e for bill ing:
	3791
	3792	1 PRIM ARY
	3793	2 SECO NDARY
	3794
	3795
	3796	SELECT PAY ER SEQUENC E: 1 PRIM ARY
	3797
	3798	SELECT RAT E TYPE: ?
	3799	Answer wi th RATE TY PE NUMBER, or NAME
	3800	Do you wa nt the ent ire 17-Ent ry RATE TY PE List? y (Yes)
	3801	Choose from:
	3802	1 CRIM E VICTIM Who's Resp onsible: I NSURER
	3803	2 DENT AL Who's Responsibl e: PATIENT
	3804	3 HUMA NITARIAN Who's Resp onsible: P ATIENT
	3805	4 INTE RAGENCY W ho's Respo nsible: OT HER (INSTI TUTION)
	3806	5 MEAN S TEST Wh o's Respon sible: PAT IENT
	3807	6 MEDI CARE ESRD Who's Res ponsible: OTHER (INS TITUTION)
	3808	7 NO F AULT INS. Who's Res ponsible: INSURER
	3809	8 REIM BURSABLE I NS. Who's Responsib le: INSURE R
	3810	9 SHAR ING AGREEM ENT Who's Responsib le: OTHER (INSTITUTI ON)
	3811	10 TORT FEASOR W ho's Respo nsible: IN SURER
	3812	11 WORK ERS' COMP. Who's Re sponsible: INSURER
	3813	12 CATE GORY C Wh o's Respon sible: PAT IENT
	3814	13 CHAM PVA REIMB. INS. Who 's Respons ible: INSU RER
	3815	14 CHAM PVA Who's Responsib le: INSURE R
	3816	15 TRIC ARE REIMB. INS. Who 's Respons ible: INSU RER
	3817	16 TRIC ARE Who's Responsib le: INSURE R
	3818	17 INEL IGIBLE Wh o's Respon sible: PAT IENT
	3819
	3820	SELECT RAT E TYPE: 15 TRICARE REIMB. INS . Who's R esponsible : INSURER
	3821	DO YOU WIS H TO ADD/E DIT INSURA NCE COMPAN Y DATA FOR THIS PATI ENT?(Y/N)? N// NO
	3822
	3823
	3824	Insuranc e COB Subscrib er ID Grou p Hol der Eff ective Ex pires
	3825	======== ====== === = ======== ===== ==== ====== === ====== === ======= == ========
	3826	EXPRESS SCRIP PRI XXXXXX DODA PAT IENT 12/ 27/2008
	3827
	3828
	3829	PRIMARY IN SURANCE PO LICY: SH T RICARE (PR IMARY) - T RICARE PLA N
	3830	SUBMIT CLA IM TO SH T RICARE ?(Y /N)? Y// y YES
	3831
	3832	TRICARE Pr escription 2055242 s ubmitted t o ECME for claim gen eration.
	3833
	3834
	3835
	3836	7Accessing the Pharm acy ECME M anager Men u
	3837
	3838	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.
	3839
	3840
	3841	You must h old the BP S MANAGER key to vie w the Phar macy ECME Manager Me nu option.
	3842
	3843	Example 7- 1: Accessi ng the Pha rmacy ECME Manager M enu Option
	3844	*** ****** ****** ****** ****** **
	3845	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3846	* XXXXXX VAMC *
	3847	* Main M enu *
	3848	*** ****** ****** ****** ****** **
	3849
	3850
	3851	U ECME User Screen
	3852	COB ECME Pharm acy COB .. .
	3853	MGR Pharmacy E CME Manage r Menu ...
	3854	RPT Pharmacy E lectronic Claims Rep orts ...
	3855
	3856
	3857
	3858	Select ECM E Option: MGR Pharm acy ECME M anager Men u
	3859
	3860	Example 7- 2: Display ing Pharma cy ECME Ma nager Menu Options
	3861	*** ****** ****** ****** ****** **
	3862	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3863	* XXXXXXX VAMC *
	3864	* Phar macy ECME Manager Me nu *
	3865	*** ****** ****** ****** ****** **
	3866
	3867
	3868	MNT ECME trans action mai ntenance o ptions ...
	3869	SET Pharmacy E CME Setup Menu ...
	3870	STAT Statistics Screen
	3871
	3872
	3873	Select Pha rmacy ECME Manager M enu Option :
	3874
	3875
	3876	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.
	3877	7.1 ECME T ransaction Maintenan ce Options
	3878
	3879	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.
	3880	Example 7. 1-1: Acces sing the E CME Transa ction Main tenance Op tions
	3881	*** ****** ****** ****** ****** **
	3882	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	3883	* XXXXX V AMC *
	3884	* Phar macy ECME Manager Me nu *
	3885	*** ****** ****** ****** ****** **
	3886
	3887
	3888
	3889	MNT ECME trans action mai ntenance o ptions ...
	3890	SET Pharmacy E CME Setup Menu ...
	3891	STAT Statistics Screen
	3892
	3893
	3894
	3895	Select Pha rmacy ECME Manager M enu Option : MNT ECM E transact ion mainte nance opti ons
	3896
	3897	**** ****** ****** ****** ****** ***
	3898	* Elec tronic Cla ims Manage ment Engin e (ECME) v 1.0 *
	3899	* XXXXX VAMC *
	3900	* B PS MENU MA INTENANCE *
	3901	**** ****** ****** ****** ****** ***
	3902
	3903
	3904
	3905	UNS View/Unstr and Submis sions Not Completed
	3906	ROC Re Open CL OSED/Resub mit Claim
	3907
	3908	Select ECM E transact ion mainte nance opti ons Option :
	3909
	3910	7.1.1 View /Unstrand Submission s Not Comp leted
	3911
	3912	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”.
	3913
	3914	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.
	3915
	3916
	3917
	3918	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.
	3919
	3920	(A) Enter UNS at th e “Select ECME trans action mai ntenance o ptions Opt ion:” to a ccess the unstrand o ptions.
	3921
	3922
	3923
	3924
	3925
	3926	Example 7. 1.1-1: Acc essing the View/Unst rand Submi ssions Not Completed Option
	3927	UNS View/Unstr and Submis sions Not Completed
	3928	ROC Re Open CL OSED/Resub mit Claim
	3929
	3930	Select ECM E transact ion mainte nance opti ons Option : UNS Vie w/Unstrand Submissio ns Not Com pleted
	3931
	3932	Please be aware that if there are submis sions appe aring on t he ECME Us er Screen
	3933	with a sta tus of 'In progress - Transmit ting', the n there ma y be a pro blem
	3934	with HL7 o r with sys tem connec tivity wit h the Aust in Automat ion Center (AAC).
	3935	Please con tact your IRM to ver ify that c onnectivit y to the A AC is work ing
	3936	and the HL 7 link BPS NCPDP is processing messages before usi ng this op tion
	3937	to unstran d submissi ons with a status of 'In progr ess - Tran smitting'.
	3938
	3939	Do you wan t to conti nue? NO//
	3940
	3941	(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.
	3942
	3943	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 .
	3944
	3945	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.
	3946
	3947	Example 7. 1.1-2: Ent ering Date Range for View/Unst rand Submi ssions Not Completed Option
	3948	FIRST TRAN SACTION DA TE: // T-1 20
	3949	LAST TRANS ACTION DAT E: T// T
	3950	Please wai t...
	3951
	3952	Example 7. 1.1-3: Di splaying t he View/Un strand Sub missions N ot Complet ed Actions
	3953	ECME UNSTR AND SUBMIS SIONS Oct 08, 20 10@15:12:0 8 Page: 1 of 1
	3954	Submission s Stranded from 09/2 8/2010 thr ough 10/08 /2010
	3955	Sorted by Transactio n Date
	3956
	3957	## Trans DT Patie nt Name ID RX/Fill D OS Ins Co
	3958	* CLA IMS *
	3959	1 10/07/ 2010 ECMEp atient,One 2637 101297/1 06/24/2009 AETNA
	3960	In Pro gress - Do ne
	3961	2 10/07/ 2010 ECMEp atient,One 2637 101320/1 04/27/2009 AETNA
	3962	In Pro gress - Do ne
	3963	3 10/07/ 2010 2637 1100349/0 10/07/201 0 AETNA
	3964	In Pro gress - Pr ocessing r equest
	3965	* REVER SALS *
	3966	4 10/07/ 2010 ECMEp atient,One 2637 101298/1 06/25/2009 AETNA
	3967	In Pro gress - Do ne
	3968	* E LIGIBILITY INQUIRIES *
	3969	5 10/08/ 2010 ECMEp atient,One 2637 10/ 08/2010 AE TNA
	3970	In Pro gress - Pa rsing resp onse
	3971
	3972
	3973
	3974	Enter ?? f or more ac tions >>>
	3975	ALL Unstra nd Current Submissio ns PRT Print Current Su bmissions
	3976	SEL Select Submissio ns to Unst rand EX Exit
	3977
	3978	7.1.2 Re O pen CLOSED /Resubmit Claim
	3979
	3980	The Reopen a Closed/ Resubmit C laim optio n allows y ou to reop en an elec tronic cla im after i t has been Closed or resubmit a claim.
	3981	7.1.2.1 RE OPEN a CLO SED ECME C laim
	3982	The Reopen a Closed ECME Claim action al lows you t o reopen a n electron ic claim a fter it ha s been Clo sed. The p rescriptio n can be R eleased or Not Relea sed. You a re prompte d to enter a patient name and date range OR enter one or man y prescrip tions to s elect clai ms by date of servic e. Once a claim is R eopened, y ou may res ubmit the claim to t he payer f or payment .
	3983
	3984	Enter ROC at the “Se lect actio n:” to acc ess the Re Open CLOS ED/Resubmi t Claim op tion.
	3985
	3986	Example 7. 1.2.1-1: A ccessing t he Re Open CLOSED/Re submit Cla im Option
	3987	UNS View/Unstr and Submis sions Not Completed
	3988	ROC Re Open CL OSED/Resub mit Claim
	3989
	3990
	3991	Select ECM E transact ion mainte nance opti ons Option : ROC Re Open CLOSE D/Resubmit Claim
	3992
	3993
	3994	You will b e prompted for a pat ient name or prescri ption numb er.
	3995
	3996	Example 7. 1.2.1-2: E ntering Pa tient Name or Prescr iption Num ber to Dis play Claim s
	3997	Select by (P)atient Name or Pr escription (N)umber: P
	3998
	3999	Select Pat ient: ECME patient,On e 6-1-60 666006666
	4000	NSC VET ERAN
	4001
	4002	Select by (P)atient Name or Pr escription (N)umber: N
	4003
	4004	Select Pre scription: 2000000 ECMEp atient,One AMOXICIL LIN 250/CL AV
	4005	Select Pre scription:
	4006
	4007	You will b e prompted for a dat e range fo r the date s of servi ce of clos ed claims.
	4008
	4009	Example 7. 1.2.1-3: E ntering Da tes of Ser vice for C laims List ing
	4010	START W ITH DATE:T ODAY//6/13 /06 (Jun 1 3, 2006)
	4011	GO TO DATE :TODAY//T (JUL 05, 2006)
	4012
	4013
	4014	Enter ROC to reopen and choose the line item of th e closed c laim that will be re opened.
	4015	Example 7. 1.2.1-4: C hoosing to Reopen a Closed Cla im and Sel ecting a L ine Item
	4016	REOPEN/RES UBMIT CLAI MS J ul 05, 200 6@15:29:21 Page: 1 of 1
	4017
	4018	# PATIENT /DRUG/COMM ENTS INS URANCE/NDC /DOS/RX#/E CME# S TATUS/LOC/ TYP/RXINF
	4019	1 ECMEpat ient,One ( 135P) MED CO/800-999 -9999 VE T Pb:0 Rj: 0 AcRv:1 R jRv:0
	4020	1.1 RESE RPINE 0.25 MG 4300000 0000 10/26 100000000 $ 0/000 003888888 W RT AC/N
	4021	p-Re versal acc epted/Clos ed
	4022
	4023
	4024	Enter ?? f or more ac tions
	4025	ROC Reopen Closed Cl aims RES Resubmit C laim EX Exit
	4026	Select act ion:Quit// ROC Reo pen Closed Claims
	4027	Select ite m: 1.1
	4028
	4029
	4030	You are pr ompted to enter a te xt comment , Reopen C omments, a fter claim informati on is disp layed.
	4031
	4032	Example 7. 1.2.1-5: E ntering Te xt Comment for Reope ned Closed Claim
	4033	PATIENT NAME: ECM Epatient,O ne RX#: 100000000 $ 0 DRU G: RESERPI NE 0.25MG
	4034	CLOSED JUL 5,200 6@15:13:42
	4035	ECME#: 000005047 27, DOS: J UL 5,2006, RELEASE D ATE: JUL 5 ,2006@15:1 2:11
	4036	PLAN: HIPPA05 IN SURANCE: M EDCO
	4037	CLOSE REASON: RE FILL TOO S OON
	4038	DROP T O PAPER: N O
	4039	CLOSE USER: ECME user,One
	4040
	4041	You have s elected th e CLOSED e lectronic claim list ed above.
	4042
	4043	REOPEN COM MENTS: Cla im reopene d for new refill
	4044
	4045	Example 7. 1.2.1-6: E ntering Ye s to “Are You Sure” Prompt
	4046	ARE YOU SU RE YOU WAN T TO RE-OP EN THIS CL AIM? (Y/N) ? No// YES
	4047	ReOpening Claim: VA2 006=171288 4=000014=0 006687 ... OK
	4048
	4049	1 claim ha s been reo pened.
	4050	Enter RETU RN to cont inue or '^ ' to exit:
	4051
	4052	7.1.2.2 Re submit ECM E Claim
	4053
	4054	The Resubm it ECME Cl aim action allows yo u to resub mit an ele ctronic cl aim. The p rescriptio n can be R eleased or Not Relea sed and th e claim mu st be open . You are prompted t o enter a patient na me and dat e range OR enter one or many p rescriptio ns to sele ct claims by date of service.
	4055
	4056	Enter ROC at the “Se lect ECME transactio n maintena nce option s <TEST AC COUNT> Opt ion:” to a ccess the Re Open CL OSED/Resub mit Claim option.
	4057
	4058	Example 7. 1.2.2-1: A ccessing t he Re Open CLOSED/Re submit Cla im Option
	4059	UNS View/Unstr and Submis sions Not Completed
	4060	ROC Re Open CL OSED/Resub mit Claim
	4061
	4062
	4063	Select ECM E transact ion mainte nance opti ons Option : ROC Re Open CLOSE D/Resubmit Claim
	4064
	4065
	4066	You will b e prompted for a pat ient name or prescri ption numb er.
	4067
	4068	Example 7. 1.3-2: Ent ering Pati ent Name o r Prescrip tion Numbe r to Displ ay Claims
	4069	Select by (P)atient Name or Pr escription (N)umber: P
	4070
	4071	Select Pat ient: ECME patient,On e 6-1-60 666006666
	4072	NSC VET ERAN
	4073
	4074	Select by (P)atient Name or Pr escription (N)umber: N
	4075
	4076	Select Pre scription: 2000000 ECMEp atient,One AMOXICIL LIN 250/CL AV
	4077	Select Pre scription:
	4078
	4079	You will b e prompted for a dat e range fo r the date s of servi ce of clos ed claims.
	4080
	4081	Example 7. 1.2.2-3: E ntering Da tes of Ser vice for C laims List ing
	4082	START W ITH DATE:T ODAY//6/13 /06 (Jun 1 3, 2006)
	4083	GO TO DATE :TODAY//T (JUL 05, 2006)
	4084
	4085
	4086	Enter RES to resubmi t and choo se the lin e item of the claim to resubmi t.
	4087	Example 7. 1.2.2-4: C hoosing to Resubmit a Claim an d Selectin g a Line I tem
	4088	REOPEN/RES UBMIT CLAI MS J ul 05, 200 6@15:29:21 Page: 1 of 1
	4089
	4090	# PATIENT /DRUG/COMM ENTS INS URANCE/NDC /DOS/RX#/E CME# S TATUS/LOC/ TYP/RXINF
	4091	1 ECMEpat ient,One ( 135P) MED CO/800-999 -9999 VE T Pb:0 Rj: 0 AcRv:1 R jRv:0
	4092	1.1 RESE RPINE 0.25 MG 4300000 0000 10/26 100000000 $ 0/000 003888888 W RT AC/N
	4093	p-Re versal acc epted/Clos ed
	4094
	4095
	4096	Enter ?? f or more ac tions
	4097	ROC Reopen Closed Cl aims RES Resubmit C laim EX Exit
	4098	Select act ion:Quit// RES Res ubmit Clai m
	4099	Select ite m: 1.1
	4100
	4101
	4102	You are pr ompted “Ar e you sure ” after cl aim inform ation is d isplayed.
	4103	Example 7. 1.2.2-5: E ntering Ye s to “Are You Sure” Prompt
	4104	You've cho sen to RES UBMIT the following prescripti on for ECM Epatient,O ne
	4105	1.1 RESE RPINE 0.25 MG O 4300 0000000 10 /26 100000 000$ 0/ 0000038888 88 W RT AC /N
	4106	Are you su re?(Y/N)? YES
	4107
	4108	7.2 Pharma cy ECME Se tup Menu
	4109
	4110	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.
	4111
	4112
	4113	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.
	4114	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 .
	4115	Example 7. 2-1: Acces sing the P harmacy EC ME Manager Menu Opti on
	4116	*** ****** ****** ****** ****** **
	4117	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4118	* XXXX V AMC *
	4119	* Phar macy ECME Manager Me nu *
	4120	*** ****** ****** ****** ****** **
	4121	MNT ECME trans action mai ntenance o ptions ...
	4122	SET Pharmacy E CME Setup Menu ...
	4123	STAT Statistics Screen
	4124
	4125	Select Pha rmacy ECME Manager M enu Option : SET Pha rmacy ECME Setup Men u
	4126
	4127
	4128	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.
	4129
	4130
	4131	Example 7. 2-2: Pharm acy ECME S etup Menu Options
	4132	*** ****** ****** ****** ****** **
	4133	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4134	* XXXXXXX VAMC *
	4135	* Pha rmacy ECME Setup Men u *
	4136	*** ****** ****** ****** ****** **
	4137
	4138	BAS Edit Basic ECME Para meters
	4139	PHAR Edit ECME Pharmacy D ata
	4140	REG Register P harmacy wi th Austin Informati on Technol ogy Center
	4141
	4142	Select Pha rmacy ECME Setup Men u Option:
	4143
	4144
	4145	7.2.1 Edit Basic ECM E Paramete rs
	4146
	4147	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.
	4148
	4149
	4150	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.
	4151
	4152	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.
	4153
	4154	Example 7. 2.1-1: Acc essing the Edit Basi c ECME Par ameters Op tion
	4155	*** ****** ****** ****** ****** **
	4156	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4157	* XXXXXX VAMC *
	4158	* Pha rmacy ECME Setup Men u *
	4159	*** ****** ****** ****** ****** **
	4160
	4161	BAS Edit Basic ECME Para meters
	4162	PHAR Edit ECME Pharmacy D ata
	4163	REG Register P harmacy wi th Austin Informatio n Technolo gy Center
	4164
	4165	Select Pha rmacy ECME Setup Men u Option: BAS Edit Basic ECME Parameter s
	4166
	4167	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.
	4168
	4169	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.
	4170
	4171
	4172	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.
	4173
	4174	This optio n also all ows you to set the “ Insurer As leep” inte rval time and number of retrie s. The Ins urer Aslee p Interval parameter allows an input bet ween 0 and 29 minute s with a d efault of 20. The In surer Asle ep Retries parameter allows an input bet ween 0 and 99 retrie s with a d efault of 10. If eit her the In surer Asle ep Interva l or the I nsurer Asl eep Retrie s paramete r is set t o 0, the f unctionali ty will be disabled. If the us er does di sable this functiona lity, any claims tha t are in a n Insurer Asleep sta te will au tomaticall y be resub mitted to the payer.
	4175
	4176	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.
	4177
	4178	Reject Cod e
	4179	Explanatio n
	4180	90
	4181	Host Hung Up
	4182	91
	4183	Host Respo nse Error
	4184	92
	4185	System Una vailable/H ost Unavai lable
	4186	95
	4187	Time Out
	4188	96
	4189	Scheduled Downtime
	4190	97
	4191	Payer Unav ailable
	4192	98
	4193	Connection To Payer Is Down
	4194
	4195
	4196	Example 7. 2.1-2: Ent ering Edit Basic ECM E Paramete rs
	4197
	4198	Select Pha rmacy ECME Setup Men u Option: BAS Edit Basic ECME Parameter s
	4199
	4200	Edit Pharm acy ECME c onfigurati on
	4201
	4202	ECME timeo ut? (0 to 30 seconds ): 30//
	4203	Insurer As leep Inter val (0 to 29 minutes ): 5//
	4204	Insurer As leep Retri es (0 to 9 9): 3//
	4205	Default El igibility Pharmacy: PHARMACY-1 //
	4206
	4207
	4208	7.2.2 Edit ECME Phar macy Data
	4209
	4210	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.
	4211
	4212
	4213	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.
	4214
	4215
	4216	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.
	4217	Example 7. 2.2-1: Acc essing the Edit ECME Pharmacy Data Optio n
	4218
	4219	*** ****** ****** ****** ****** **
	4220	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4221	* XXXXXX VAMC *
	4222	* Pha rmacy ECME Setup Men u *
	4223	*** ****** ****** ****** ****** **
	4224
	4225	BAS Edit Basic ECME Para meters
	4226	PHAR Edit ECME Pharmacy D ata
	4227	REG Register P harmacy wi th Austin Informatio n Technolo gy Center
	4228
	4229	Select Pha rmacy ECME Manager M enu Option : PHAR Ed it Pharmac y ECME Pha rmacy Data
	4230
	4231	Example 7. 2.2-2: Ent ering Edit ECME Phar macy Data Options
	4232	Select BPS PHARMACIE S NAME: XX XXXX VAMC PHARMACY
	4233
	4234	NAME: XXXX XX VAMC PH ARMACY
	4235	STATUS: AC TIVE
	4236	NCPDP #: 1 111111
	4237	NPI: 12345 67893
	4238	Select OUT PATIENT SI TE: XXXXXX VAMC PHAR MACY // <E NTER>
	4239	OUTPATIE NT SITE: X XXXXX VAMC PHARMACY // <ENTER>
	4240	Select OUT PATIENT SI TE: <ENTE R>
	4241	CMOP SWITC H: CMOP ON // <ENTER>
	4242	AUTO-REVER SE PARAMET ER: 5// 5
	4243	DEFAULT DE A #: AG123 45
	4244
	4245
	4246	The follow ing table describes the Edit E CME Pharma cy Data op tion field s:
	4247	Table 7.2. 2-1: Descr iption of Edit ECME Pharmacy D ata Option Fields
	4248	Entry
	4249	Descriptio n
	4250	BPS PHARM ACIES NAME
	4251	Pharmacy i n a specif ic VAMC (D epartment of Veteran s Affairs Medical Ce nter) data base. The pharmacy u ser may en ter a new BPS pharma cy, which must be 3- 30 alphabe tical char acters.
	4252	NAME
	4253	Display-on ly field t hat displa ys the ful l pharmacy name ente red.
	4254	NCPDP #
	4255	A 7-digit number ass igned to t he specifi ed pharmac y by the N ational Co uncil for Prescripti on Drug Pr ograms (NC PDP). It i s also kno wn as NABP .
	4256	NPI
	4257	National P rovider Id entifier. A 10-digit number re quired by the Health Insurance Portabili ty and Acc ountabilit y Act of 1 996 (HIPAA ) to ident ify indivi dual and o rganizatio nal provid ers, such as outpati ent sites. The NPI h as a usage requireme nt date be ginning Ma y 23, 2008 .
	4258	STATUS
	4259	The status of the BP S Pharmacy is either ACTIVE or INACTIVE. The STATU S of the p harmacy ma y be revis ed through the Regis ter Pharma cy with Au stin Infor mation Tec hnology Ce nter optio n.
	4260	OUTPATIENT SITES
	4261	One or mor e Outpatie nt Sites ( from File 59) may be linked wi th a singl e BPS Phar macy entry . However, an Outpat ient Site can only b e linked w ith a sing le BPS Pha rmacy. All of the si tes linked with a BP S Pharmacy should ha ve the sam e NCPDP nu mber. When an Outpat ient Site is linked to an acti ve BPS Pha rmacy entr y, the ECM E switch f or that si te is cons idered ENA BLED. If a n Outpatie nt Site is linked to an incorr ect BPS Ph armacy, it must be r emoved fro m the inco rrect entr y before i t can be l inked to t he correct entry.
	4262	CMOP
	4263	ON if the transmissi on of pres criptions to the CMO P (Consoli dated Mail Outpatien t Pharmacy ) dispensi ng site wi ll automat ically sub mit electr onic third party pre scription claims to the insura nce payers . See note below for explanati on of clai ms generat ed before and after switch is turned on or off.
	4264	AUTO-REVER SE PARAMET ER
	4265	Enter numb ers from 3 to 10 for the numbe r of days to wait be fore ECME reverses n on-release d prescrip tion claim s with a P AYABLE pay er-returne d response . Each sit e’s busine ss practic e will dic tate what this value should be .
	4266	DEFAULT DE A #
	4267	The pharma cy’s Drug Enforcemen t Administ ration (DE A) number.
	4268
	4269
	4270
	4271
	4272	An Outpati ent Site i s consider ed ECME ac tive if th e Outpatie nt Site is linked to a BPS Pha rmacy, and if that B PS Pharmac y is ACTIV E. Once an Outpatien t Site is ECME activ e, claims for the Ou tpatient S ite can be transmitt ed to the third-part y payer.
	4273	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.
	4274	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.
	4275
	4276
	4277
	4278	7.2.3 Regi ster Pharm acy with A ustin Info rmation Te chnology C enter
	4279
	4280	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.
	4281
	4282	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.
	4283
	4284	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
	4285	From: ECME PACKAGE In 'IN' ba sket. Pa ge 1 New
	4286	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	4287	Source Pro cess: ECME Pharmacy Registrati on
	4288	ECME Pharm acy Regist ration HL7 Message n ot created .
	4289	PHARMAC Y NAME: TE ST PHARMAC Y 2
	4290	** NPI NUM BER - Miss ing/Invali d
	4291	Enter mess age action (in IN ba sket): Del ete//
	4292
	4293
	4294	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.
	4295
	4296
	4297	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.
	4298
	4299
	4300	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.
	4301
	4302	Example 7. 2.3-2: Acc essing the Register Pharmacy w ith Austin Informati on Technol ogy Center Option
	4303	*** ****** ****** ****** ****** **
	4304	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4305	* XXXXX V AMC *
	4306	* Pha rmacy ECME Setup Men u *
	4307	*** ****** ****** ****** ****** **
	4308
	4309
	4310
	4311	BAS Edit Basic ECME Para meters
	4312	PHAR Edit ECME Pharmacy D ata
	4313	REG Register P harmacy wi th Austin Informatio n Technolo gy Center
	4314
	4315
	4316	Select Pha rmacy ECME Setup Men u Option: REG Regis ter Pharma cy with Au stin Infor mation Tec hnology Ce nter
	4317
	4318	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
	4319
	4320
	4321	E CME Site R egistratio n
	4322
	4323
	4324	-- PRIMAR Y SITE CON TACT DATA --
	4325
	4326	SITE CONTA CT: ECMEUS ER,ONE// < ENTER>
	4327	OFFICE P HONE: XXX- XXX-XXXX// <ENTER>
	4328	EMAIL AD DRESS: ECM EUSER.ONE@ FORUM.VA.G OV// <ENTE R>
	4329
	4330
	4331	-- ALTERN ATE SITE C ONTACT DAT A --
	4332
	4333	ALTERNATE SITE CONTA CT: ECMEUS ER,TWO// < ENTER>
	4334	OFFICE P HONE: XXX- XXX-XXXX// <ENTER>
	4335	EMAIL AD DRESS: two .ecmeuser@ va.gov//
	4336	Replace < ENTER>
	4337
	4338
	4339
	4340	-- Applica tion Regis tration Va lidation R esults:
	4341	DOMAIN NAME - Req uired - VA LID: XXXXX XXX.XXXXXX -XXX-XXXX. XXX.XX.XXX
	4342	TCP/IP ADDRESS FO R "EPHARM OUT" - Req uired - VA LID: XX.XX X.XXX.XXX
	4343	"EPHARM OUT" PORT NUMBER - Required - VALID: XX XX
	4344	SITE NU MBER - Req uired - VA LID: XXX
	4345	INTERFA CE VERSION - Require d - VALID: 3
	4346	CONTACT NAME - VA LID: ECMEU SER,ONE
	4347	CONTACT MEANS - V ALID: NET INTERNET ECMEUSER.O NE@FORUM.V A.GOV
	4348	ALTERNA TE CONTACT NAME - VA LID: ECMEU SER,TWO
	4349	ALTERNA TE CONTACT MEANS - V ALID: NET INTERNET two.ecmeus er@va.gov
	4350
	4351	* * Applicat ion Regist ration Dat a VALID **
	4352
	4353	Enter RETU RN to cont inue or '^ ' to exit: <ENTER>
	4354
	4355
	4356	Enter/veri fy Pharmac y Registra tion Data
	4357
	4358	Select BPS PHARMACIE S NAME: TE ST PHARMAC Y 3
	4359
	4360	--SITE DA TA
	4361
	4362	STATUS: IN ACTIVE// < ENTER>
	4363	NCPDP #: X XXXXXX// < ENTER>
	4364	DEFAULT DE A #: XXXXX XXX// <ENT ER>
	4365	SITE ADDRE SS NAME: 1 11 MAIN ST R// <ENTER >
	4366	SITE ADDRE SS 1: 111 MAIN STREE T// <ENTER >
	4367	SITE ADDRE SS 2: <ENT ER>
	4368	SITE CITY: BROOKLYN/ / <ENTER>
	4369	SITE STATE : NEW YORK // <ENTER>
	4370	SITE ZIP C ODE: 11223 // <ENTER>
	4371	REMITTANCE ADDRESS N AME: 1111 TEST STR// <ENTER>
	4372	REMIT ADDR ESS 1: 111 TEST STRE ET// <ENTE R>
	4373	REMIT ADDR ESS 2: <EN TER>
	4374	REMIT CITY : TOPEKA// <ENTER>
	4375	REMIT STAT E: KANSAS/ / <ENTER>
	4376	REMIT ZIP: 66606// < ENTER>
	4377
	4378	--PRIMARY CONTACT D ATA
	4379
	4380	VA CONTACT : ECMEUSER ,ONE// <EN TER>
	4381	OFFICE P HONE: XXX- XXX-XXXX// <ENTER>
	4382	EMAIL AD DRESS: ECM EUSER.ONE@ FORUM.VA.G OV
	4383	Replace < ENTER>
	4384	TITLE: O I&T STAFF/ / <ENTER>
	4385
	4386	--ALTERNA TE CONTACT DATA
	4387
	4388	VA ALTERNA TE CONTACT : ECMEUSER ,THREE L// <ENTER>
	4389	OFFICE P HONE: XXX- XXX-XXXX// <ENTER>
	4390	EMAIL AD DRESS: thr ee.ecmeuse r@med.va.g ov Replac e <ENTER>
	4391	TITLE: O I&T STAFF/ / <ENTER>
	4392
	4393	--PHARMAC IST DATA
	4394
	4395	VA LEAD PH ARMACIST: ECMEUSER,F OUR// <ENT ER>
	4396	OFFICE P HONE: XXX- XXX-XXXX / / <ENTER>
	4397	EMAIL AD DRESS: <EN TER>
	4398	TITLE: O I&T STAFF/ / <ENTER>
	4399	VA LEAD PH ARMACIST L ICENSE #: XXXXXXX// <ENTER>
	4400
	4401
	4402	-- Pharmac y Registra tion Valid ation Resu lts --
	4403
	4404	PHARMAC Y NAME: TE ST PHARMAC Y 3
	4405
	4406	-- Pharmac y Registra tion Data VALID. --
	4407
	4408
	4409
	4410	Enter/veri fy Pharmac y Registra tion Data
	4411	Select BPS PHARMACIE S NAME: <E NTER>
	4412
	4413
	4414	Applicatio n Registra tion Data is VALID
	4415
	4416	Pharmacy R egistratio n Data is:
	4417	VALID for TEST P HARMACY 1 and will b e transmit ted.
	4418	*INVALID for TEST P HARMACY 2 and will N OT be tran smitted.
	4419	VALID for TEST P HARMACY 3 and will b e transmit ted.
	4420
	4421	Send Appli cation Reg istration: Y/N ? n NO
	4422
	4423	Press RETU RN to cont inue...
	4424
	4425	7.3 Statis tics Scree n
	4426	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.
	4427
	4428
	4429	You must h old the BP SMENU and BPS MANAGE R keys to view the S tatistics Screen opt ion.
	4430
	4431	Access the menu by e ntering ST AT at the “Select Ph armacy ECM E Manager Menu Optio n:” prompt in the Ph armacy ECM E Manager Menu optio n.
	4432
	4433
	4434	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.
	4435	Example 7. 3-1: Acces sing the S tatistics Screen Opt ion
	4436	*** ****** ****** ****** ****** **
	4437	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4438	* XXXXXX VAMC *
	4439	* Phar macy ECME Manager Me nu *
	4440	*** ****** ****** ****** ****** **
	4441
	4442
	4443
	4444	MNT ECME trans action mai ntenance o ptions ...
	4445	SET Pharmacy E CME Setup Menu ...
	4446	STAT Statistics Screen
	4447
	4448
	4449
	4450	Select Pha rmacy ECME Manager M enu Option : STAT Sta tistics Sc reen
	4451
	4452	Example 7. 3-2: Stati stics Scre en
	4453	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	4454	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	4455
	4456	* CLAIM STATUS * * CLAIM RES ULTS *
	4457	Waiting to start 0 P aid claims 2,93 4
	4458	Building the trans action 0 R ejected cl aims 2,17 1
	4459	Building the claim 0 D ropped to Paper 1 5
	4460	Building the HL7 p acket 1 D uplicate c laims 0
	4461	Preparin g for tran smit 0 C aptured cl aims 0
	4462	Transmit ting 0 A ccepted Re versals 2,06 7
	4463	Parsing response 0 R ejected Re versals 16 6
	4464	Processi ng respons e 0 A ccepted El igibility 7
	4465	R ejected El igibility 4 4
	4466	E rrors 1 4
	4467
	4468
	4469
	4470
	4471	Enter ?? f or more ac tions
	4472	UC Updat e continuo usly Z Zero (cle ar) stats
	4473	U1 Displ ay update EX Exit
	4474	Select Act ion:U1//
	4475
	4476	This secti on diagram s and desc ribes the different elements o f the Stat istics Scr een.
	4477
	4478	ECME STATI STICS Nov 03, 2 010@16:50: 30 Page: 1 of 1
	4479	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	4480
	4481
	4482	* CLAIM STATUS * * CLAIM RES ULTS *
	4483	Waiting to start 0 P aid claims 2,93 4
	4484	Building the trans action 0 R ejected cl aims 2,17 1
	4485	Building the claim 0 D ropped to Paper 1 5
	4486	Building the HL7 p acket 1 D uplicate c laims 0
	4487	Preparin g for tran smit 0 C aptured cl aims 0
	4488	Transmit ting 0 A ccepted Re versals 2,06 7
	4489	Parsing response 0 R ejected Re versals 16 6
	4490	Processi ng respons e 0 A ccepted El igibility 7
	4491	R ejected El igibility 4 4
	4492	E rrors 1 4
	4493
	4494
	4495
	4496	Enter ?? f or more ac tions
	4497	UC Updat e continuo usly Z Zero (cle ar) stats
	4498	U1 Displ ay update EX Exit
	4499	Select Act ion:U1//
	4500	ECME STATI STICS Nov 03, 2 010@16:50: 30 Page: 1 of 1
	4501	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	4502
	4503
	4504	* CLAIM STATUS * * CLAIM RES ULTS *
	4505	Waiting to start 0 P aid claims 2,93 4
	4506	Building the trans action 0 R ejected cl aims 2,17 1
	4507	Building the claim 0 D ropped to Paper 1 5
	4508	Building the HL7 p acket 1 D uplicate c laims 0
	4509	Preparin g for tran smit 0 C aptured cl aims 0
	4510	Transmit ting 0 A ccepted Re versals 2,06 7
	4511	Parsing response 0 R ejected Re versals 16 6
	4512	Processi ng respons e 0 A ccepted El igibility 7
	4513	R ejected El igibility 4 4
	4514	E rrors 1 4
	4515
	4516
	4517
	4518	Enter ?? f or more ac tions
	4519	UC Updat e continuo usly Z Zero (cle ar) stats
	4520	U1 Displ ay update EX Exit
	4521	Select Act ion:U1//Di agram 7.3- 1: Statist ics Option Areas
	4522
	4523	Header
	4524	Area
	4525	Header
	4526	Area
	4527
	4528
	4529
	4530
	4531
	4532	Stats
	4533	Area
	4534	Stats
	4535	Area
	4536
	4537
	4538
	4539
	4540
	4541	Message Wi ndow
	4542
	4543	Message Wi ndow
	4544
	4545
	4546	Action
	4547	Area
	4548	Action
	4549	Area
	4550
	4551
	4552	The table below desc ribes the Statistics Screen op tion areas :
	4553	Table 7.3- 1: Descrip tion of St atistics S creen Opti on
	4554	Screen Are as
	4555	Descriptio n
	4556	Header Are a
	4557	Displays t he date fo r which yo u requeste d the Stat istics Scr een option .
	4558	Stats Area
	4559	Displays s tatistics for all EC ME claims. Claim Sta tus report s statisti cs of ECME transacti ons in pro gress. Cla im Results gives sta tistics ab out comple ted ECME t ransaction s.
	4560	Message Wi ndow
	4561	This secti on display s informat ional text (i.e., En ter ?? for more acti ons).
	4562	Action Are a
	4563	Available options. A double qu estion mar k (??) may be entere d at the " Select Act ion:" prom pt for a l ist of all List Mana ger option s availabl e.
	4564
	4565	7.3.1 Upda te Continu ously
	4566	The system can updat e the clai ms statist ics every 3 seconds.
	4567
	4568	Enter UC to display statistic s that wil l be updat ed every 3 seconds.
	4569	Example 7. 3.1-1: Acc essing Upd ate Contin uously Opt ion
	4570	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	4571	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	4572
	4573
	4574	* CLAIM STATUS * * CLAIM RES ULTS *
	4575	Waiting to start 0 P aid claims 2,93 4
	4576	Building the trans action 0 R ejected cl aims 2,17 1
	4577	Building the claim 0 D ropped to Paper 1 5
	4578	Building the HL7 p acket 1 D uplicate c laims 0
	4579	Preparin g for tran smit 0 C aptured cl aims 0
	4580	Transmit ting 0 A ccepted Re versals 2,06 7
	4581	Parsing response 0 R ejected Re versals 16 6
	4582	Processi ng respons e 0 A ccepted El igibility 7
	4583	R ejected El igibility 4 4
	4584	E rrors 1 4
	4585
	4586
	4587
	4588	Enter ?? f or more ac tions
	4589	UC Updat e continuo usly Z Zero (cle ar) stats
	4590	U1 Displ ay update EX Exit
	4591	Select Act ion:U1//UC Update co ntinuously
	4592
	4593
	4594	Press ^ or Q to stop the updat ing. The s ystem will go back t o the Stat istics Scr een.
	4595	Example 7. 3.1-2: Dis playing Cl aims Statu s and Resu lts in Upd ate Contin uously Mod e
	4596	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	4597	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	4598
	4599
	4600	* CLAIM STATUS * * CLAIM RES ULTS *
	4601	Waiting to start 0 P aid claims 2,93 4
	4602	Building the trans action 0 R ejected cl aims 2,17 1
	4603	Building the claim 0 D ropped to Paper 1 5
	4604	Building the HL7 p acket 1 D uplicate c laims 0
	4605	Preparin g for tran smit 0 C aptured cl aims 0
	4606	Transmit ting 0 A ccepted Re versals 2,06 7
	4607	Parsing response 0 R ejected Re versals 16 6
	4608	Processi ng respons e 0 A ccepted El igibility 7
	4609	R ejected El igibility 4 4
	4610	E rrors 1 4
	4611
	4612	In continu ous update mode: pre ss Q to Qu it
	4613
	4614	Q Quit
	4615
	4616	7.3.2 Disp lay Update
	4617	You can up date the s tatistics once every time the option U1 is entered .
	4618	Example 7. 3.2-1: Acc essing Dis play Updat e Option
	4619	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	4620	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	4621
	4622
	4623	* CLAIM STATUS * * CLAIM RES ULTS *
	4624	Waiting to start 0 P aid claims 2,93 4
	4625	Building the trans action 0 R ejected cl aims 2,17 1
	4626	Building the claim 0 D ropped to Paper 1 5
	4627	Building the HL7 p acket 1 D uplicate c laims 0
	4628	Preparin g for tran smit 0 C aptured cl aims 0
	4629	Transmit ting 0 A ccepted Re versals 2,06 7
	4630	Parsing response 0 R ejected Re versals 16 6
	4631	Processi ng respons e 0 A ccepted El igibility 7
	4632	R ejected El igibility 4 4
	4633	E rrors 1 4
	4634
	4635
	4636
	4637	Enter ?? f or more ac tions
	4638	UC Updat e continuo usly Z Zero (cle ar) stats
	4639	U1 Displ ay update EX Exit
	4640	Select Act ion:U1//U1 Display u pdate
	4641
	4642	7.3.3 Zero (clear) S tatistics
	4643	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.
	4644
	4645	Enter Z to access th e Zero (cl ear) stats option.
	4646	Example 7. 3.3-1: Acc essing Zer o (clear) stats Opti on
	4647	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	4648	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	4649
	4650
	4651	* CLAIM STATUS * * CLAIM RES ULTS *
	4652	Waiting to start 0 P aid claims 2,93 4
	4653	Building the trans action 0 R ejected cl aims 2,17 1
	4654	Building the claim 0 D ropped to Paper 1 5
	4655	Building the HL7 p acket 1 D uplicate c laims 0
	4656	Preparin g for tran smit 0 C aptured cl aims 0
	4657	Transmit ting 0 A ccepted Re versals 2,06 7
	4658	Parsing response 0 R ejected Re versals 16 6
	4659	Processi ng respons e 0 A ccepted El igibility 7
	4660	R ejected El igibility 4 4
	4661	E rrors 1 4
	4662
	4663
	4664
	4665	Enter ?? f or more ac tions
	4666	UC Updat e continuo usly Z Zero (cle ar) stats
	4667	U1 Displ ay update EX Exit
	4668	Select Act ion:U1//Z Z (clear ) stats
	4669
	4670
	4671	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 .
	4672
	4673
	4674	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.
	4675
	4676	Example 7. 3.3-2: Ent ering Zero (clear) s tats Optio n to Delet e Local Cl aim Result s Statisti cs
	4677	Selec t one of t he followi ng:
	4678
	4679	L Local Copy
	4680	P Permanent Copy
	4681
	4682	Delete (L) ocal Copy or (P)erma nent Copy of the sta tistics: L ocal Copy/ / L Local Copy
	4683
	4684	When the s ystem asks if you ar e sure, en ter Y to c ontinue or N to stop the delet ion.
	4685	Example 7. 3.3-3: Ent ering Yes to “Are Yo u Sure” Pr ompt
	4686	Are you su re? N// YE S
	4687
	4688
	4689	Enter Z to access th e Zero (cl ear) stats option.
	4690	Example 7. 3.3-4: Dis playing Ze roed Claim s Statisti cs
	4691	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	4692	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	4693
	4694
	4695	* CLAIM STATUS * * CLAIM RES ULTS *
	4696	Waiting to start 0 P aid claims 2,93 4
	4697	Building the trans action 0 R ejected cl aims 2,17 1
	4698	Building the claim 0 D ropped to Paper 1 5
	4699	Building the HL7 p acket 1 D uplicate c laims 0
	4700	Preparin g for tran smit 0 C aptured cl aims 0
	4701	Transmit ting 0 A ccepted Re versals 2,06 7
	4702	Parsing response 0 R ejected Re versals 16 6
	4703	Processi ng respons e 0 A ccepted El igibility 7
	4704	R ejected El igibility 4 4
	4705	E rrors 1 4
	4706
	4707	Enter ?? for more a ctions
	4708	UC Updat e continuo usly Z Zero (cle ar) stats
	4709	U1 Displ ay update EX Exit
	4710	Select Act ion:U1// Z Zero (c lear) stat s
	4711	Delete (L) ocal Copy or (P)erma nent Copy of the sta tistics: L ocal Copy/ / Local Co py
	4712	Are you su re? N// YE S
	4713
	4714
	4715
	4716	7.3.4 Exit ing the St atistics S creen
	4717	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.
	4718	Example 7. 3.4-1: Acc essing Exi t Option
	4719	ECME STATI STICS Nov 03, 20 10@16:50:3 0 Page: 1 of 1
	4720	Communicat ions stati stics last cleared o n AUG 18,2 003@16:36: 28
	4721
	4722
	4723	* CLAIM STATUS * * CLAIM RES ULTS *
	4724	Waiting to start 0 P aid claims 2,93 4
	4725	Building the trans action 0 R ejected cl aims 2,17 1
	4726	Building the claim 0 D ropped to Paper 1 5
	4727	Building the HL7 p acket 1 D uplicate c laims 0
	4728	Preparin g for tran smit 0 C aptured cl aims 0
	4729	Transmit ting 0 A ccepted Re versals 2,06 7
	4730	Parsing response 0 R ejected Re versals 16 6
	4731	Processi ng respons e 0 A ccepted El igibility 7
	4732	R ejected El igibility 4 4
	4733	E rrors 1 4
	4734
	4735
	4736
	4737	Enter ?? f or more ac tions
	4738	UC Updat e continuo usly Z Zero (cle ar) stats
	4739	U1 Displ ay update EX Exit
	4740	Select Act ion:U1// E X Exit
	4741
	4742	(This page included for two-si ded copyin g.)
	4743
	4744
	4745	8Accessing the Pharm acy Electr onic Claim s Reports
	4746
	4747	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.
	4748
	4749
	4750	You must h old the BP SMENU and BPS REPORT S keys to view the P harmacy El ectronic C laims Repo rts option .
	4751
	4752
	4753	Access it by enterin g RPT at t he “Select ECME Opti on:” promp t on the E CME Main M enu option screen.
	4754	Example 8- 1: Accessi ng the Pha rmacy Elec tronic Cla ims Report s Option
	4755	*** ****** ****** ****** ****** **
	4756	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4757	* XXXXX V AMC *
	4758	* Main M enu *
	4759	*** ****** ****** ****** ****** **
	4760
	4761
	4762
	4763	U ECME User Screen
	4764	COB ECME Pharm acy COB .. .
	4765	MGR Pharmacy E CME Manage r Menu ...
	4766	RPT Pharmacy E lectronic Claims Rep orts ...
	4767
	4768
	4769
	4770	Select ECM E Option: RPT Pharm acy Electr onic Claim s Reports
	4771
	4772	Example 8- 2: Display ing Pharma cy Electro nic Claims Reports O ptions
	4773	*** ****** ****** ****** ****** **
	4774	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4775	* XXXXX V AMC *
	4776	* Pharmacy Electroni c Claims R eports *
	4777	*** ****** ****** ****** ****** **
	4778
	4779
	4780
	4781	CLA Claim Resu lts and St atus ...
	4782	OTH Other Repo rts ...
	4783
	4784
	4785
	4786	Select Pha rmacy Elec tronic Cla ims Report s Option:
	4787	8.1 Claim Results an d Status
	4788
	4789	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.
	4790
	4791	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.
	4792	Example 8. 1-1: Acces sing the C laim Resul ts and Sta tus Option
	4793	*** ****** ****** ****** ****** **
	4794	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4795	* XXXXX VAMC *
	4796	* Pharmacy Electroni c Claims R eports *
	4797	*** ****** ****** ****** ****** **
	4798
	4799
	4800
	4801	CLA Claim Resu lts and St atus ...
	4802	OTH Other Repo rts ...
	4803
	4804
	4805
	4806	Select Pha rmacy Elec tronic Cla ims Report s Option: CLA Claim Results a nd Status
	4807
	4808	You have a choice of Claims Re sults and Status rep orts to ch oose from.
	4809	Example 8. 1-2: Displ aying All Claims Res ults and S tatus Opti ons
	4810	*** ****** ****** ****** ****** **
	4811	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4812	* XXXXXX VAMC *
	4813	* Cla im Results and Statu s *
	4814	*** ****** ****** ****** ****** **
	4815
	4816
	4817
	4818	PAY Payable Cl aims Repor t
	4819	REJ Rejected C laims Repo rt
	4820	ECMP CMOP/ECME Activity R eport
	4821	REV Reversal C laims Repo rt
	4822	NYR Claims Sub mitted, No t Yet Rele ased
	4823	REC Recent Tra nsactions
	4824	DAY Totals by Date
	4825	CLO Closed Cla ims Report
	4826	NBS Non-Billab le Status Report
	4827	SPA Spending A ccount Rep ort
	4828	Select Cla im Results and Statu s Option:
	4829
	4830
	4831	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.
	4832
	4833
	4834	Most of th e Claim Re sults and Status rep orts requi re that a device wit h 256 colu mn width b e used. Th ey will no t display correctly using 80 c olumn widt h devices.
	4835
	4836	Example 8. 1-3: Displ aying ECME Report It em/Filter Options fo r ALL REPO RTS
	4837	Selec t one of t he followi ng:
	4838
	4839	D DIVISION
	4840	A ALL
	4841
	4842	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: <Ent er> ALL
	4843
	4844	Selec t one of t he followi ng:
	4845
	4846	S Summary
	4847	D Detail
	4848
	4849	Display (S )ummary or (D)etail Format: De tail// Sum mary
	4850
	4851	Selec t one of t he followi ng:
	4852
	4853	I SPECIFIC I NSURANCE(S )
	4854	A ALL
	4855
	4856	Select Cer tain (I)NS URANCE or (A)LL): A/ / I SPECI FIC INSURA NCES(S)
	4857	Select INS URANCE: IB INSUR1 123 ANY WHERE ST HER NDON V IRGINIA
	4858	Y
	4859	Selected :
	4860	IBINSUR1
	4861	Select INS URANCE: DE VELOPMENT INS 123 HERE S TREET SAN FR ANCISCO
	4862	CALIFORN IA Y
	4863	Selected :
	4864	DEVELOPMEN T INS
	4865	IBINSUR1
	4866	Select INS URANCE: <E nter>
	4867
	4868	Selec t one of t he followi ng:
	4869
	4870	C CMOP
	4871	M Mail
	4872	W Window
	4873	A ALL
	4874
	4875	Display (C )MOP or (M )ail or (W )indow or (A)LL: ALL // <Enter> ALL
	4876
	4877	Selec t one of t he followi ng:
	4878
	4879	R Real Time Fills
	4880	B Backbill
	4881	P PRO Option
	4882	S Resubmissi on
	4883	A ALL
	4884
	4885	Display (R )ealTime, (B)ackbill s, (P)RO O ption, Re( S)ubmissio n or (A)LL : A// <Ent er> ALL
	4886
	4887	Selec t one of t he followi ng:
	4888
	4889	D Drug
	4890	C Drug Class
	4891	A ALL
	4892
	4893	Display Sp ecific (D) rug or Dru g (C)lass or (A)LL: ALL// <Ent er> ALL
	4894	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 .
	4895
	4896	Example 8. 1-4: Reque sting Repo rt Data in Excel Spr eadsheet F ormat
	4897	Do you wan t to captu re report data for a n Excel do cument? NO // YES
	4898
	4899	Befor e continui ng, please set up yo ur termina l to captu re the
	4900	detai l report d ata and sa ve the det ail report data in a text file
	4901	to a local driv e. This r eport may take a whi le to run.
	4902
	4903	Note: To avoid undesired wrapping of the dat a saved to the file,
	4904	please en ter '0;256 ;99999' at the 'DEVI CE:' promp t.
	4905
	4906
	4907	8.1.1 Paya ble Claims Report
	4908
	4909	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.
	4910
	4911
	4912	You must h old the BP SMENU and BPS REPORT S keys to view the P ayable Cla ims Report option.
	4913
	4914
	4915
	4916	The Payabl e Claims R eport opti on has the most acce ssible inf ormation o n payable claims fro m the BPS Claims Fil e. A FileM an inquiry into the BPS Claims File will find that the infor mation is in NCPDP ( National C ouncil for Prescript ion Drug P rograms) V . D.0 for mats.
	4917
	4918	Access the report by entering PAY at the “Select C laim Resul ts and Sta tus Option :” prompt on the Cla im Results and Statu s option s creen.
	4919	Example 8. 1.1-1: Acc essing the Payable C laims Repo rt Option
	4920	*** ****** ****** ****** ****** **
	4921	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	4922	* XXXXX V AMC *
	4923	* Cla im Results and Statu s *
	4924	*** ****** ****** ****** ****** **
	4925
	4926	PAY Payable Cl aims Repor t
	4927	REJ Rejected C laims Repo rt
	4928	ECMP CMOP/ECME Activity R eport
	4929	REV Reversal C laims Repo rt
	4930	NYR Claims Sub mitted, No t Yet Rele ased
	4931	REC Recent Tra nsactions
	4932	DAY Totals by Date
	4933	CLO Closed Cla ims Report
	4934	NBS Non-Billab le Status Report
	4935	SPA Spending A ccount Rep ort
	4936
	4937
	4938	Select Cla im Results and Statu s Option: PAY Payab le Claims Report
	4939
	4940	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; Sele cted Patie nts or All ; Selected Range for Billed Am ount or Al l; and Exc el display format an d device s election.
	4941	Example 8. 1.1-2: Add itional pr ompts aske d by the P ayable Cla ims Report Option
	4942	START WITH TRANSACTI ON DATE: T -1// T-99
	4943	GO TO TR ANSACTION DATE: T// <Enter>
	4944
	4945	Selec t one of t he followi ng:
	4946
	4947	R RELEASED
	4948	N NOT RELEAS ED
	4949	A ALL
	4950
	4951
	4952	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	4953
	4954	Selec t one of t he followi ng:
	4955
	4956	V VETERAN
	4957	T TRICARE
	4958	C CHAMPVA
	4959	A ALL
	4960
	4961	Display (V )ETERAN or (T)RICARE or (C)HAM PVA or (A) LL: A// AL L
	4962
	4963	Selec t one of t he followi ng:
	4964
	4965	P Patient
	4966	A ALL
	4967
	4968	Display Se lected (P) atients or (A)LL: AL L//
	4969
	4970	Selec t one of t he followi ng:
	4971
	4972	R Range
	4973	A ALL
	4974
	4975	Select (R) ange for B illed Amou nt or (A)L L: ALL//
	4976
	4977	Data field s VA Ingre dient Cost , VA Dispe nsing Fee, Ingredien t Cost Pai d,
	4978	Dispensing Fee Paid and Patien t Responsi bility (IN S) will on ly be incl uded
	4979	when the r eport is c aptured fo r an Excel document. All addi tional dat a fields
	4980	may not be present f or all rep orts.
	4981
	4982	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	4983
	4984	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	4985	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	4986
	4987	DEVICE: HO ME// <Ente r> IP net work
	4988
	4989	Please wai t...
	4990
	4991
	4992	(This page included for two-si ded copyin g.)
	4993
	4994	Example 8. 1.1-3: Pay able Claim s Report
	4995	ECME PAYAB LE CLAIMS DETAIL REP ORT Print Da te: MAY 21 , 2008@11: 41:54 Pag e: 1
	4996	DIVISION(S ): ALL Fi ll Locatio ns: C,M,W Fill type : RT,BB,RS
	4997	Insurance: SELECTED D rugs/Class es: ALL
	4998	Eligibilit y: CVA,TRI ,VET Patie nt: ALL
	4999	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 02/12/ 08 through 05/21/08
	5000	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =====
	5001	PATIENT NA ME Pt. ID ELIG RX# REF/ECM E# DA TE $B ILLED $ INS RESPON SE $CO LLECT
	5002	DRUG NDC REL EASED ON RX INFO BILL# C OB
	5003	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =====
	5004	DIVISION: PHARMACY-1
	5005	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -----
	5006	DEVELOPMEN T INS
	5007	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -----
	5008	ECMEpatien t,One (XX XX) TRI 100222$ 2/000000 111264 04/15/0 8 51 .00 40.00
	5009	AMITRI PTYLINE 10 MG TAB 00182-10 18-10 04/ 15/08 W RT A C/R K8000K9 p
	5010
	5011	ECMEpatien t, Three (XX XX) VET 222$ 0/000000 000492 03/1 0/08 51.00 68 .32
	5012	METHAD ONE 10MG T AB W RT E X/N
	5013
	5014	-------- -- - ---------
	5015	SUBTOTALS for INS:DE VELOPMENT INS 102. 00 108.32 0.00
	5016	COUNT 2 2 2
	5017	MEAN 51. 00 54.16 0.00
	5018	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -----
	5019	IBINSUR1
	5020	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -----
	5021	ECMEpatien t, Two (XX XX) VET 100574$ 0/000000 000484 03/0 5/08 51.00 40 .00
	5022	NEODEC ADRON OPHT MALIC SOL. 00006-76 39-03 03/ 05/08 W RT A C/R K8000H6 p
	5023	ECMEpatien t, Two (XX XX) VET 100575$ 0/000000 000485 03/0 5/08 51.00 40 .00
	5024	PENTAE RYTHRITOL 10MG TAB 00725-20 64-10 03/ 05/08 W RT A C/R K8000H7 p
	5025
	5026	...
	5027
	5028	SUBTOTALS for INS:IB INSUR1 2142. 00 1652.28 5.00
	5029	COUNT 42 42 42
	5030	MEAN 51. 00 39.34 0.12
	5031
	5032	-------- -- --------- ----- -----
	5033	SUBTOTALS for DIV:PH ARMACY-1 2244. 00 1760.60 5.00
	5034	COUNT 44 44 44
	5035	MEAN 51. 00 40.01 0.11
	5036
	5037	-------- -- --------- ----- -----
	5038	GRAND TOTA LS 2244. 00 1760.60 5.00
	5039	COUNT 44 44 44
	5040	MEAN 51. 00 40.01 0.11
	5041
	5042	Press RETU RN to cont inue:
	5043	(This page included for two-si ded copyin g.)
	5044
	5045	8.1.2 Reje cted Claim s Report
	5046	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.
	5047
	5048
	5049	You must h old the BP SMENU and BPS REPORT S keys to view the R ejected Cl aims Repor t option.
	5050
	5051
	5052	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.
	5053
	5054
	5055	Access the report by entering REJ at the “Select C laim Resul ts and Sta tus Option :” prompt on the Cla im Results and Statu s option s creen.
	5056	Example 8. 1.2-1: Acc essing the Rejected Claims Rep ort Option
	5057	*** ****** ****** ****** ****** **
	5058	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	5059	* XXXXX V AMC *
	5060	* Cla im Results and Statu s *
	5061	*** ****** ****** ****** ****** **
	5062
	5063
	5064
	5065	PAY Payable Cl aims Repor t
	5066	REJ Rejected C laims Repo rt
	5067	ECMP CMOP/ECME Activity R eport
	5068	REV Reversal C laims Repo rt
	5069	NYR Claims Sub mitted, No t Yet Rele ased
	5070	REC Recent Tra nsactions
	5071	DAY Totals by Date
	5072	CLO Closed Cla ims Report
	5073	NBS Non-Billab le Status Report
	5074	SPA Spending A ccount Rep ort
	5075
	5076
	5077	Select Cla im Results and Statu s Option: REJ Rejec ted Claims Report
	5078
	5079
	5080	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, Selected Patients o r All, Sel ected Rang e for Bill ed Amount or All, Ex cel displa y format a nd device selection.
	5081	Example 8. 1.2-2: Add itional pr ompts aske d by the R ejected Cl aims Repor t Option
	5082	START WITH TRANSACTI ON DATE: T -1// T-30
	5083	GO TO TR ANSACTION DATE: T// <Enter>
	5084
	5085	Selec t one of t he followi ng:
	5086
	5087	R RELEASED
	5088	N NOT RELEAS ED
	5089	A ALL
	5090
	5091	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	5092
	5093	Selec t one of t he followi ng:
	5094
	5095	S Specific R eject Code
	5096	A ALL
	5097
	5098	Include (S )pecific R eject Code or (A)LL: ALL// <En ter>
	5099
	5100	Selec t one of t he followi ng:
	5101
	5102	O OPEN
	5103	C CLOSED
	5104	A ALL
	5105
	5106	Include (O )pen, (C)l osed, or ( A)ll Claim s: O// ALL
	5107
	5108	Selec t one of t he followi ng:
	5109
	5110	V VETERAN
	5111	T TRICARE
	5112	C CHAMPVA
	5113	A ALL
	5114
	5115	Include Ce rtain Elig ibility Ty pe or (A)l l: V// ALL
	5116
	5117	Selec t one of t he followi ng:
	5118
	5119	O OPEN
	5120	C CLOSED
	5121	A ALL
	5122
	5123	Include (O )pen, (C)l osed, or ( A)ll Claim s: O// PEN
	5124
	5125	Selec t one of t he followi ng:
	5126
	5127	S SPECIFIC P RESCRIBER( S)
	5128	A ALL PRESCR IBERS
	5129
	5130	Select Spe cific Pres criber(s) or include ALL Presc ribers: A/ / LL PRESC RIBERS
	5131
	5132	Selec t one of t he followi ng:
	5133
	5134	P Patient
	5135	A ALL
	5136
	5137	Display Se lected (P) atients or (A)LL: AL L//
	5138
	5139	Selec t one of t he followi ng:
	5140
	5141	R Range
	5142	A ALL
	5143
	5144	Select (R) ange for B illed Amou nt or (A)L L: ALL//
	5145
	5146	Data field s VA Ingre dient Cost , VA Dispe nsing Fee, Ingredien t Cost Pai d,
	5147	Dispensing Fee Paid and Patien t Responsi bility (IN S) will on ly be incl uded
	5148	when the r eport is c aptured fo r an Excel document. All addi tional dat a fields
	5149	may not be present f or all rep orts.
	5150
	5151	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	5152
	5153	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	5154	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	5155
	5156	DEVICE: HO ME// <Ente r> IP net work
	5157
	5158	Please wai t...
	5159
	5160	Example 8. 1.2-3: Rej ected Clai ms Report
	5161	ECME REJEC TED CLAIMS DETAIL RE PORT Prin t Date: MA Y 21, 2008 @17:20:35 Page: 1
	5162	DIVISION(S ): ALL Fill Locat ions: C,M, W Fill ty pe: RT,BB, RS
	5163	Insurance: SELECTED Drugs/ Classes: A LL
	5164	Reject Cod e: ALL Elig ibility: A LL Open/Close d: ALL
	5165	Prescriber : ALL Patient: A LL
	5166	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 05/01/ 08 through 05/21/08
	5167	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	5168	PATIENT NA ME Pt.ID ELIG RX# REF/ ECME# DATE RELEASED O N RX INFO CO B OPEN/ CLOSED
	5169	CARDHOL D.ID GR OUP ID $B ILLED QT Y NDC# PRESCRI BER ID NAME
	5170	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	5171	DIVISION: PHARMACY-1
	5172	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5173	IBINSUR1 - 123456
	5174	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5175	ECMEPATIEN T,ONE (XXXX) VET 100 888$ 0/00 0000000808 0 5/04/08 0 5/04/08 W RT D S/R s Op en
	5176	123456 55 5 51.00 90 00777 -0877-03 9998887 777 ECMEPRESCR IBER,ONE
	5177	FENOPROFEN 300MG CAP
	5178	Claim ID: VA2008=400 0000016=00 0010=00018 15
	5179	07:M/I Car dholder ID Number
	5180	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
	5181	123456 55 5 51.00 90 00777 -0877-03 9998887 777 ECMEPRESCR IBER,ONE
	5182	FENOPROFEN 300MG CAP
	5183	Claim ID: VA2008=400 0000016=00 0010=00018 22
	5184	07:M/I Car dholder ID Number
	5185	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
	5186	123456 55 5 51.00 90 00777 -0877-03 9998887 777 ECMEPRESCR IBER,ONE
	5187	FENOPROFEN 300MG CAP
	5188	Claim ID: VA2008=400 0000016=00 0010=00018 23
	5189	07:M/I Car dholder ID Number
	5190
	5191	--------- -
	5192	SUBTOTALS for INS:IB INSUR1 153.0 0
	5193	COUNT 3
	5194	MEAN 51.0 0
	5195	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5196	OPINSUR1 - 654321
	5197	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5198	ECMEPATIEN T,TWO (XXXX) VET 100 896$ 0/00 0000000816 0 5/06/08 W RT DS /N p Open
	5199	111 51.00 1 80 0000 3-0626-50 9995552 277 ECMEPRESCR IBER,FIVE
	5200	CHLORAL HY DRATE 500M G CAP
	5201	Claim ID: VA2008=400 0000016=00 0010=00018 33
	5202	12:M/I Pat ient Locat ion
	5203	ECMEPATIEN T,TWO (XXXX) VET 100 899$ 0/00 0000000819 0 5/06/08 W RT DS /N p Open
	5204	111 51.00 1 80 0014 9-0030-66 9995552 277 ECMEPRESCR IBER,FIVE
	5205	DANTROLENE 25MG CAP
	5206	Claim ID: VA2008=400 0000016=00 0010=00018 34
	5207	75:Prior A uthorizati on Require d
	5208	ECMEPATIEN T,TWO (XXXX) VET 100 901$ 0/00 0000000821 0 5/06/08 W RT DS /N p Open
	5209	111 51.00 9 0 0059 1-5521-04 9995552 277 ECMEPRESCR IBER,FIVE
	5210	PHENYLBUTA ZONE 100MG TAB
	5211	05/06/08 - Prior Aut horization Code (8/3 2432242) s ubmitted.
	5212	Claim ID: VA2008=400 0000016=00 0010=00018 35
	5213	75:Prior A uthorizati on Require d
	5214	ECMEPATIEN T,TWO (XXXX) VET 100 902$ 0/00 0000000822 0 5/06/08 W RT DS /N p Open
	5215	111 51.00 1 80 0002 3-4534-67 9995552 277 ECMEPRESCR IBER,FIVE
	5216	BACLOFEN 1 0MG TABS
	5217	05/06/08 - Clarifica tion Code 4,3 submit ted.
	5218	Claim ID: VA2008=400 0000016=00 0010=00018 40
	5219	79:Refill Too Soon
	5220	ECMEPATIEN T,TWO (XXXX) VET 100 903$ 0/00 0000000823 0 5/06/08 W RT DS /N s Open
	5221	111 51.00 1 80 0002 3-4534-67 9995552 277 ECMEPRESCR IBER,FIVE
	5222	BACLOFEN 1 0MG TABS
	5223	05/06/08 - Clarifica tion Code 4,3 submit ted.
	5224	Claim ID: VA2008=400 0000016=00 0010=00018 41
	5225	79:Refill Too Soon
	5226	ECMEPATIEN T,TWO (XXXX) VET 100 906$ 0/00 0000000826 0 5/06/08 M RT DS /N p Open
	5227	111 51.00 1 80 0083 9-7221-06 9995552 277 ECMEPRESCR IBER,FIVE
	5228	DOXEPIN 25 MG CAP
	5229	05/06/08 - Clarifica tion Code 4,3 submit ted.
	5230	Claim ID: VA2008=400 0000016=00 0010=00018 43
	5231	79:Refill Too Soon
	5232	ECMEPATIEN T,TWO (XXXX) VET 100 907$ 0/00 0000000827 0 5/06/08 M RT AC /N p Open
	5233	111 51.00 1 80 0008 1-0635-35 9995552 277 ECMEPRESCR IBER,FIVE
	5234	CHLORAMBUC IL 2MG TAB
	5235	Claim ID: VA2008=400 0000016=00 0010=00018 45
	5236	79:Refill Too Soon
	5237	ECMEPATIEN T,TWO (XXXX) VET 100 915$ 0/00 0000000835 0 5/07/08 W RT DS /N p Open
	5238	111 51.00 1 80 0002 3-4534-67 9995552 277 ECMEPRESCR IBER,FIVE
	5239	BACLOFEN 1 0MG TABS
	5240	05/07/08 - DAFASFDAF DASFDASFAS
	5241	Claim ID: VA2008=400 0000016=00 0010=00018 68
	5242	75:Prior A uthorizati on Require d
	5243	ECMEPATIEN T,TWO (XXXX) VET 100 938$ 0/00 0000000858 0 5/08/08 W RT AC /N p Open
	5244	111 51.00 3 0 0002 4-2253-04 9995552 277 ECMEPRESCR IBER,FIVE
	5245	STANOZOLOL 2MG
	5246	Claim ID: VA2008=400 0000016=00 0010=00018 92
	5247	75:Prior A uthorizati on Require d
	5248	ECMEPATIEN T,TWO (XXXX) VET 100 939$ 0/00 0000000859 0 5/08/08 W RT DS /N p Open
	5249	111 51.00 1 80 0007 8-0005-10 9995552 277 ECMEPRESCR IBER,FIVE
	5250	THIORIDAZI NE 100MG T AB
	5251	05/08/08 - FDDSFADFA
	5252	Claim ID: VA2008=400 0000016=00 0010=00018 93
	5253	75:Prior A uthorizati on Require d
	5254	ECMEPATIEN T,TWO (XXXX) VET 100 942$ 0/00 0000000862 0 5/08/08 W RT AC /N p Open
	5255	111 51.00 1 80 0002 8-0105-10 9995552 277 ECMEPRESCR IBER,FIVE
	5256	TERBUTALIN E 5MG TABS
	5257	Claim ID: VA2008=400 0000016=00 0010=00018 94
	5258	75:Prior A uthorizati on Require d
	5259	79:Refill Too Soon
	5260	ECMEPATIEN T,TWO (XXXX) VET 100 945$ 0/00 0000000865 0 5/08/08 W RT DS /N p Open
	5261	111 51.00 1 80 0004 5-0412-60 9995552 277 ECMEPRESCR IBER,FIVE
	5262	TOLMETIN 2 00MG TABS
	5263	Claim ID: VA2008=400 0000016=00 0010=00018 97
	5264	75:Prior A uthorizati on Require d
	5265	79:Refill Too Soon
	5266	ECMEPATIEN T,TWO (XXXX) VET 101 002$ 0/00 0000000926 0 5/14/08 W RT DS /N p Open
	5267	111 51.00 1 80 0002 3-4534-67 9995552 277 ECMEPRESCR IBER,FIVE
	5268	BACLOFEN 1 0MG TABS
	5269	Claim ID: VA2008=400 0000016=00 0010=00019 89
	5270	64:Claim S ubmitted D oes Not Ma tch Prior Authorizat ion
	5271	ECMEPATIEN T,TWO (XXXX) VET 101 011$ 0/00 0000000935 0 5/14/08 W RT D S/N p Open
	5272	111 51.00 1 80 0078 1-1367-10 9995552 277 ECMEPRESCR IBER,FIVE
	5273	BENZTROPIN E 2MG TAB
	5274	Claim ID: VA2008=400 0000016=00 0010=00020 05
	5275	12:M/I Pat ient Locat ion
	5276
	5277	Press RETU RN to cont inue, '^' to exit:
	5278
	5279
	5280	(This page included for two-si ded copyin g.)
	5281
	5282
	5283	8.1.3 CMOP /ECME Acti vity Repor t
	5284
	5285	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
	5286
	5287
	5288	You must h old the BP SMENU and BPS REPORT S keys to view the C MOP/ECME A ctivity Re port optio n.
	5289
	5290	Access the report by entering ECMP at th e “Select Claim Resu lts and St atus Optio n:” prompt on the Cl aim Result s and Stat us option screen.
	5291	Example 8. 1.3-1: Acc essing the CMOP/ECME Activity Report Opt ion
	5292	*** ****** ****** ****** ****** **
	5293	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	5294	* XXXXX V AMC *
	5295	* Cla im Results and Statu s *
	5296	*** ****** ****** ****** ****** **
	5297
	5298	PAY Payable Cl aims Repor t
	5299	REJ Rejected C laims Repo rt
	5300	ECMP CMOP/ECME Activity R eport
	5301	REV Reversal C laims Repo rt
	5302	NYR Claims Sub mitted, No t Yet Rele ased
	5303	REC Recent Tra nsactions
	5304	DAY Totals by Date
	5305	CLO Closed Cla ims Report
	5306	NBS Non-Billab le Status Report
	5307	SPA Spending A ccount Rep ort
	5308
	5309
	5310	Select Cla im Results and Statu s Option: ECMP CMOP /ECME Acti vity Repor t
	5311	ENTER BEGI NNING TRAN SMISSION D ATE: 8/31
	5312	ENTER ENDI NG TRANSMI SSION DATE : 9/1
	5313
	5314	SELECTION OF DIVISIO N(S)
	5315
	5316	Selec t one of t he followi ng:
	5317
	5318	A ALL DIVISI ONS
	5319	S SELECT DIV ISIONS
	5320
	5321	Enter resp onse: SELE CT DIVISIO NS
	5322	1 XXXXX XXXXX
	5323	2 YYYYY YYYYY
	5324	3 ZZZZZ ZZZZZ
	5325
	5326	Select Div ision(s) : (1-4): 1
	5327
	5328	You have s elected:
	5329	1 XXXXX XXXXX
	5330	Is this co rrect? YES // <Enter>
	5331
	5332	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	5333
	5334	Select Pri nter: HOME ;132;999 IP network
	5335
	5336	Example 8. 1.3-2: CMO P/ECME Act ivity Repo rt
	5337	CMOP/ ECME ACTIV ITY REPORT for XXXXX XXXXX
	5338	For AUG 31 ,2005 thr u SEP 1,2 005 Printed: N OV 23,2005 @10:25:49
	5339	========== ========== ========== ========== ========== ========== ========== ========== =========
	5340
	5341	TRA NSMISSION: 2671
	5342	STA TUS: TRANS MITTED
	5343	DIV ISION: XXXXX XXXXX
	5344	CMO P SYSTEM: LEAVE NWORTH
	5345	TRA NSMISSION DATE/TIME: AUG 3 1, 2005@16 :17:14
	5346	TOT AL PATIENT S: 3
	5347	TOT AL RXS: 3
	5348	NAME ECME#/ RX#/FL# NDC S ENT NDC RECV D CMOP-STAT
	5349	DRUG INSUR ANCE PAY- STAT BILL # REL-DA TE
	5350	========== ========== ========== ========== ========== ========== ========== ========== =========
	5351	ECMEpatien t,One (XXX X) 000001 106254/909 911$e/0 00000-0158 -23 TRANS MI
	5352	AT ORVASTATIN CALCI WEBMD E PA YAB
	5353
	5354	8.1.4 Reve rsal Claim s Report
	5355	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.
	5356
	5357
	5358	You must h old the BP SMENU and BPS REPORT S keys to view the R eversal Cl aims Repor t option.
	5359
	5360
	5361	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.
	5362	Example 8. 1.4-1: Acc essing the Reversal Claims Rep ort Option
	5363	*** ****** ****** ****** ****** **
	5364	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	5365	* XXXXX V AMC *
	5366	* Cla im Results and Statu s *
	5367	*** ****** ****** ****** ****** **
	5368
	5369	PAY Payable Cl aims Repor t
	5370	REJ Rejected C laims Repo rt
	5371	ECMP CMOP/ECME Activity R eport
	5372	REV Reversal C laims Repo rt
	5373	NYR Claims Sub mitted, No t Yet Rele ased
	5374	REC Recent Tra nsactions
	5375	DAY Totals by Date
	5376	CLO Closed Cla ims Report
	5377	NBS Non-Billab le Status Report
	5378	SPA Spending A ccount Rep ort
	5379
	5380
	5381	Select Cla im Results and Statu s Option: REV Rever sal Claims Report
	5382
	5383	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, Selected P atients or All, Sele cted Range for Bille d Amount o r All, Exc el display format an d device s election.
	5384	Example 8. 1.4-2: Add itional Pr ompts for the Revers al Claims Report Opt ion
	5385	START WITH TRANSACTI ON DATE: T -1// T-30
	5386	GO TO TR ANSACTION DATE: T// <Enter>
	5387
	5388	Selec t one of t he followi ng:
	5389	R RELEASED
	5390	N NOT RELEAS ED
	5391	A ALL
	5392
	5393	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	5394	Selec t one of t he followi ng:
	5395	R AutoRevers ed
	5396	A ALL
	5397
	5398	Include Au to(R)evers ed or (A)L L: ALL// < Enter>
	5399	Selec t one of t he followi ng:
	5400
	5401	C Accepted
	5402	R Rejected
	5403	A ALL
	5404
	5405	Include A( C)cepted o r (R)eject ed or (A)L L: Rejecte d// ALL
	5406
	5407	Selec t one of t he followi ng:
	5408
	5409	V VETERAN
	5410	T TRICARE
	5411	C CHAMPVA
	5412	A ALL
	5413
	5414	Display (V )ETERAN or (T)RICARE or (C)HAM PVA or (A) LL: A// AL L
	5415
	5416	Selec t one of t he followi ng:
	5417
	5418	P Patient
	5419	A ALL
	5420
	5421	Display Se lected (P) atients or (A)LL: AL L// <Enter >
	5422
	5423	Selec t one of t he followi ng:
	5424
	5425	R Range
	5426	A ALL
	5427
	5428	Select (R) ange for B illed Amou nt or (A)L L: ALL// < Enter>
	5429
	5430	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.
	5431
	5432	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	5433
	5434	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	5435	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	5436
	5437	DEVICE: HO ME// <Ente r> IP net work
	5438	Please wai t...
	5439
	5440
	5441	Example 8. 1.4-3: Rev ersal Clai ms Report
	5442
	5443
	5444	ECME REVER SED CLAIMS DETAIL RE PORT Prin t Date: AP R 17, 2009 @14:17:15 Page: 1
	5445	DIVISION(S ): ALL Fill Locat ions: C,M, W Fill ty pe: RT,BB, RS
	5446	Insurance: ALL ALL R eversals ALL R eturned St atus Dru gs/Classes : ALL
	5447	Eligibilit y: ALL Patient : ALL
	5448	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 03/18/ 09 through 04/17/09
	5449	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	5450	PATIENT NA ME Pt.ID EL IG RX# REF/ECME # D ATE $ BILLED $INS RES PONSE $COLLECT
	5451	DRUG NDC RX INFO COB
	5452	RELE ASED ON REVERSAL METHOD/RE TURN STATU S/REASON
	5453	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	5454	DIVISION: YYYYYYYY
	5455	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5456	COB INSURA NCE
	5457	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5458	ECMEPATIEN T,ONE (XXXX) TRI 102445$ 0/000001 13725 03/20/ 09 21.88 40. 00 0.00
	5459	OXYTOC IN 10 UNIT INJ 00071-416 0-03 W RT AC /R s
	5460	03/1 8/09 REGULAR/ ACCEPTED/2
	5461
	5462	-------- -- --- ------- ----- -----
	5463	SUBTOTALS for INS:CO B INSURANC E 21.88 40. 00 0.00
	5464	COUNT 1 1 1
	5465	MEAN 21.88 40. 00 0.00
	5466	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5467	ECME INSUR ANCE
	5468	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5469	ECMEPATIEN T,TWO (XXXX) VET 102446$ 0/000001 13727 03/20/ 09 11.00 40.00 0.00
	5470	DACARB AZINE 100M G INJ 00 026-8151-1 0 W RT DS /R s
	5471	03/2 0/09 REGULAR/ ACCEPTED/R EVERSING P RIMARY CLA IM
	5472
	5473	--------- - ---- ------ ------- ---
	5474	SUBTOTALS for INS:EC ME INSURAN CE 11.00 40. 00 0.00
	5475	COUNT 1 1 1
	5476	MEAN 11.00 40. 00 0.00
	5477	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5478	ECME1 INSU RANCE
	5479	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	5480	ECMEPATIEN T,TWO (XXXX) VET 102422$ 1/000001 13698 03/20/0 9 0.00 68.3 2 0.00
	5481	GENTAM ICIN OPHTH ALMIC OINT . 00719-70 58-61 W RT DS /N p
	5482	REGULAR/ ACCEPTED/R X DISCONTI NUED
	5483	ECMEPATIEN T,ONE (XXXX) TRI 102435$ 0/000001 13713 04/06/0 9 0.00 40.0 0 0.00
	5484	METHOX AMINE 10MG /CC INJ 00081-0957 -10 W RT AC /N p
	5485	REGULAR/ ACCEPTED/ RX DISCONT INUED
	5486
	5487
	5488	--------- - ---- ------ ------- ---
	5489	SUBTOTALS for INS:EC ME1 INSURA NCE 0.00 108. 32 0.00
	5490	COUNT 2 2 2
	5491	MEAN 0.00 54. 16 0.00
	5492
	5493	--------- - ---- ------ ------- ---
	5494	SUBTOTALS for DIV:YY YYYYYY 32.88 188. 32 0.00
	5495	COUNT 4 4 4
	5496	MEAN 8.22 47. 08 0.00
	5497
	5498	--------- - ---- ------ ------- ---
	5499	GRAND TOTA LS 32.88 188. 32 0.00
	5500	COUNT 4 4 4
	5501	MEAN 8.22 47 .08 0.00
	5502
	5503
	5504
	5505	8.1.5 Clai ms Submitt ed, Not Ye t Released
	5506
	5507	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.
	5508
	5509	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.
	5510
	5511	Access the report by entering NYR at the “Select C laim Resul ts and Sta tus Option :” prompt on the Cla im Results and Statu s option s creen.
	5512
	5513	Example 8. 1.5-1: Acc essing Cla ims Submit ted, Not Y et Release d Option
	5514	*** ****** ****** ****** ****** **
	5515	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	5516	* XXXXX V AMC *
	5517	* Cla im Results and Statu s *
	5518	*** ****** ****** ****** ****** **
	5519
	5520	PAY Payable Cl aims Repor t
	5521	REJ Rejected C laims Repo rt
	5522	ECMP CMOP/ECME Activity R eport
	5523	REV Reversal C laims Repo rt
	5524	NYR Claims Sub mitted, No t Yet Rele ased
	5525	REC Recent Tra nsactions
	5526	DAY Totals by Date
	5527	CLO Closed Cla ims Report
	5528	NBS Non-Billab le Status Report
	5529	SPA Spending A ccount Rep ort
	5530
	5531
	5532	Select Cla im Results and Statu s Option: NYR Claim s Submitte d, Not Yet Released
	5533
	5534
	5535	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, S elected Pa tients or All, Selec ted Range for Billed Amount or All, Exce l display format and device se lection.
	5536	Example 8. 1.5-2: Add itional pr ompts to C laims Subm itted, Not Yet Relea sed Option
	5537	START WITH TRANSACTI ON DATE: T -1// T
	5538	GO TO TR ANSACTION DATE: T// T
	5539
	5540	Select one or more o f the foll owing:
	5541
	5542	V VETER AN
	5543	T TRICA RE
	5544	C CHAMP VA
	5545	A ALL
	5546
	5547	Display (V )ETERAN or (T)RICARE or (C)HAM PVA or (A) LL: A//
	5548
	5549	Selec t one of t he followi ng:
	5550
	5551	P Patient
	5552	A ALL
	5553
	5554	Display Se lected (P) atients or (A)LL: AL L//
	5555
	5556	Selec t one of t he followi ng:
	5557
	5558	R Range
	5559	A ALL
	5560
	5561	Select (R) ange for B illed Amou nt or (A)L L: ALL//
	5562
	5563	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.
	5564
	5565	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	5566
	5567	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	5568	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	5569
	5570	DEVICE: HO ME// <Ente r> IP net work
	5571
	5572	Example 8. 1.5-3: Cla ims Submit ted, Not Y et Release d Report
	5573	ECME SUBMI T,NOT RELE ASED CLAIM S DETAIL R EPORT Prin t Date: SE P 23, 2005 @15:01:21 Page: 1
	5574	DIVISION(S ): ALL Fi ll Locatio ns: C,M,W Fill type: RT,BB,RS
	5575	Insurance: ALL Drugs/Clas ses: ALL
	5576	Eligibilit y: CVA,TRI ,VET Patien t: ALL
	5577	PRESCRIPTI ONS (NOT R ELEASED) B Y TRANSACT ION DATE: From 09/23 /05 throug h 09/23/05
	5578	========== ========== ========== ========== ========== ========== ========== ========== ========
	5579	PATIENT NA ME Pt .ID RX# REF/EC ME# D ATE $BILLED $INS RESPONSE
	5580	DRUG NDC RX INFO CO B ELIG
	5581	========== ========== ========== ========== ========== ========== ========== ========== ========
	5582	DIVISION: ZZZZZZZ
	5583	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------
	5584	WEBMD
	5585	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------
	5586	ECMEpatien t,One (XX XX) 909716 $ 0/00000 1105959 0 9/23/05 45.0 0 40.00
	5587	PROTAM INE SULFAT E 5ML INJ 00000-00 00-00 W RT AC/N p VET
	5588	---- ------ -- --------
	5589	SUBTOTALS for INS:WE BMD 45.00 40.00
	5590	COUNT 1 1
	5591	MEAN 45.00 40.00
	5592
	5593	---- ------ -- --------
	5594	SUBTOTALS for DIV:ZZ ZZZZZ 4 5.00 40.00
	5595	COUNT 1 1
	5596	MEAN 45.00 40.00
	5597
	5598	GRAND TOTA LS 45.00 40.00
	5599	COUNT 1 1
	5600	MEAN 45.00 40.00
	5601
	5602
	5603	8.1.6 Rece nt Transac tions
	5604
	5605	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.
	5606
	5607	You must h old the BP SMENU and BPS REPORT S keys to view the R ecent Tran sactions R eport opti on.
	5608
	5609	Access the report by entering REC at the “Select C laim Resul ts and Sta tus Option :” prompt on the Cla im Results and Statu s option s creen.
	5610	Example 8. 1.6-1: Rec ent Transa ctions Opt ion
	5611	*** ****** ****** ****** ****** **
	5612	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	5613	* XXXXX V AMC *
	5614	* Cla im Results and Statu s *
	5615	*** ****** ****** ****** ****** **
	5616
	5617	PAY Payable Cl aims Repor t
	5618	REJ Rejected C laims Repo rt
	5619	ECMP CMOP/ECME Activity R eport
	5620	REV Reversal C laims Repo rt
	5621	NYR Claims Sub mitted, No t Yet Rele ased
	5622	REC Recent Tra nsactions
	5623	DAY Totals by Date
	5624	CLO Closed Cla ims Report
	5625	NBS Non-Billab le Status Report
	5626	SPA Spending A ccount Rep ort
	5627
	5628	Select Cla im Results and Statu s Option: REC Recen t Transact ions
	5629
	5630	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.
	5631	Example 8. 1.6-2: Add itional pr ompts aske d by the R ecent Tran sactions O ption
	5632	START WITH TRANSACTI ON DATE: T -1// T
	5633	GO TO TR ANSACTION DATE: T// T
	5634
	5635	Selec t one of t he followi ng:
	5636
	5637	R RELEASED
	5638	N NOT RELEAS ED
	5639	A ALL
	5640
	5641	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	5642
	5643	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	5644
	5645	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	5646	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	5647
	5648	DEVICE: HO ME// <Ente r> IP netw ork
	5649	Please wai t...
	5650
	5651	(This page included for two-si ded copyin g.)
	5652
	5653	Example 8. 1.6-3: Rec ent Transa ctions Rep ort
	5654
	5655	ECME RECEN T TRANSACT IONS DETAI L REPORT P rint Date: NOV 03, 2 010@17:10: 39 Page: 1
	5656	DIVISION(S ): ALL Fill Lo cations: C ,M,W Fill type: RT,B B,RS
	5657	Insurance: ALL Dru gs/Classes : ALL
	5658	PRESCRIPTI ONS BY TRA NSACTION D ATE: From 10/04/10 t hrough 11/ 03/10
	5659	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	5660	PATIENT NA ME Pt. ID RX# REF /ECME# COMPL ETED TRANS T YPE PAYER RESP ONSE COB
	5661	DRUG NDC RX INFO I NSURANCE ELAP TIM E IN SECON DS
	5662	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	5663	DIVISION: XXXXXXXX
	5664	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	5665	ECMEPATIEN T,THREE ( XXXX) 102 128$ 1 /000000002 509 10/04/10 02:52PM SUBMIT E REJECT ED p
	5666	DIAZEP AM 10MG S. T. 00 555-0164-0 4 M RT EX/N RE J OPI NSUR1 9
	5667	ECMEPATIEN T,THREE ( XXXX) 110 0249$ 1 / 10/ 06/10 11:2 9AM SUBMI T E UNSTRA NDED p
	5668	GENTAM ICIN OPHTH ALMIC O 00 719-7058-6 1 W RT AC/N OPI NSUR1 502339
	5669	ECMEPATIEN T,SIX ( XXXX) 110 0341$ 0 /000000003 126 10/ 07/10 12:0 6AM SUBMI T E REJECT ED p
	5670	DOXEPI N 25MG CAP 00 839-7221-0 6 W RT AC/R RE J OPI NSUR2 7
	5671	ECMEPATIEN T,SIX ( XXXX) 110 0342$ 0 /000000003 127 10/ 07/10 01:5 9PM SUBMI T E PAYABL E p
	5672	CORTIC OTROPIN 40 UNIT HP 00 053-1330-0 1 W RT AC/R OPI NSUR2 4
	5673	ECMEPATIEN T,SIX ( XXXX) 110 0336$ 0 /000000003 120 10/ 07/10 03:0 5PM REVER SAL E REVERS AL OTHER p
	5674	TRIAMT ERENE 50MG , HCTZ 00 484-3590-3 0 W RT DS/R OPI NSUR2 3
	5675	ECMEPATIEN T,ONE ( XXXX) 100 952$ 0 /000000000 874 10/07/10 05:29PM SUBMIT E UNSTRA NDED p
	5676	MEDROX YPROGESTRO NE 10MG 00 009-0050-0 2 W RT DS/N OPI NSUR1 76220585
	5677	ECMEPATIEN T,ONE ( XXXX) 100 933$ 0 /000000000 853 10/07/10 07:45PM SUBMIT E REJECT ED p
	5678	DOXEPI N 25MG CAP 00 839-7221-0 6 M RT DS/N RE J OPI NSUR1 7
	5679	ECMEPATIEN T,ONE ( XXXX) 101 814$ 0 /000000002 181 10/08/10 04:11PM REVERSAL E REVERS AL UNSTRAN DED p
	5680	IMIPRA MINE 25MG TAB 00 779-0588-3 0 W RT DS/N OPI NSUR1 57199104
	5681	ECMEPATIEN T,ONE ( XXXX) 100 954$ 0 /000000000 876 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	5682	DOXEPI N 25MG CAP 00 839-7221-0 6 M RT DS/N OPI NSUR1 76194694
	5683	ECMEPATIEN T,ONE ( XXXX) 100 991$ 0 /000000000 915 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	5684	BACLOF EN 10MG TA BS 00 023-4534-6 7 W RT DS/N OPI NSUR1 75772098
	5685	ECMEPATIEN T,ONE ( XXXX) 101 860$ 0 /000000002 228 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	5686	IMIPRA MINE 25MG TAB 00 779-0588-3 0 W RT EX/N OPI NSUR1 57199347
	5687	ECMEPATIEN T,ONE ( XXXX) 101 861$ 0 /000000002 229 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	5688	CHLORA L HYDRATE 500MG C 00 003-0626-5 1 W RT DS/N OPI NSUR1 57199249
	5689	ECMEPATIEN T,ONE ( XXXX) 101 959$ 0 /000000002 331 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	5690	LIDOCA INE 2% 50M L INJ M 00 186-0240-0 2 W RT DS/N OPI NSUR1 51602609
	5691	ECMEPATIEN T,THREE ( XXXX) 102 225$ 0 /000000002 607 10/08/10 04:16PM SUBMIT E UNSTRA NDED p
	5692	BIPERI DEN 2MG TA B 00 044-0120-0 4 M RT DS/N OPI NSUR1 46160110
	5693
	5694
	5695	(This page included for two-si ded copyin g.)
	5696
	5697	8.1.7 Tota ls by Date
	5698
	5699	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.
	5700
	5701	You must h old the BP SMENU and BPS REPORT S keys to view the T otals by D ay Report option.
	5702
	5703
	5704	Access the report by entering DAY at the “Select C laim Resul ts and Sta tus Option :” prompt on the Cla im Results and Statu s option s creen.
	5705	Example 8. 1.7-1: Tot als by Dat e Option
	5706	*** ****** ****** ****** ****** **
	5707	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	5708	* XXXXX V AMC *
	5709	* Cla im Results and Statu s *
	5710	*** ****** ****** ****** ****** **
	5711
	5712	PAY Payable Cl aims Repor t
	5713	REJ Rejected C laims Repo rt
	5714	ECMP CMOP/ECME Activity R eport
	5715	REV Reversal C laims Repo rt
	5716	NYR Claims Sub mitted, No t Yet Rele ased
	5717	REC Recent Tra nsactions
	5718	DAY Totals by Date
	5719	CLO Closed Cla ims Report
	5720	NBS Non-Billab le Status Report
	5721	SPA Spending A ccount Rep ort
	5722
	5723
	5724	Select Cla im Results and Statu s Option: DAY Total s by Date
	5725
	5726	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.
	5727	Example 8. 1.7-2: Add itional pr ompts aske d by the T otals by D ay Option
	5728	START WITH TRANSACTI ON DATE: T -1// T-30
	5729	GO TO TR ANSACTION DATE: T// <Enter>
	5730
	5731	Selec t one of t he followi ng:
	5732
	5733	R RELEASED
	5734	N NOT RELEAS ED
	5735	A ALL
	5736
	5737	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	5738
	5739	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	5740
	5741	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	5742	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	5743
	5744	DEVICE: HO ME// <Ente r> IP netw ork
	5745	Please wai t...
	5746
	5747
	5748	Example 8. 1.7-3: Tot als by Dat e Report ( Compacted to fit int o document )
	5749	ECME TOTAL S DETAIL R EPORT Print D ate: SEP 2 3, 2005@15 :18:52 Pa ge: 1
	5750	DIVISION(S ): ALL Fil l Location s: C,M,W F ill type: RT,BB,RS
	5751	Insurance: DEVELOPME NT INS, OP INSUR1 D rugs/Class es: ALL
	5752	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 09/23/ 05 through 09/23/05
	5753	========== ========== ========== ========== ========== ========== ========== ========== ======
	5754	AMOUNT RETURNE D RETURNE D AMO UNT
	5755	DATE #CLAIMS SUBMITTED REJECTE D PAYABL E TO RECE IVE DIFF ERENCE
	5756	========== ========== ========== ========== ========== ========== ========== ========== ======
	5757	DIVISION: ZZZZZZZ
	5758	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------
	5759	09/23/05 2 90.00 45.0 0 45.0 0 40 .00 5.00
	5760	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------
	5761	TOTALS 2 90.00 45.0 0 45.0 0 40 .00 5.00
	5762	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ------
	5763	GRAND TOTA LS 2 90.00 45.0 0 45.0 0 40 .00 5.00
	5764
	5765	Press RETU RN to cont inue:
	5766
	5767	8.1.8 Clos ed Claims Report
	5768	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.
	5769
	5770	You must h old the BP SMENU and BPS REPORT S keys to view the C losed Clai ms Report option.
	5771
	5772	Access the report by entering CLO at the “Select C laim Resul ts and Sta tus Option :” prompt on the Cla im Results and Statu s option s creen.
	5773	Example 8. 1.8-1: Acc essing the Closed Cl aims Repor t Option
	5774	*** ****** ****** ****** ****** **
	5775	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	5776	* XXXXX V AMC *
	5777	* Cla im Results and Statu s *
	5778	*** ****** ****** ****** ****** **
	5779
	5780
	5781
	5782	PAY Payable Cl aims Repor t
	5783	REJ Rejected C laims Repo rt
	5784	ECMP CMOP/ECME Activity R eport
	5785	REV Reversal C laims Repo rt
	5786	NYR Claims Sub mitted, No t Yet Rele ased
	5787	REC Recent Tra nsactions
	5788	DAY Totals by Date
	5789	CLO Closed Cla ims Report
	5790	NBS Non-Billab le Status Report
	5791	SPA Spending A ccount Rep ort
	5792
	5793
	5794	Select Cla im Results and Statu s Option: CLO Close d Claims R eport
	5795
	5796
	5797	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, Sel ected Pati ents or Al l, Excel d isplay for mat and de vice selec tion.
	5798	Example 8. 1.8-2: Sel ecting Spe cific Clos e Claim Re ason Optio n
	5799	START WITH CLOSE DAT E: T-1// T -50
	5800	GO TO CL OSE DATE: T// <Enter >
	5801
	5802	Selec t one of t he followi ng:
	5803
	5804	R RELEASED
	5805	N NOT RELEAS ED
	5806	A ALL
	5807
	5808	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: RELEASE D// ALL
	5809
	5810	Select one of th e followin g:
	5811	S Specific C lose Claim Reason
	5812	A ALL
	5813
	5814	Include (S )pecific C lose Claim Reason or (A)LL: AL L// <Enter >
	5815
	5816	Selec t one of t he followi ng:
	5817
	5818	V VETERAN
	5819	T TRICARE
	5820	C CHAMPVA
	5821	A ALL
	5822
	5823	Display (V )ETERAN or (T)RICARE or (C)HAM PVA or (A) LL: A// AL L
	5824
	5825	Selec t one of t he followi ng:
	5826
	5827	P Patient
	5828	A ALL
	5829
	5830	Display Se lected (P) atients or (A)LL: AL L// ALL
	5831
	5832	Data field for bille d amount w ill only b e included when the report is captured
	5833	for an Exc el documen t. All add itional da ta fields may not be present f or all
	5834	reports.
	5835
	5836	Do you wan t to captu re report data for a n Excel do cument? NO // <Enter>
	5837
	5838	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	5839	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	5840
	5841	DEVICE: HO ME// <Ente r> IP netw ork
	5842	Please wai t...
	5843
	5844
	5845
	5846	Example 8. 1.8-2: Clo sed Claims Report
	5847	ECME CLOSE D CLAIMS D ETAIL REPO RT P rint Date: APR 17, 2 009@14:21: 22 Page: 1
	5848	DIVISION(S ): ALL Fill Lo cations: C ,M,W Fill type: RT, BB,RS
	5849	Insurance: ALL Close Rea son: ALL Drugs/ Classes: A LL
	5850	Eligibilit y: ALL Pa tient: AL L
	5851	RELEASED P RESCRIPTIO NS BY CLOS E DATE: Fr om 03/18/0 9 through 04/17/09
	5852	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	5853	PATIENT NA ME Pt.ID ELIG RX# REF/EC ME# RX I NFO DRUG NDC
	5854	CARDHOL D.ID GROUP ID CLOSE DAT E/TIME C LOSED BY CLO SE REASON
	5855	COB
	5856	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	5857	DIVISION: YYYYYYYY
	5858	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	5859	ECME1 INSU RANCE
	5860	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	5861	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
	5862	1234098 7 10001 03/20/09 03:55PM E CMEUSER,ON E IN VALID NDC FROM CMOP
	5863	p
	5864	Claim ID: VA2009=500 0000021=00 0010=00054 94
	5865	54:Non-M atched Pro duct/Servi ce ID Numb er
	5866
	5867	SUBTOTALS for INS: E CMEUSER,ON E
	5868	ECMEPAT ,ONE 1
	5869	-----
	5870	CLOSED CLA IMS SUBTOT AL 1
	5871
	5872	SUBTOTALS for DIV:YY YYYYYY
	5873	ECMEUSE R,ONE 1
	5874	-----
	5875	CLOSED CLA IMS SUBTOT AL 1
	5876
	5877	GRAND TOTA LS (ALL DI VISIONS) B Y BILLER
	5878	ECMEUSE R,ONE 1
	5879	-----
	5880	CLOSED CLA IMS GRAND TOTAL 1
	5881
	5882
	5883
	5884
	5885
	5886
	5887
	5888	8.1.9 Non- Billable S tatus Repo rt
	5889	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.
	5890
	5891
	5892	You must h old the BP SMENU and BPS REPORT S keys to view the N on-Billabl e Status R eport opti on.
	5893
	5894
	5895
	5896	Access the report by entering NBS at the “Select C laim Resul ts and Sta tus Option :” prompt on the Cla im Results and Statu s option s creen.
	5897	Example 8. 1.9-1: Acc essing the Non-Billa ble Status Report Op tion
	5898	*** ****** ****** ****** ****** **
	5899	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	5900	* XXXXX V AMC *
	5901	* Cla im Results and Statu s *
	5902	*** ****** ****** ****** ****** **
	5903
	5904
	5905
	5906	PAY Payable Cl aims Repor t
	5907	REJ Rejected C laims Repo rt
	5908	ECMP CMOP/ECME Activity R eport
	5909	REV Reversal C laims Repo rt
	5910	NYR Claims Sub mitted, No t Yet Rele ased
	5911	REC Recent Tra nsactions
	5912	DAY Totals by Date
	5913	CLO Closed Cla ims Report
	5914	NBS Non-Billab le Status Report
	5915	SPA Spending A ccount Rep ort
	5916
	5917
	5918	Select Cla im Results and Statu s Option: NBS Non-B illable St atus Repor t
	5919
	5920	After you have made selections from the “ALL REPOR TS” prompt s, you wil l be given a series of prompts as shown below:
	5921
	5922
	5923
	5924	Example 8. 1.9-2: Sel ecting Non -Billable Status Rep ort option
	5925	START WITH TRANSACTI ON DATE: T -1// T-10 (MAY 29, 2015)
	5926	GO TO TRAN SACTION DA TE: T// T (JUN 08, 2015)
	5927
	5928	Selec t one of t he followi ng:
	5929
	5930	R RELEASED
	5931	N NOT RELEAS ED
	5932	AALL
	5933
	5934	Include Rx s - (R)ELE ASED or (N )OT RELEAS ED or (A)L L: ALL//
	5935	R Most Recen t
	5936	A ALL
	5937
	5938	Select Mos t (R)ecent or (A)ll: MOST RECE NT//
	5939
	5940	Selec t one or m ore of the following :
	5941
	5942	V VETERAN
	5943	T TRICARE
	5944	C CHAMPVA
	5945	A ALL
	5946
	5947	Display (V )ETERAN or (T)RICARE or (C)HAM PVA or (A) LL: ALL//
	5948
	5949	Selec t one of t he followi ng:
	5950
	5951	P Patient
	5952	A ALL
	5953
	5954	Display Se lected (P) atients or (A)LL: AL L//
	5955
	5956	Selec t one of t he followi ng:
	5957
	5958	R Range
	5959	A ALL
	5960
	5961	Select (R) ange for B illed Amou nt or (A)L L: ALL//
	5962
	5963	Selec t one of t he followi ng:
	5964
	5965	S NON-BILLAB LE STATUS
	5966	A ALL
	5967
	5968	Select Cer tain Non-B illable (S )tatus or (A)ll: ALL //
	5969
	5970
	5971
	5972	Do you wan t to captu re report data for a n Excel do cument? NO //
	5973
	5974	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	5975	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	5976
	5977	DEVICE: HO ME// HOM E (CRT) Right Ma rgin: 80// 132
	5978	Please wai t...
	5979
	5980	Example 8. 1.9-3: Non -Billable Status Rep ort
	5981	ECME RXs W ITH Non-Bi llable STA TUS REPORT Print Dat e: Sept 26 , 2014@11: 41:54 Pag e: 1
	5982	DIVISION(S ): GENERIC Fill Locat ions: C,M, W
	5983	Insurance: ALL D rugs/Class es: ALL
	5984	Eligibilit ies: ALL Patient Na me: ALL
	5985	NON-BILLAB LE STATUS: ALL
	5986	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 2/22/0 9 through 09/23/14
	5987	========== ========== ========== ========== ========== ========== ========== ========== ========== =======
	5988	PATIENT NA ME Pt. ID ELIG RX# REF DATE $DRUG COST
	5989	DRUG NDC REL EASED ON RX INFO NON-B ILLABLE ST ATUS
	5990	========== ========== ========== ========== ========== ========== ========== ========== ========== =======
	5991	DIVISION: GENERIC DI VISION
	5992	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------
	5993	GENERIC IN S
	5994	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------
	5995	ECMEpatien t,One (XX XX) TRI ######$ 2 04/15/ 09 5 1.00
	5996	AMITRI PTYLINE 10 MG TAB 00182-10 18-10 04/ 15/09 W AC/R Plan not active , local
	5997	ECMEpatien t, Three (XX XX) VET ######$ 0 03/10/ 09 5 1.00
	5998	METHAD ONE 10MG T AB 000054-8 554-2 03/ 10/09 W EX/N Plan not linked to Payer
	5999
	6000	------ ----
	6001	SUBTOTALS for INS:GE NERIC INS 102. 00
	6002	COUNT 2
	6003	MEAN 51. 00
	6004
	6005	Press RETU RN to cont inue
	6006
	6007	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------
	6008	GENERIC IN SURANCE 2
	6009	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -------
	6010	ECMEpatien t, Two (XX XX) VET 100574$ 0 03/05/ 09 5 1.00
	6011	NEODEC ADRON OPHT MALIC SOL. 00006-76 39-03 03/ 05/08 W AC/R Plan n ot found
	6012
	6013	ECMEpatien t, Two (XX XX) VET 100575$ 0 03/05/ 09 5 1.00
	6014	PENTAE RYTHRITOL 10MG TAB 00725-20 64-10 03/ 05/08 W AC/R Plan D eactivated
	6015
	6016	...
	6017
	6018	SUBTOTALS for INS:GE NERIC INSU RANCE 2 214 2.00
	6019	COUNT 42
	6020	MEAN 5 1.00
	6021
	6022	------ ----
	6023	SUBTOTALS for DIV:GE NERIC DIVI SION 224 4.00
	6024	COUNT 44
	6025	MEAN 5 1.00
	6026
	6027	------ ----
	6028	GRAND TOTA LS 224 4.00
	6029	COUNT 44
	6030	MEAN 5 1.00
	6031
	6032	Press RETU RN to cont inue:
	6033
	6034
	6035
	6036	(This page included for two-si ded copyin g.
	6037
	6038
	6039
	6040	8.1.10 Spe nding Acco unt Report
	6041	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.
	6042
	6043
	6044	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.
	6045	Example 8. 1.10-1: Ac cessing th e Spending Account R eport Opti on
	6046	*** ****** ****** ****** ****** **
	6047	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	6048	* XXXXX V AMC *
	6049	* Cla im Results and Statu s *
	6050	*** ****** ****** ****** ****** **
	6051
	6052
	6053
	6054	PAY Payable Cl aims Repor t
	6055	REJ Rejected C laims Repo rt
	6056	ECMP CMOP/ECME Activity R eport
	6057	REV Reversal C laims Repo rt
	6058	NYR Claims Sub mitted, No t Yet Rele ased
	6059	REC Recent Tra nsactions
	6060	DAY Totals by Date
	6061	CLO Closed Cla ims Report
	6062	NBS Non-Billab le Status Report
	6063	SPA Spending A ccount Rep ort
	6064
	6065
	6066	Select Cla im Results and Statu s Option: SPA Spe nding Acco unt Report
	6067	Example 8. 1.10-2: Se lecting Sp ending Acc ount Repor t Option
	6068	Selec t one of t he followi ng:
	6069
	6070	D DIVISION
	6071	A ALL
	6072
	6073	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: DIVI SION
	6074
	6075	Select ECM E Pharmacy Division( s): XXXXXX X
	6076	Selected :
	6077	XXXXXXXX
	6078
	6079	Select ECM E Pharmacy Division( s): YYYYYY Y CBOC X XX
	6080	Selected :
	6081	XXXXXXXX
	6082	XXXXX
	6083
	6084	Select ECM E Pharmacy Division( s):
	6085
	6086	Selec t one of t he followi ng:
	6087
	6088	S Summary
	6089	D Detail
	6090
	6091	Display (S )ummary or (D)etail Format: De tail//
	6092
	6093	Selec t one of t he followi ng:
	6094
	6095	I SPECIFIC I NSURANCE(S )
	6096	A ALL
	6097
	6098	Select Cer tain (I)NS URANCE or (A)LL): A/ / ALL
	6099
	6100	Selec t one of t he followi ng:
	6101
	6102	C CMOP
	6103	M Mail
	6104	W Window
	6105	A ALL
	6106
	6107	Display (C )MOP or (M )ail or (W )indow or (A)LL: ALL //
	6108
	6109	Selec t one of t he followi ng:
	6110
	6111	R Real Time Fills
	6112	B Backbill
	6113	S ReSubmissi on
	6114	A ALL
	6115
	6116	Display (R )ealTime, (B)ackbill s, (P)RO O ption, Re( S)ubmissio n or (A)LL : A//
	6117
	6118
	6119	Selec t one of t he followi ng:
	6120
	6121	D Drug
	6122	C Drug Class
	6123	A ALL
	6124
	6125	Display Sp ecific (D) rug or Dru g (C)lass or (A)LL: ALL//
	6126
	6127	START WITH TRANSACTI ON DATE: T -1//
	6128	GO TO TR ANSACTION DATE: T//
	6129
	6130	Selec t one of t he followi ng:
	6131
	6132	R RELEASED
	6133	N NOT RELEAS ED
	6134	A ALL
	6135
	6136	Include R xs - (R)EL EASED or ( N)OT RELEA SED or (A) LL: RELEAS ED//
	6137
	6138	Selec t one of t he followi ng:
	6139
	6140	S Specific R eject Code
	6141	A ALL
	6142
	6143	Include ( S)pecific Reject Cod e or (A)LL : ALL//
	6144
	6145	Do you wan t to captu re report data for a n Excel do cument? NO //
	6146
	6147	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	6148	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	6149
	6150	DEVICE: HO ME//
	6151
	6152	Please wai t...
	6153
	6154
	6155
	6156	Example 8. 1.10-3: Sp ending Acc ount Repor t – Summar y
	6157
	6158	ECME SPEND ING ACCOUN T REPORT S UMMARY REP ORT P rint Date: DEC 02, 2 011@16:51: 34 Page: 1
	6159	DIVISION(S ): ALL F ill Locati ons: C,M,W Fill typ e: RT,BB,P 2,RS
	6160	Insurance: ALL Dru gs/Classes : ALL
	6161	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 06/05/ 11 through 12/02/11
	6162	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	6163	PATIENT NA ME Pt. ID RX# REF /ECME# DA TE $BILLED $IN S RESPONSE $COLLE CT
	6164	DRUG RX INFO INS GR OUP# I NS GROUP N AME BILL#
	6165	$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
	6166	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	6167	DIVISION: XXXXXX
	6168	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	6169
	6170	-- -------- ---------- -------- --
	6171	SUBTOTALS for INS:EP HARM INSUR ANCE 12.00 999999.99 0. 00
	6172	0.00 0 .00 0.00 0.00 0.0 0 0.00 12.3 0
	6173	COUNT 1 1 1
	6174	1 1 1 1 1 1 1
	6175	MEAN 12.00 999999.99 0. 00
	6176	0.00 0 .00 0.00 0.00 0.0 0 0.00 12.3 0
	6177
	6178	-- -------- ---------- -------- --
	6179	SUBTOTALS for INS:EX PRESS SCRI PTS 9 99999.99 999999.99 0. 00
	6180	0.00 0 .00 0.00 0.00 0.0 0 0.00 15.4 1
	6181	COUNT 1 1 1
	6182	1 1 1 1 1 1 1
	6183	MEAN 9 99999.99 999999.99 0. 00
	6184	0.00 0 .00 0.00 0.00 0.0 0 0.00 15.4 1
	6185
	6186	-- -------- ---------- -------- --
	6187	SUBTOTALS for DIV:XX XXXX 10 00011.99 1999999.98 0. 00
	6188	0.00 0 .00 0.00 0.00 0.0 0 0.00 27.7 1
	6189	COUNT 2 2 2
	6190	2 2 2 2 2 2 2
	6191	MEAN 5 00006.00 999999.99 0. 00
	6192	0.00 0 .00 0.00 0.00 0.0 0 0.00 13.8 6
	6193
	6194	-- -------- ---------- -------- --
	6195	GRAND TOTA LS 10 00011.99 1999999.98 0. 00
	6196	0.00 0 .00 0.00 0.00 0.0 0 0.00 27.7 1
	6197	COUNT 2 2 2
	6198	2 2 2 2 2 2 2
	6199	MEAN 5 00006.00 999999.99 0. 00
	6200	0.00 0 .00 0.00 0.00 0.0 0 0.00 13.8 6
	6201
	6202	Press RETU RN to cont inue:
	6203
	6204	Example 8. 1.10-4: Sp ending Acc ount Repor t – Detail
	6205	ECME SPEND ING ACCOUN T REPORT D ETAIL REPO RT P rint Date: DEC 02, 2 011@17:16: 36 Page: 1
	6206	DIVISION(S ): ALL F ill Locati ons: C,M,W Fill typ e: RT,BB,P 2,RS
	6207	Insurance: ALL Dru gs/Classes : ALL
	6208	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 06/05/ 11 through 12/02/11
	6209	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	6210	PATIENT NA ME Pt. ID RX# REF /ECME# DA TE $BILLED $IN S RESPONSE $COLLE CT
	6211	DRUG RX INFO INS GR OUP# I NS GROUP N AME BILL#
	6212	$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
	6213	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ==
	6214	DIVISION: XXXXXX
	6215	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	6216	EPHARM INS URANCE
	6217	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	6218	OPCOB,ONEC NF (16 6P) 27193 07 0/4 316136 08 /24/11 12.00 999999.99 0. 00
	6219	ATENOLOL 25MG TAB W P2 EX/R T00010 E PHARM INSU RANCE K1000F7
	6220	0.00 0.00 0. 00 0.00 0.00 0.00 12.30
	6221	Claim ID: VA2011=405 0000015=00 0010=00010 47
	6222
	6223	-- -------- ---------- -------- --
	6224	SUBTOTALS for INS:EP HARM INSUR ANCE 12.00 999999.99 0. 00
	6225	0.00 0 .00 0.00 0.00 0.0 0 0.00 12.3 0
	6226	COUNT 1 1 1
	6227	1 1 1 1 1 1 1
	6228	MEAN 12.00 999999.99 0. 00
	6229	0.00 0 .00 0.00 0.00 0.0 0 0.00 12.3 0
	6230
	6231
	6232	EXPRESS SC RIPTS
	6233	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- --
	6234	OPCOB,ONEC NF (16 6P) 27193 07 0/4 316136 08 /24/11 9 99999.99 999999.99 0. 00
	6235	ATENOLOL 25MG TAB W P2 EX/R T10000 0 E XPRESS SCR IPTS K1000F6
	6236	0.00 0.00 0. 00 0.00 0.00 0.00 15.41
	6237	Claim ID: VA2011=405 0000015=00 0010=00010 46
	6238
	6239	-- -------- ---------- -------- --
	6240	SUBTOTALS for INS:EX PRESS SCRI PTS 9 99999.99 999999.99 0. 00
	6241	0.00 0 .00 0.00 0.00 0.0 0 0.00 15.4 1
	6242	COUNT 1 1 1
	6243	1 1 1 1 1 1 1
	6244	MEAN 9 99999.99 999999.99 0. 00
	6245	0.00 0 .00 0.00 0.00 0.0 0 0.00 15.4 1
	6246
	6247
	6248	-- -------- ---------- -------- --
	6249	SUBTOTALS for DIV:XX XXXX 10 00011.99 1999999.98 0. 00
	6250	0.00 0 .00 0.00 0.00 0.0 0 0.00 27.7 1
	6251	COUNT 2 2 2
	6252	2 2 2 2 2 2 2
	6253	MEAN 5 00006.00 999999.99 0. 00
	6254	0.00 0 .00 0.00 0.00 0.0 0 0.00 13.8 6
	6255
	6256	-- -------- ---------- -------- --
	6257	GRAND TOTA LS 10 00011.99 1999999.98 0. 00
	6258	0.00 0 .00 0.00 0.00 0.0 0 0.00 27.7 1
	6259	COUNT 2 2 2
	6260	2 2 2 2 2 2 2
	6261	MEAN 5 00006.00 999999.99 0. 00
	6262	0.00 0 .00 0.00 0.00 0.0 0 0.00 13.8 6
	6263
	6264	Press RETU RN to cont inue:
	6265
	6266
	6267
	6268	8.2 Other Reports
	6269	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.
	6270
	6271	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.
	6272
	6273	Example 8. 2-1: Acces sing the O ther Repor ts Option
	6274	*** ****** ****** ****** ****** **
	6275	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	6276	* XXXX X *
	6277	* Pharmacy Electroni c Claims R eports *
	6278	*** ****** ****** ****** ****** **
	6279
	6280
	6281	CLA Claim Resu lts and St atus ...
	6282	OTH Other Repo rts ...
	6283
	6284
	6285	Select Pha rmacy Elec tronic Cla ims Report s Option: OTH Other Reports
	6286
	6287	Example 8. 2-2: Displ aying Othe r Reports Options
	6288	*** ****** ****** ****** ****** **
	6289	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	6290	* XXXX X *
	6291	* Other Re ports *
	6292	*** ****** ****** ****** ****** **
	6293
	6294
	6295	CRI ECME Claim s-Response Inquiry
	6296	PAY Payer Shee t Detail R eport
	6297	PHAR ECME Setup - Pharmac ies Report
	6298	TAT Turn-aroun d time sta tistics
	6299	VER View ePhar macy Rx
	6300	OPR OPECC Prod uctivity R eport
	6301
	6302
	6303	Select Oth er Reports Option:
	6304
	6305
	6306	8.2.1 ECME Claims-Re sponse Inq uiry Optio n
	6307
	6308	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.
	6309
	6310	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.
	6311
	6312	Example 8. 2.1-1: Acc essing the ECME Clai ms-Respons e Inquiry Option
	6313	*** ****** ****** ****** ****** **
	6314	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	6315	* XXXX X *
	6316	* Other Re ports *
	6317	*** ****** ****** ****** ****** **
	6318
	6319
	6320	CRI ECME Claim s-Response Inquiry
	6321	PAY Payer Shee t Detail R eport
	6322	PHAR ECME Setup - Pharmac ies Report
	6323	TAT Turn-aroun d time sta tistics
	6324	VER View ePhar macy Rx
	6325	OPR OPECC Prod uctivity R eport
	6326
	6327
	6328	Select Oth er Reports Option: C RI ECME C laims-Resp onse Inqui ry
	6329
	6330	Example 8. 2.1-2: ECM E Claims-R esponse In quiry Opti on
	6331	Select VA Claim ID: VA2009=500 0000021=10 5220=00055 24 VA2009 =500000002 1=105220=0
	6332	005524
	6333
	6334	Note: This report co ntains thr ee separat e sections - transac tion data, claims
	6335	data , and resp onse data. There wi ll be a pa ge break/f orm feed a fter
	6336	each section r egardless of the pag e length s pecified i n the devi ce input.
	6337
	6338	DEVICE: HO ME// <Ente r> UCX/T ELNET R ight Margi n: 80// < Enter>
	6339
	6340	ECME Claim s-Response Inquiry R eport Pr int Date: 04/17/09
	6341	VA CLAIM I D: VA2009= 5000000021 =105220=00 05524
	6342
	6343	BPS TRANSA CTION/BPS LOG OF TRA NSACTION D ATA:
	6344
	6345	ENTRY#: 11 3414.00042 STATUS: 99
	6346	PHARMACY : PHARM1 PRESCRIPTI ON #: 1021 79
	6347	RXI-INTE RNAL (c): 113414
	6348	PLAN NAM E: COB INS URANCE PHARMACY P LAN ID: VA 105220
	6349	CLAIM IE N (c): 552 4 RESPONSE I EN (c): 53 69
	6350
	6351	Press RETU RN to cont inue, '^' to exit:
	6352	BPS CLAIMS FILE DATA :
	6353
	6354
	6355	CLAIM ID: VA2009=500 0000021=10 5220=00055 24
	6356	ELECTRON IC PAYER: MNMEDB1 TRANSMIT F LAG: YES ( POINT OF S ALE)
	6357	TRANSMIT TED ON: AP R 17,2009@ 14:54:27 CREATED ON : APR 17,2 009@14:54: 27
	6358	TRANSACT ION: 11341 4.00042 PATIENT NA ME: ECMEpa tient,One
	6359	GROUP IN SURANCE PL AN: COB IN SURANCE BIN NUMBER : 610459
	6360	VERSION RELEASE NU MBER: D0 TRANSACTIO N CODE: B1
	6361	PROCESSO R CONTROL NUMBER: MH CP TRANSACTIO N COUNT: 1
	6362	SOFTWARE VENDER CE RT ID: SERVICE PR OVIDER ID: 500000002 1
	6363	SERVICE PROVIDER I D QUAL: 01 GROUP ID: C19977
	6364	CARDHOLD ER ID: C2X XXXXX PERSON COD E: C301
	6365	DATE OF BIRTH: C4X XXXXXXX PATIENT GE NDER CODE: MALE
	6366	PATIENT RELATIONSH IP CODE: C ARDHOLDER
	6367	PLACE OF SERVICE: C700 ELIGIBILIT Y CLARIFIC ATION CODE : C90
	6368	PATIENT FIRST NAME : CAONE PATIENT LA ST NAME: C BECMEPATIE NT
	6369	CARDHOLD ER FIRST N AME: CCONE
	6370	CARDHOLD ER LAST NA ME: CDECME PATIENT
	6371	HOME PLA N: CE36
	6372	PATIENT STREET ADD RESS: CM13 DFG
	6373	PATIENT CITY ADDRE SS: CNXXXX XXXX
	6374	PATIENT STATE PROV ADDRESS: COXX PATIENT ZI P POSTAL Z ONE: CPXXX XX
	6375	PATIENT PHONE NUMB ER: CQXXXX XXXXX PATIENT ID QUALIFIER : CX01
	6376	PATIENT ID: CYXXXX XXXX EMPLOYER I D: CZ
	6377	SMOKER I NDICATOR: 1C PREGNANCY INDICATOR: 2C
	6378	FACILITY ID: 8C
	6379	MEDICATION ORDER: 1 MEDICATION NAME: BET AZOLE 50MG /ML INJ
	6380	PRESCRIP TION NUMBE R: 102179 OTHER COVE RAGE CODE: C800
	6381	ALTERNAT E ID: CW00 0000000000 00000000
	6382	COB OTHER PAYMENT CO UNTER: 4C1 OTHER PAYE R COVERAGE TYPE: 5C0 1
	6383	OTHER PA YER ID QUA LIFIER: 6C 03 OTHER PAYE R ID: 7C12 3456
	6384	OTHER PA YER DATE: APR 14,200 9 OTHER PAYE R AMOUNT P AID COUNT: HB1
	6385	OTHER PA YER REJECT COUNT: 5E 00
	6386	OTHER PAYE R AMT PAID QUALIFIER : HC08 OTHER PAYE R AMOUNT P AID: DV004 00{
	6387	DATE OF SE RVICE: APR 14,2009 PR ESCRIPTION REFERENCE NUMBER: D 20113414
	6388	FILL NUM BER: D304 DAYS SUPPL Y: D5001
	6389	COMPOUND CODE: D61
	6390	PRODUCT SERVICE ID : D7000021 43916
	6391	DISPENSE AS WRITTE N: D80 INGREDIENT COST SUBM ITTED: D90 000510{
	6392	PRESCRIB ER ID: DBX XXXXXXXX DISPENSING FEE SUBMI TTED: DC00 000000
	6393	DATE PRE SCRIPTION WRITTEN: D E20090112
	6394	NUMBER O F REFILLS AUTHORIZED : DF05 LEVEL OF S ERVICE: DI 00
	6395	PRESCRIP TION ORIGI N CODE: DJ 1 SUBMISSION CLARIFICA TION CODE: DK00
	6396	BASIS OF COST DETE RMINATION: DN07 USUAL AND CUSTOMARY CHARGE: DQ 0000510{
	6397	SPECIAL PACKAGING INDICATOR: DT0 GROSS AMOU NT DUE: DU 0000510{
	6398	PRESCRIB ER LAST NA ME: ECMEPR ESCRIBER
	6399	OTHER PA YER AMOUNT : DV00400{
	6400	PATIENT PAID AMOUN T SUBMITTE D: DX00000 00{
	6401	PRODUCT SERVICE ID QUALIFIER : E103 QUANTITY D ISPENSED: E700000010 00
	6402	ORIGINAL LY PRESCRI BED QUANTI TY: EB0000 001000
	6403	SCHEDULE D RX ID NU MBER: EK00 0000000000
	6404	PRESCRIP TION SERVI CE REFEREN CE: EM1 QUANTITY P RESCRIBED: ET0000001 000
	6405	PRIOR AU THORIZATIO N TYPE COD E: EU00
	6406	PRIOR AU THORIZATIO N SUBMITTE D: EV00000 000000
	6407	INTERMED IARY AUTH TYPE ID: E W00
	6408	INTERMED IARY AUTHO RIZATION I D: EX
	6409	PRESCRIB ER ID QUAL IFIER: EZ0 1 PRESCRIBER LOCATION CODE: 1E
	6410	PC PROVI DER LOCATI ON CODE: H 5036 PC PROVIDE R LAST NAM E: 4EECMEP ROVIDER
	6411	PROFESSI ONAL FEE S UBMITTED: BE00000000
	6412	FLAT SAL ES TAX SUB MITTED: HA 00000000
	6413	PERCENTA GE SALES T AX SUBMITT ED: GE0000 000{
	6414	PERCENTA GE SALES T AX RATE: H E0000000 PERCENTAGE SALES TAX BASIS: JE
	6415	PRESCRIB ER PHONE N UMBER: PMX XXXXXXXXX
	6416	DATE OF SERVICE: 2 0090414 PLAN ID: F OECME INS
	6417	RAW DATA SENT:
	6418	61045951B 1MHCP 101500000 0021 2 0090414
	6419	AM01CX01C YXXXXXXXXX C41960010 1C51CAONEC BECMEPATIE NT CM13
	6420	DFG CNX XXXXXXX C OXXCPXXXXX CQXXXX XXXXXXC700
	6421	CZ 1C 2C
	6422	AM04C2234 234CCONECD ECMEPATIEN T CE36 FOECME INS C908C C1997 7
	6423	C301 C61
	6424	AM07EM1D2 0113414E10 3D70000214 3916 E7000000 1000D304D5 001D61D80D E20090112D
	6425	F05DJ1DK00 ET00000010 00C800DT0E B000000100 0CW0000000 0000000000 000EK00000 0000000DI0
	6426	0EU00EV000 00000000EW 00EX
	6427	AM02
	6428	AM03EZ01D BXXXXXXXXX X 1E ECMEPRESC RIBER H50364 EECMEPROVI DER
	6429	AM054C15C 016C037C12 3456 E8 20090414HB 1DV00400{
	6430	AM11D9000 0510{DC000 00000BE000 00000DX000 0000{HA000 00000GE000 0000{HE000 0000JE DQ
	6431	0000510{DU 0000510{DN 07
	6432
	6433
	6434	Press RETU RN to cont inue, '^' to exit:
	6435
	6436	BPS RESPON SE FILE DA TA:
	6437
	6438	BPS CLAIM: VA2009=50 00000021=1 05220=0005 524
	6439	DATE RES PONSE RECE IVED: APR 17, 2009@1 4:54:30
	6440	VERSION RELEASE NU MBER: D0 TRANSACTIO N CODE: B1
	6441	TRANSACT ION COUNT: 1 SERVICE PR OVIDER ID: XXXXXXXXX X
	6442	SERVICE PROVIDER I D QUALIFIE R: 01 DATE OF SE RVICE: APR 14,2009
	6443	RESPONSE STATUS: R EJECTED
	6444	MESSAGE: EV161-MAN DATORY FIE LD HC MISS ING IN SEG 05
	6445	MEDICATION ORDER: 1 TRANSACTIO N RESPONSE STATUS: R EJECTED
	6446	PRESCRIP TION RESPO NSE STATUS : REJECTED CLAIM
	6447	REJECT C OUNT: 04
	6448	REJECT COD E: 85 (Cla im Not Pro cessed)
	6449	REJECT COD E: NN (Tra nsaction R ejected At Switch Or Intermedi ary
	6450	REJECT COD E: R8 (Syn tax Error)
	6451	REJECT COD E: HC (M/I Other Pay er Amount Paid Quali fier)
	6452	REJECT COD E: 79 (REF ILL TOO SO ON)
	6453	NEXT AVA IL FILL DA TE: APR 20 ,2009
	6454	RAW DATA RECEIVED:
	6455	VA2009=XX XXXXXXXX=1 05220=000x xxxxxB11R0 1XXXXXXXXX X
	6456	20090414\ X1E\\X1C\A M20\X1C\F4 EV161-MAND ATORY FIEL D HC MISSI NG IN SEG
	6457	05\X1D\\X 1E\\X1C\AM 21\X1C\ANR \X1C\FA04\ X1C\FB85\X 1C\FBNN\X1 C\FBR8\X1C \FBHC
	6458
	6459	Press RETU RN to cont inue:
	6460
	6461
	6462
	6463
	6464	8.2.2 Paye r Sheet De tail Repor t Option
	6465
	6466	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.
	6467
	6468	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.
	6469
	6470	Example 8. 2.2-1: Acc essing the Payer She et Detail Report Opt ion
	6471	*** ****** ****** ****** ****** **
	6472	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	6473	* XXXXX V AMC *
	6474	* Other Re ports *
	6475	*** ****** ****** ****** ****** **
	6476
	6477
	6478	CRI ECME Claim s-Response Inquiry
	6479	PAY Payer Shee t Detail R eport
	6480	PHAR ECME Setup - Pharmac ies Report
	6481	TAT Turn-aroun d time sta tistics
	6482	VER View ePhar macy Rx
	6483	OPR OPECC Prod uctivity R eport
	6484
	6485
	6486	Select Oth er Reports Option: P AY Payer Sheet Deta il Report
	6487	Example 8. 2.2-2: Pay er Sheet D etail Repo rt Option
	6488	Select Pay er Sheet: ABCTEST1
	6489
	6490	DEVICE: HO ME// IP network
	6491
	6492	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 1
	6493	Payer Sh eet Name: ABCTEST1 Version Number: 7
	6494	Status: PRODUCTION NCPDP Version: V ersion D.0
	6495
	6496
	6497	Seq Field Fie ld Name Proc Mode
	6498	--- ----- --- ------- ---------
	6499	* Trans action Hea der Segmen t *
	6500	1 101-A 1 BIN NUMBER S
	6501	2 102-A 2 VER SION/RELEA SE NUMBER S
	6502	3 103-A 3 TRA NSACTION C ODE S
	6503	5 104-A 4 PRO CESSOR CON TROL NUMBE R S
	6504	17 202-B 2 SER V PROVIDER ID QUALIF IER S
	6505	19 201-B 1 SER VICE PROVI DER ID S
	6506	21 401-D 1 DAT E FILLED S
	6507
	6508	Press RETU RN to cont inue, '^' to exit: < Enter>
	6509
	6510
	6511	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 2
	6512	Payer Sh eet Name: ABCTEST1 Version Number: 7
	6513
	6514	Seq Field Fie ld Name Proc Mode
	6515	--- ----- --- ------- ---------
	6516	* Trans action Hea der Segmen t *
	6517	22 110-A K SOF TWARE VEND OR/CERT ID S
	6518
	6519	* Patient Se gment *
	6520	31 111-A M SEG MENT IDENT IFICATION S
	6521	33 331-C X PAT IENT ID QU ALIFIER S
	6522	35 332-C Y PAT IENT ID S
	6523	36 304-C 4 DAT E OF BIRTH S
	6524	37 305-C 5 SEX CODE S
	6525	39 307-C 7 CUS TOMER LOCA TION S
	6526	40 335-2 C PRE GNANCY IND ICATOR S
	6527
	6528	* I nsurance S egment *
	6529	49 111-A M SEG MENT IDENT IFICATION S
	6530	51 302-C 2 CAR DHOLDER ID NUMBER S
	6531	53 301-C 1 GRO UP NUMBER S
	6532
	6533	Press RETU RN to cont inue, '^' to exit: < Enter>
	6534
	6535	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 3
	6536	Payer Sh eet Name: ABCTEST1 Version Number: 7
	6537
	6538	Seq Field Fie ld Name Proc Mode
	6539	--- ----- --- ------- ---------
	6540	* I nsurance S egment *
	6541	54 306-C 6 REL ATIONSHIP CODE S
	6542
	6543	* Claim Seg ment *
	6544	64 111-A M SEG MENT IDENT IFICATION S
	6545	66 455-E M RX/ SERVICE RE F NUMBER Q UAL S
	6546	69 402-D 2 PRE SCRIPTION NUMBER S
	6547	71 436-E 1 PRO DUCT/SERV ID QUAL S
	6548	73 407-D 7 PRO DUCT/SERVI CE ID S
	6549	75 442-E 7 QUA NTITY DISP ENSED S
	6550	77 403-D 3 NEW /REFILL CO DE S
	6551	78 405-D 5 DAY S SUPPLY S
	6552	79 406-D 6 COM POUND CODE S
	6553	80 408-D 8 OTH ER COVERAG E CODE S
	6554	82 414-D E DAT E PRESCRIP TION WRITT EN S
	6555	85 308-C 8 OTH ER COVERAG E CODE S
	6556
	6557	Press RETU RN to cont inue, '^' to exit: < Enter>
	6558
	6559	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 4
	6560	Payer Sh eet Name: ABCTEST1 Version Number: 7
	6561
	6562	Seq Field Fie ld Name Proc Mode
	6563	--- ----- --- ------- ---------
	6564	* Claim Seg ment *
	6565	87 429-D T UNI T DOSE IND ICATOR S
	6566	89 453-E J ORI G PRESCR P ROD/SERV I D QUAL S
	6567	92 445-E A ORI G PRESCRIB ED PROD/SE RV CODE S
	6568	95 446-E B ORI GINALLY PR ESCRIBED Q TY S
	6569	97 418-D I LEV EL OF SERV ICE S
	6570	99 461-E U PRI OR AUTHORI ZATION TYP E CODE S
	6571	102 462-E V PRI OR AUTHORI ZATION NUM SUB S
	6572	106 463-E W INT ERMED AUTH TYPE ID S
	6573	109 464-E X INT ERMEDIARY AUTHORIZAT ION ID S
	6574	112 343-H D DIS PENSING ST ATUS S
	6575	114 344-H F QTY INTENDED TO BE DISP ENSED S
	6576	117 345-H G DAY S SUPPLY I NTEND TO B E DISP S
	6577
	6578	* Pharm acy Provid er Segment *
	6579	127 111-A M SEG MENT IDENT IFICATION S
	6580
	6581	Press RETU RN to cont inue, '^' to exit: < Enter>
	6582
	6583	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 5
	6584	Payer Sh eet Name: ABCTEST1 Version Number: 7
	6585
	6586	Seq Field Fie ld Name Proc Mode
	6587	--- ----- --- ------- ---------
	6588	* Pharm acy Provid er Segment *
	6589	129 465-E Y PRO VIDER ID Q UALIFIER S
	6590	131 444-E 9 PRO VIDER ID S
	6591
	6592	* P rescriber Segment *
	6593	140 111-A M SEG MENT IDENT IFICATION S
	6594	142 466-E Z PRE SCRIBER ID QUALIFIER S
	6595	144 411-D B PRE SCRIBER ID S
	6596	146 427-D R PRE SCRIBER LA ST NAME S
	6597	148 498-P M PRE SCRIBER TE LEPHONE NU MBER S
	6598	150 468-2 E PRI MARY CARE PROV ID QU AL S
	6599	153 421-D L PRI MARY PRESC RIBER S
	6600	155 469-H 5 PRI M CARE PRO V LOCATION CODE S
	6601	158 470-4 E PRI M CARE PRO VIDER LAST NAME S
	6602
	6603
	6604	Press RETU RN to cont inue, '^' to exit: < Enter>
	6605
	6606	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 6
	6607	Payer Sh eet Name: ABCTEST1 Version Number: 7
	6608
	6609	Seq Field Fie ld Name Proc Mode
	6610	--- ----- --- ------- ---------
	6611	* COB/O ther Payme nts Segmen t *
	6612	168 111-A M SEG MENT IDENT IFICATION S
	6613	170 337-4 C COB /OTHER PAY MENTS COUN TER S
	6614	172 338-5 C OTH ER PAYER C OVERAGE TY PE S
	6615	174 339-6 C OTH ER PAYER I D QUALIFIE R S
	6616	177 340-7 C OTH ER PAYER I D S
	6617	180 443-E 8 Oth er Payer D ate S
	6618	182 341-H B OTH ER PAYER A MOUNT PAID COUNT S
	6619	185 342-H C OTH PYR AMOUN T PAID QUA L. S
	6620	188 431-D V OTH ER PAYOR A MOUNT S
	6621	190 471-5 E OTH ER PAYER R EJECT COUN T S
	6622	192 472-6 E OTH ER PAYER R EJECT CODE S
	6623
	6624	* Workers ' Compensa tion Segme nt *
	6625	202 111-A M SEG MENT IDENT IFICATION S
	6626	205 434-D Y DAT E OF INJUR Y S
	6627
	6628	Press RETU RN to cont inue, '^' to exit: < Enter>
	6629
	6630	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 7
	6631	Payer Sh eet Name: ABCTEST1 Version Number: 7
	6632
	6633	Seq Field Fie ld Name Proc Mode
	6634	--- ----- --- ------- ---------
	6635	* Workers ' Compensa tion Segme nt *
	6636
	6637	* DUR/PPS Se gment *
	6638	213 111-A M SEG MENT IDENT IFICATION S
	6639	215 473-7 E DUR /PPS CODE COUNTER S
	6640	218 439-E 4 DUR CONFLICT CODE S
	6641	220 440-E 5 DUR INTERVENT ION CODE S
	6642	222 441-E 6 DUR OUTCOME C ODE S
	6643	224 474-8 E DUR /PPS LEVEL OF EFFORT S
	6644	227 475-J 9 DUR CO-AGENT ID QUALIFI ER S
	6645	230 476-H 6 DUR CO-AGENT ID S
	6646
	6647	* Pricing Se gment *
	6648	240 111-A M SEG MENT IDENT IFICATION S
	6649	242 409-D 9 ING REDIENT CO ST S
	6650	244 412-D C DIS PENSING FE E SUBMITTE D S
	6651
	6652	Press RETU RN to cont inue, '^' to exit: < Enter>
	6653
	6654	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 8
	6655	Payer Sh eet Name: ABCTEST1 Version Number: 7
	6656
	6657	Seq Field Fie ld Name Proc Mode
	6658	--- ----- --- ------- ---------
	6659	* Pricing Se gment *
	6660	246 477-B E PRO FESSIONAL SERV FEE S UBMIT S
	6661	249 433-D X PAT IENT PAID AMOUNT S
	6662	252 481-H A FLA T SALES TA X AMOUNT S UBMIT S
	6663	255 482-G E PER CENTAGE SA LES TAX AM T SUB S
	6664	258 484-J E PER CENT SALES TAX BASIS SUB S
	6665	261 426-D Q USU AL & CUSTO MARY CHARG E S
	6666	264 430-D U GRO SS AMOUNT DUE S
	6667	266 423-D N BAS IS OF COST DETERMINA TION S
	6668
	6669	* Coupon Se gment *
	6670	275 111-A M SEG MENT IDENT IFICATION S
	6671	277 485-K E COU PON TYPE S
	6672	278 486-M E COU PON NUMBER S
	6673	279 487-N E COU PON VALUE AMOUNT S
	6674
	6675
	6676	Press RETU RN to cont inue, '^' to exit: < Enter>
	6677
	6678	Payer Shee t Detail R eport Pri nt Date: 0 9/09/05 Page: 9
	6679	Payer Sh eet Name: ABCTEST1 Version Number: 7
	6680
	6681	Seq Field Fie ld Name Proc Mode
	6682	--- ----- --- ------- ---------
	6683	* Compound S egment *
	6684	288 111-A M SEG MENT IDENT IFICATION S
	6685	290 450-E F Com pound Dose Form Desc Code S
	6686	293 451-E G Com pound Disp ense Unt F orm Ind S
	6687	295 452-E H Com pound Rout e of Admin S
	6688	297 447-E C Com pound Ingr ed Comp Co unt S
	6689	299 488-R E Com pound Prod uct ID Qua lifier S
	6690	301 489-T E Com pound Prod uct ID S
	6691	302 448-E D Com pound Ingr edient Qua ntity S
	6692	304 449-E E Com pound Ingr edient Dru g Cost S
	6693	307 490-U E Com p Ingred B asis Cost Determ S
	6694
	6695	Press RETU RN to cont inue:
	6696
	6697
	6698	8.2.3 ECME Setup – P harmacies Report
	6699
	6700	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.
	6701
	6702	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 .
	6703	Example 8. 2.3-1: Acc essing ECM E Setup – Pharmacies Report Op tion
	6704	*** ****** ****** ****** ****** **
	6705	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	6706	* XXXXX V AMC *
	6707	* Other Re ports *
	6708	*** ****** ****** ****** ****** **
	6709
	6710
	6711
	6712	CRI ECME Claim s-Response Inquiry
	6713	PAY Payer Shee t Detail R eport
	6714	PHAR ECME Setup - Pharmac ies Report
	6715	TAT Turn-aroun d time sta tistics
	6716	VER View ePhar macy Rx
	6717	OPR OPECC Prod uctivity R eport
	6718
	6719
	6720	Select Set up (Config uration) R eports Opt ion: PHAR ECME Setup - Pharmac ies Report
	6721	DEVICE: IP network
	6722
	6723	Example 8. 2.3-2: ECM E Setup - Pharmacies Report Op tion
	6724	BPS PHARMA CIES LIST SEP 9,2005 07:17 P AGE 1
	6725	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	6726
	6727	NU MBER: 2
	6728
	6729	NAME: XXXX XXXXX NCPDP #: X XXXXXX
	6730	DEFAULT DEA #: AGX XXXX CMOP SWITC H: CMOP ON
	6731	AUTO-REV ERSE PARAM ETER: 0 STATUS: AC TIVE
	6732	SITE ADD RESS 1: 10 1 MAIN STR EET
	6733	SITE CIT Y: XXXXXXX XX SITE STATE : XXXXX
	6734	SITE ZIP CODE: XXX XX SITE ADDRE SS NAME: 1 01 MAIN ST REET
	6735	HOURS OF OPERATION : 24 START DAY RANGE: MON
	6736	END DAY RANGE: MON START HOUR RANGE: 08 00
	6737	END HOUR RANGE: 16 00~TUE NPI: XXXXX XXXXX
	6738	DATE/TIM E OF LAST NPI CHANGE : OCT 10, 2006@15:05 :05
	6739	OUTPATIENT SITE: XXX XXXXXXXXX
	6740	REMITTAN CE ADDRESS NAME: MAI N REMIT ADDR ESS 1: 101 MAIN STRE ET
	6741	REMIT CI TY: XXXXXX XXX REMIT STAT E: XXXXXX
	6742	REMIT ZI P: XXXXX VA CONTACT : CONTACT, ONE
	6743	VA ALTER NATE CONTA CT: CONTAC T,ONE VA LEAD PHAR MACIST: CO NTACT,ONE
	6744	VA LEAD PHARMACIST LICENSE # : XXXXXXXX
	6745	Monday C lose Time: 1600 Tuesday Cl ose Time: 1600
	6746	Wednesda y Close Ti me: 1600 Thursday C lose Time: 1600
	6747	Friday C lose Time: 1600 Saturday C lose Time: 1600
	6748	Monday O pen Time: 0800 Tuesday Op en Time: 0 800
	6749
	6750
	6751	BPS PHARMA CIES LIST SEP 09, 2005@ 17:17 P AGE 2
	6752	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	6753
	6754	Wednesda y Open Tim e: 0800 Thursday O pen Time: 0800
	6755	Friday O pen Time: 0800 Saturday O pen Time: 0800
	6756	NU MBER: 3
	6757
	6758	NAME: XXXX XXXXXXX NCPDP #: X XXXXXX
	6759	DEFAULT DEA #: AGX XXXX CMOP SWITC H: CMOP ON
	6760	AUTO-REV ERSE PARAM ETER: 2 STATUS: AC TIVE
	6761	SITE ADD RESS 1: 10 1 MAIN AVE
	6762	SITE CIT Y: XXXXXXX XXXX SITE STATE : XXXXXX
	6763	SITE ZIP CODE: XXX XX SITE ADDRE SS NAME: 1 01 MAIN AV E
	6764	HOURS OF OPERATION : 24 START DAY RANGE: MON
	6765	END DAY RANGE: MON START HOUR RANGE: 08 00
	6766	END HOUR RANGE: 16 00~TUE NPI: 00000 00006
	6767	DATE/TIM E OF LAST NPI CHANGE : OCT 10, 2006@15:05 :05
	6768	OUTPATIENT SITE: XXX XXXXXXX VA
	6769	OUTPATIENT SITE: XXX XXXXXX CBO C
	6770	OUTPATIENT SITE: XXX XX VA CBOC
	6771	REMITTAN CE ADDRESS NAME: XXX XXXXXXX XX XXXX
	6772	REMIT AD DRESS 1: 1 01 XXXXXXX XXXXXXXXX
	6773	REMIT CI TY: XXXXXX XXXXX REMIT STAT E: XXXXXXX X
	6774	REMIT ZI P: XXXXX VA CONTACT : CONTACT, ONE
	6775	VA ALTER NATE CONTA CT: CONTAC T,TWO
	6776	VA LEAD PHARMACIST : PHARMACI ST,ONE Monday Cl ose Time: 1600
	6777	Tuesday Close Time : 1600 Wednesday Close Time : 1600
	6778	Thursday Close Tim e: 1600 Friday Clo se Time: 1 600
	6779
	6780	BPS PHARMA CIES LIST SEP 09, 2005@ 17:17 P AGE 3
	6781	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	6782
	6783	Saturday Close Tim e: 1600 Monday Ope n Time: 08 00
	6784	Tuesday Open Time: 0800 Wednesday Open Time: 0800
	6785	Thursday Open Time : 0800 Friday Ope n Time: 08 00
	6786	Saturday Open Time : 0800
	6787
	6788	Press ENTE R to conti nue:
	6789
	6790
	6791	8.2.4 Turn -around ti me statist ics
	6792	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.
	6793
	6794	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.
	6795
	6796	Example 8. 2.4-1: Acc essing the Turn-arou nd time st atistics R eport Opti on
	6797	*** ****** ****** ****** ****** **
	6798	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	6799	* XXXXX V AMC *
	6800	* Other Re ports *
	6801	*** ****** ****** ****** ****** **
	6802
	6803
	6804	CRI ECME Claim s-Response Inquiry
	6805	PAY Payer Shee t Detail R eport
	6806	PHAR ECME Setup - Pharmac ies Report
	6807	TAT Turn-aroun d time sta tistics
	6808	VER View ePhar macy Rx
	6809	OPR OPECC Prod uctivity R eport
	6810
	6811
	6812	Select Oth er Reports Option: T AT Turn-a round time statistic s
	6813
	6814	Example 8. 2.4-2: Dis playing th e Turn-aro und time s tatistics Report
	6815	START WITH DATE: T-1 // <Enter > (SEP 08, 2005)
	6816	GO TO DATE : T// <En ter> (SEP 09, 2005)
	6817	For Prescr iption: 1106378.00 001 (Rx#: 382992)
	6818	Begin 08:19:48
	6819	Gathering informatio n 08:19:52
	6820	Claim ID c reated 08:19:55
	6821	Claim Sent 08:19:56
	6822	Response s tored 08:20:04
	6823	Completed at: 08:20:04
	6824	Turn-aroun d time 16
	6825
	6826	For Prescr iption: 1106380.00 001 (Rx#: 382994)
	6827	Begin 08:19:48
	6828	Gathering informatio n 08:19:52
	6829	Claim ID c reated 08:19:55
	6830	Claim Sent 08:20:16
	6831	Response s tored 08:20:18
	6832	Completed at: 08:20:18
	6833	Turn-aroun d time 30
	6834
	6835	For Prescr iption: 1106379.00 001 (Rx#: 382993)
	6836	Begin 08:19:48
	6837	Gathering informatio n 08:19:52
	6838	Claim ID c reated 08:19:55
	6839	Claim Sent 08:20:06
	6840	Response s tored 08:20:08
	6841	Completed at: 08:20:08
	6842	Turn-aroun d time 20
	6843
	6844	For Prescr iption: 1106384.00 001 (Rx#: 909952)
	6845	Begin 11:27:13
	6846	Gathering informatio n 11:27:15
	6847	Claim ID c reated 11:27:16
	6848	Claim Sent 11:27:17
	6849	Response s tored 11:27:23
	6850	Completed at: 11:27:23
	6851	Turn-aroun d time 10
	6852
	6853	For Prescr iption: 1106386.00 001 (Rx#: 909954)
	6854	Begin 11:27:13
	6855	Gathering informatio n 11:27:15
	6856	Claim ID c reated 11:27:17
	6857	Claim Sent 11:27:37
	6858	Response s tored 11:27:39
	6859	Completed at: 11:27:39
	6860	Turn-aroun d time 26
	6861
	6862
	6863	Average Tu rn-around time: 13
	6864
	6865
	6866	8.2.5 View ePharmacy Rx
	6867	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.
	6868
	6869	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.
	6870
	6871	Example 8. 2.5-1: Acc essing the View ePha rmacy Rx R eport Opti on
	6872	*** ****** ****** ****** ****** **
	6873	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	6874	* ALASKA V AHSRO *
	6875	* Other Re ports *
	6876	*** ****** ****** ****** ****** **
	6877
	6878
	6879	CRI ECME Claim s-Response Inquiry
	6880	PAY Payer Shee t Detail R eport
	6881	PHAR ECME Setup - Pharmac ies Report
	6882	TAT Turn-aroun d time sta tistics
	6883	VER View ePhar macy Rx
	6884	OPR OPECC Prod uctivity R eport
	6885
	6886
	6887	Select Oth er Reports Option: VER View ePharmacy Rx
	6888
	6889	Example 8. 2.5-2: Dis playing th e View ePh armacy Rx Report
	6890	Select Pre scription: 2055346
	6891	ATE NOLOL 25MG TAB
	6892
	6893	Patient Rx# Dru g Name Rx Stat us
	6894	ECMEPATIE NT,ONE 20553 46 TAM OXIFEN CIT RATE 10MG TA DISCONT INUED
	6895
	6896	OK to cont inue? Yes/ / YES
	6897
	6898
	6899	Rx# 205534 6 has the following fills:
	6900
	6901	Fill# Fill Dat e Rele ase Date
	6902	----- -------- -- ---- --------
	6903	0 01/29/20 09 01/2 9/2009
	6904	1 02/26/20 09 02/2 5/2009
	6905
	6906
	6907	Select Fil l Number: 1 02/26/20 09 02/2 6/2009
	6908
	6909
	6910	Selec t one of t he followi ng:
	6911
	6912	M Most recen t transact ion for ea ch payer
	6913	A All transa ctions
	6914
	6915	There ar e 2 ECME t ransaction s for this Rx/fill.
	6916	1 for th e primary payer, 1 f or the sec ondary pay er.
	6917
	6918	Select Mos t recent t ransaction for each payer or A ll transac tions: M// All trans
	6919	actions
	6920
	6921	Compiling data for V iew Prescr iptions .. .
	6922	Compiling data for t he ECME Cl aim Log .. .
	6923	Compiling data for t he ECME Bi lling Even ts Report ...
	6924	Compiling data for t he ECME Cl aims-Respo nse Inquir y (CRI) Re port ...
	6925	Compiling data for V iew Insura nce Polici es ... ... .......... ......
	6926	Compiling the list o f TPJI bil ls ...
	6927	Compiling data for T PJI Claim Informatio n ...
	6928	Compiling data for T PJI AR Acc ount Profi le ...
	6929	Compiling data for T PJI AR Com ment Histo ry ...
	6930	Compiling data for T PJI ECME R x Response ...
	6931	Compiling data for V iew Regist ration Eli gibility S tatus ...
	6932	Compiling data for V iew Regist ration Eli gibility V erificatio n ...
	6933
	6934
	6935
	6936	View Presc ription
	6937	Rx View (D iscontinue d) Feb 08, 2 011@13:59: 27 P age: 1 of 1
	6938	ECMEPATIEN T,ONE
	6939	PID: 666 -87-4529 Ht(cm): _ ______ (__ ____)
	6940	DOB: OCT 18,1963 ( 47) Wt(kg): _ ______ (__ ____)
	6941	+--------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	6942	Rx # : 2055346$ e (ECME#: 000001615 253)
	6943	Orde rable Item : TAMOXIFE N CITRATE TAB
	6944	CMOP Drug : TAMOXIFE N CITRATE 10MG TAB
	6945	NDC : 00378-01 44-93
	6946	*Dosage : 10MG
	6947	Verb : TAKE
	6948	Disp ense Units : 1
	6949	Noun : TABLET
	6950	*Route : ORAL (BY MOUTH)
	6951	*Schedule : BID
	6952	Patient In structions :
	6953	SIG : TAKE ONE TABLET BY MOUTH TWI CE A DAY
	6954	Pati ent Status : OUTPT NO N-SC
	6955	Issue Date : 01/29/09 Fil l Date: 01 /29/09
	6956	Last Fill Date : 02/26/09 (Mail, Tr ansmitted)
	6957	Last Re lease Date : 02/25/09 Lot #:
	6958	Expires : 01/30/10 MFG:
	6959	D ays Supply : 3 QT Y (TAB): 6 0
	6960	# of Refills : 11 Rem aining: 9
	6961	Provider : ECMEPROV IDER,ONE
	6962	Routing : Window
	6963	Copies : 1
	6964	Method of Pickup :
	6965	Clinic : Not on F ile
	6966	Division : CHEYENNE VAM&ROC ( 442)
	6967	Pharmacist : ECMEPROV IDER,ONE
	6968	Patient Counseling : NO
	6969	Remarks : New Orde r Created by copying Rx # 2055 345.
	6970	F inished By : ECMEPROV IDER,ONE
	6971	Entry B y: ECMEPRO VIDER,ONE Entry Da te: 01/29/ 09 12:59:3 8
	6972	Original F ill Releas ed: 02/25/ 09 Ro uting: Win dow
	6973	Refill Lo g:
	6974	# Log Dat e Refill Date Qty Routi ng Lot # Phar macist
	6975	========== ========== ========== ========== ========== ========== ========== =========
	6976	1 02/25/ 09 02/25 /09 60 Mail
	6977	Division: 442 Dispensed: 02/25/09 Released : 2/25/09 NDC: 0037 8-0144-91
	6978	2 02/25/ 09 02/26 /09 60 Mail
	6979	Division: 442 Dispensed: 02/26/09 Released :
	6980
	6981	Partial Fi lls:
	6982	# Log Da te Date Qty Routing Lot # Pharm acist
	6983	========== ========== ========== ========== ========== ========== ========== =========
	6984	There are NO Partial s for this Prescript ion
	6985	Activity L og:
	6986	# Date Reas on Rx Ref Init iator Of A ctivity
	6987	========== ========== ========== ========== ========== ========== ========== =========
	6988	1 02/25/ 09 SUSP ENSE REFILL 1 ECME PROVIDER,O NE
	6989	Comments: RX Placed on Suspens e for CMOP until 02- 25-09
	6990	2 02/25/ 09 PROC ESSED REFILL 1 ECME PROVIDER,O NE
	6991	Comments: Transmitte d to DALLA S CMOP
	6992	3 02/25/ 09 SUSP ENSE REFILL 2 ECME PROVIDER,O NE
	6993	Comments: RX Placed on Suspens e for CMOP until 02- 26-09
	6994	4 02/25/ 09 SUSP ENSE REFILL 2 ECME PROVIDER,O NE
	6995	Comments: 3/4 of Day s Supply S USPENSE HO LD until 2 /28/09.
	6996	5 03/01/ 09 PROC ESSED REFILL 2 ECME PROVIDER,O NE
	6997	Comments: Transmitte d to DALLA S CMOP
	6998	6 06/11/ 09 DISC ONTINUED REFILL 2 ECME PROVIDER,T WO
	6999	Comments: Discontinu ed During New Prescr iption Ent ry - Dupli cate Drug
	7000
	7001	Copay Acti vity Log:
	7002	# Date Reas on Rx Ref Initiato r Of Activ ity
	7003	========== ========== ========== ========== ========== ========== ========== =========
	7004	There's NO Copay act ivity to r eport
	7005	Label Log:
	7006	# Date Rx R ef Printed By
	7007	========== ========== ========== ========== ========== ========== ========== =========
	7008	1 02/25/ 09 ORIG INAL ECMEPROV IDER,ONE
	7009	Comments: From RX nu mber 20553 46
	7010
	7011	ECME Log:
	7012	# Date/T ime Rx Ref Initiator Of Activit y
	7013	========== ========== ========== ========== ========== ========== ========== =========
	7014	1 1/29/0 9@12:59:55 ORIGIN AL ECMEPROVID ER,ONE
	7015	Comments: Submitted to ECME:WI NDOW FILL( NDC:00378- 0144-93)-E REJECTED
	7016	2 2/25/0 9@16:49:16 ORIGIN AL ECMEPROVID ER,ONE
	7017	Comments: Submitted to ECME:RE JECT WORKL IST-E PAYA BLE
	7018	3 2/25/0 9@16:51:03 REFILL 1 ECMEPROVID ER,ONE
	7019	Comments: Submitted to ECME:CM OP TRANSMI SSION(NDC: 00378-0144 -91)
	7020	4 3/1/09 @14:00:05 REFILL 2 ECMEPROVID ER,ONE
	7021	Comments: Submitted to ECME:CM OP TRANSMI SSION(NDC: 00378-0144 -91)
	7022
	7023	ECME REJEC T Log:
	7024	# Date/Ti me Rcvd Rx Ref Reject Ty pe STA TUS Da te/Time Re solved
	7025	========== ========== ========== ========== ========== ========== ========== =========
	7026	1 1/29/09 @12:59:54 ORIGINAL REFILL TO O SOON RES OLVED 2/ 25/09@16:4 9:04
	7027	Comments: AUTOMATICA LLY CLOSED (CLAIM RE -SUBMITTED )
	7028
	7029	CMOP Event Log:
	7030	Date/Time Rx Ref TRN-Order Stat Comment s
	7031	========== ========== ========== ========== ========== ========== ========== =========
	7032	02/25/09@1 656 Ref 1 16346-1 DISP ND C: 0037801 4491
	7033	Carrier: U SPS Pkg ID: P GKID999
	7034	03/01/09@1 403 Ref 2 16360-1 TRAN
	7035
	7036	CMOP Lot#/ Expiration Date Log:
	7037	Rx Ref Lot # Expiratio n Date
	7038	========== ========== ========== ========== ========== ========== ========== =========
	7039	Ref 1 A87904 03/22/07
	7040
	7041	ECME Claim Log
	7042
	7043	PHARMACY E CME Feb 08, 2011@14:0 6:41 Pag e: 1 of 1
	7044	Claim Log informatio n
	7045	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	7046	Pharmacy E CME Log
	7047
	7048	VA Rx #: 2055346$ Fill #: 1 ECM E #: 16152 53
	7049
	7050	Pati ent Name: ECMEPATIEN T,ONE (452 9)
	7051	Transactio n Number: 1615253.00 011
	7052	Last S ubmitted: FEB 25,200 9@16:51:03
	7053	Last Subm itted By: ECMEPROVID ER,ONE
	7054	Last VA Claim #: VA2009=116 4471991=00 0010=00012 35
	7055
	7056	Transmissi on Informa tion (CLAI M REQUEST) (#1236)--- ---------- ---------- ---------
	7057	Created on : FEB 25,2 009@16:51: 04
	7058	VA Claim I D: VA2009= 1164471991 =000010=00 01235
	7059	Submitted By: ECMEPR OVIDER,ONE
	7060	Transactio n Type: RE QUEST
	7061	Date of Se rvice: 02/ 25/2009
	7062	NDC: 00378 -0144-91
	7063	ECME Pharm acy: CHEY9 -BOTH NPI & NCPDP
	7064	Days Suppl y: 3
	7065	Qty: 60 Unit Cos t: .928 Total Pr ice: 68.20
	7066
	7067	Insurance Name: BLUE MOON INSU RANCE
	7068	Group Name : T-GROUP1
	7069	Rx Coordin ation of B enefits: P RIMARY
	7070	BIN: 12345 6
	7071	PCN: 11234 56789
	7072	NCPDP Vers ion: D.0
	7073	Group ID: 10001
	7074	Cardholder ID:
	7075	Patient Re lationship Code: CAR DHOLDER
	7076	Cardholder First Nam e: ONE
	7077	Cardholder Last Name : OPPATIEN T
	7078	Facility I D Qualifie r:
	7079	Billing Re quest Paye r Sheet: W BTESTB1
	7080	Reversal P ayer Sheet : WBTESTB2
	7081
	7082	Response I nformation (CLAIM R EQUEST)(#1 213)------ ---------- ---------- ---------
	7083	Response R eceived: F EB 25,2009 @16:51:10
	7084	Date of Se rvice: 02/ 25/2009
	7085	Transactio n Response Status: P aid
	7086	Total Amou nt Paid: $ 58.20
	7087	Reconcilia tion ID:
	7088	Reject cod e(s):
	7089	Message:
	7090	Additional Message:
	7091	DUR Respon se Info:
	7092	DUR Additi onal Text:
	7093
	7094	ECME CRI R EPORT DATA
	7095
	7096	ECME Claim s-Response Inquiry R eport Pr int Date: 02/08/11
	7097	VA CLAIM I D: VA2009= 1164471991 =000010=00 01235
	7098
	7099	BPS TRANSA CTION/BPS LOG OF TRA NSACTION D ATA:
	7100
	7101	ENTRY#: 16 15253.0001 1 STATUS: 99
	7102	PHARMACY : CHEY9-BO TH NPI & N CPDP PRESCRIPTI ON #: 2055 346
	7103	RXI-INTE RNAL (c): 1615253
	7104	PLAN NAM E: BLUE MO ON INSURAN CE PHARMACY P LAN ID: T0 0010
	7105	CLAIM IE N (c): 123 6 RESPONSE I EN (c): 12 13
	7106
	7107	BPS CLAIMS FILE DATA :
	7108
	7109	CLAIM ID: VA2009=116 4471991=00 0010=00012 35
	7110	ELECTRON IC PAYER: WBTESTB1 TRANSMIT F LAG: YES ( POINT OF S ALE)
	7111	TRANSMIT TED ON: FE B 25,2009@ 16:51:04 CREATED ON : FEB 25,2 009@16:51: 04
	7112	PATIENT NAME: ECME PATIENT,ON E
	7113	GROUP IN SURANCE PL AN: BLUE M OON INSURA NCE
	7114	BIN NUMB ER: 123456 VERSION RE LEASE NUMB ER: D.0
	7115	TRANSACT ION CODE: B1 PROCESSOR CONTROL NU MBER: 1123 456789
	7116	TRANSACT ION COUNT: 1 SOFTWARE V ENDER CERT ID: TATP
	7117	SERVICE PROVIDER I D: 1164471 991 SERVICE PR OVIDER ID QUAL: 01
	7118	GROUP ID : C110001 CARDHOLDER ID: C2
	7119	DATE OF BIRTH: C41 9631018 PATIENT GE NDER CODE: MALE
	7120	PATIENT FIRST NAME : CAONE PATIENT LA ST NAME: C BOPPATIENT
	7121	PATIENT STREET ADD RESS: CM32 OAK STREE T
	7122	PATIENT CITY ADDRE SS: CNBIRM INGHAM
	7123	PATIENT STATE PROV ADDRESS: COAL PATIENT ZI P POSTAL Z ONE: CP352 09
	7124	PATIENT PHONE NUMB ER: CQ2055 559874 PATIENT ID QUALIFIER : CX01
	7125	PATIENT ID: CY6668 74529
	7126	TRANSACTIO N ORDER: 1
	7127	MEDICATI ON NAME: T AMOXIFEN C ITRATE 10M G TAB
	7128	PRESCRIP TION NUMBE R: 2055346 OTHER COVE RAGE CODE: C800
	7129	SUBM CLA RIFICATION CODE COUN T: 1
	7130	SUBMISSION CLRFCTN C ODE CNTR: 1 SUBMISSION CLARIFICA TION CODE: DK02
	7131	DATE OF SERVICE: F EB 25,2009 PRESCRIPTI ON/SERVICE REF NO: D 21615253
	7132	FILL NUM BER: D301 DAYS SUPPL Y: D5003
	7133	COMPOUND CODE: D61
	7134	PRODUCT SERVICE ID : D7003780 14491
	7135	DISPENSE AS WRITTE N: D80 INGREDIENT COST SUBM ITTED: D90 000510{
	7136	PRESCRIB ER ID: DB DISPENSING FEE SUBMI TTED: DC00 000000
	7137	DATE PRE SCRIPTION WRITTEN: D E20090129
	7138	NUMBER O F REFILLS AUTHORIZED : DF11 PRESCRIPTI ON ORIGIN CODE: DJ1
	7139	*SUBMISS ION CLARIF ICATION CO DE: DK02 BASIS OF C OST DETERM INATION: D N07
	7140	USUAL AN D CUSTOMAR Y CHARGE: DQ0000510{
	7141	GROSS AM OUNT DUE: DU0000510{ PRESCRIBER LAST NAME : DROPPROV IDER
	7142	PATIENT PAID AMOUN T SUBMITTE D: DX00000 00{
	7143	PRODUCT SERVICE ID QUALIFIER : E103 QUANTITY D ISPENSED: E700000600 00
	7144	PRESCRIP TION SERVI CE REFEREN CE: EM1 QUANTITY P RESCRIBED: ET0000060 000
	7145	PRESCRIB ER ID QUAL IFIER: EZ0 1 PRESCRIBER LOCATION CODE: 1E
	7146	PC PROVI DER LOCATI ON CODE: H 5001 PC PROVIDE R LAST NAM E: 4EOPPRO VIDER
	7147	PRESCRIB ER PHONE N UMBER: PM0 001234567
	7148	DATE OF SERVICE: 2 0090225
	7149	RAW DATA SENT:
	7150	12345651B 1112345678 9101116447 1991 2 0090225TAT P
	7151	AM01CX01C Y666874529 C41963101 8C51CAONE CB OPPATIENT CM32
	7152	OAK STREET CNB IRMINGHAM C OALCP35209 CQ2055 559874
	7153	AM04C2C11 0001
	7154	AM07EM1D2 1615253E10 3D70037801 4491 E7000006 0000D301D5 003D61D80D E20090129D
	7155	F11DJ1DK02 ET00000600 00C800
	7156	AM02
	7157	AM03EZ01D B 1E DROPPROVI DER H50014EO PPROVIDER
	7158	AM11D9000 0510{DC000 00000DX000 0000{DQ000 0510{DU000 0510{DN07
	7159	BPS RESPON SE FILE DA TA:
	7160
	7161	BPS CLAIM: VA2009=11 64471991=0 00010=0001 235
	7162	DATE RES PONSE RECE IVED: FEB 25, 2009@1 6:51:10
	7163	VERSION RELEASE NU MBER: D.0 TRANSACTI ON CODE: B 1
	7164	TRANSACT ION COUNT: 1 SERVICE PR OVIDER ID: 116447199 1
	7165	SERVICE PROVIDER I D QUALIFIE R: 01 DATE OF SE RVICE: FEB 25,2009
	7166	RESPONSE STATUS: A CCEPTED
	7167	TRANSACTIO N ORDER: 1 TRANSACTIO N RESPONSE STATUS: P AID
	7168	PRESCRIP TION REFER ENCE NUMBE R: 1615253
	7169	RX REFER ENCE NUMBE R QUALIFIE R: RX BILL ING
	7170	HEADER R ESPONSE ST ATUS: CLAI M PAYABLE
	7171	AUTHORIZ ATION NUMB ER: WEBMD: PAID PATIENT PA Y AMOUNT: $ 10.00
	7172	INGREDIE NT COST PA ID: $ 55. 70 DISPENSING FEE PAID: $ 12.50
	7173	TOTAL AM OUNT PAID: $ 58.20 INCENTIVE AMOUNT PAI D: $ 1.2 5
	7174	BASIS OF REIMB DET ERMINATION : 08 TAX EXEMPT INDICATOR : NOT TAX EXEMPT
	7175	FLAT SAL ES TAX PAI D: $ 1.0 0 PROFESSION AL SERVICE FEE PAID: $ 4.54
	7176	OTHER AM OUNT PAID COUNT: 1 OTHER PAYE R AMOUNT R ECOGNIZED: $ 0.00
	7177	RAW DATA RECEIVED:
	7178	VA2009=11 64471991=0 00010=0001 23551B11A0 1116447199 1
	7179	20090225\ X1D\\X1E\\ X1C\AM21\X 1C\ANP\X1C \F3WEBMD:
	7180	PAID\X1E\ \X1C\AM22\ X1C\EM1\X1 C\D2161525 3\X1E\\X1C \AM23\X1C\ F50000100{ \X1C\F6000
	7181	0557{\X1C\ F70000125{ \X1C\AV2\X 1C\AW00000 10{\X1C\FL 0000012E\X 1C\J100000 45D\X1C\J2
	7182	1\X1C\J301 \X1C\J4000 0033C\X1C\ J50000000{ \X1C\F9000 0683B\X1C\ FM08
	7183
	7184
	7185	ECME BILLI NG EVENTS REPORT
	7186
	7187	PAGE 1
	7188	BILLI NG ECME EV ENTS (DETA ILED) for ALL DIVISI ONS
	7189	SINGLE PRESCRIPT ION – 2055 346 FILL # 1
	7190	RX# FILL DAT E PA TIENT NAME DRUG
	7191	========== ========== ========== ========== ========== ========== ========== ==========
	7192	1 205534 6 1 02/2 5/09 EC MEPATIENT, ONE TAMOXIFE N CITRATE 10MG TAB
	7193	FINI SH 02/2 5/09 4:51p Status:E CME Billab le
	7194	ELIGIBILIT Y: CV:No
	7195	DRUG:TAMOX IFEN CITRA TE 10MG TA B
	7196	NDC:00378- 0144-91, B ILLED QTY: 60, COST:. 928, DEA:6 PR
	7197	PLAN:T-GRO UP1 INSUR ANCE: BLUE MOON INSU RANCE
	7198	BIN:123456 , PCN:1123 456789, PA YER SHEET B1:WBTESTB 1
	7199	PAYER SHEE T B2:WBTES TB2, PAYER SHEET B3: WBTESTB1
	7200	DISPENSING FEE:0, BA SIS OF COS T DETERM:U SUAL & CUS TOMARY
	7201	COST:68.20 , GROSS AM T DUE:68.2 0, ADMIN F EE:12.50
	7202	USER:POSTM ASTER
	7203	SUBM IT 02/2 5/09 4:51p Status:O K
	7204	ECME#:0000 01615253, FILL DATE :02/25/09
	7205	PAYER RESP ONSE: PAYA BLE
	7206	PLAN:T-GRO UP1, INSUR ANCE: BLUE MOON INSU RANCE
	7207	USER:POSTM ASTER
	7208	RELE ASE 02/2 5/09 4:56p Status:O K
	7209	ECME#:0000 01615253, FILL DATE :02/25/09
	7210	USER:POSTM ASTER
	7211	BILL ING 02/2 5/09 4:56p Status:B ill# K9000 7W created
	7212	ECME#:0000 01615253, FILL DATE :02/25/09, RELEASE DA TE:02/25/0 9
	7213	DRUG:TAMOX IFEN CITRA TE 10MG TA B
	7214	NDC:00378- 0144-91, B ILLED QTY: 60, DAYS S UPPLY:3
	7215	BILLED:68. 20, PAID:5 8.20
	7216	PLAN:T-GRO UP1, INSUR ANCE: BLUE MOON INSU RANCE
	7217	USER:POSTM ASTER
	7218
	7219
	7220	List of al l bills fo r this Rx (all fills )
	7221
	7222
	7223	BI LL RX DATE INSURANC E COB PATIE NT
	7224	------ ---------- ---------- ---------- ---------- ---------- ---------- ---------
	7225	1 K9 0007U 205 5346-0 01/29/09 BLUE MOO N INSURANC P ECMEP ATIENT,ONE
	7226	2 K9 0007W 205 5346-1 02/25/09 BLUE MOO N INSURANC P ECMEP ATIENT,ONE
	7227
	7228	Medicatio n Profile
	7229
	7230	ISSU E LAST REF DAY
	7231	# Rx# DR UG [^] QT Y ST DATE FILL REM SUP
	7232	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	7233	REFILL TOO SOON/ DUR REJECT S (Third P arty) (2 o rders)
	7234	1 299999 9e AM OXAPINE 25 MG TAB 9 0 A 11-3 0-17 11-30 -17 3 90
	7235	2 288888 8e AM OXICILLIN 250/CLAV K 62.5 1 A 12-0 1-17 12-01 -17 3 90
	7236
	7237	View Patie nt Insuran ce
	7238	Patient Po licy Infor mation Feb 23, 2011@1 3:24:18 Page: 1 of 1
	7239	Expanded P olicy Info rmation fo r: ECMEPAT IENT,ONE 666-20-458 9
	7240	OPINSUR1 I nsurance C ompany Plan Curre ntly Activ e
	7241	Plan Inf ormation Insur ance Compa ny
	7242	Is Gro up Plan: Y ES Com pany: OPIN SUR1
	7243	Gro up Name: D RUG INS St reet: 32 C ATASTROPHE WAY
	7244	Group Number: 1 11 City/S tate: BIRM INGHAM, AL 35209
	7245	BIN: Billin g Ph:
	7246	PCN: Precer t Ph:
	7247	Type of Plan: P RESCRIPTIO N
	7248	Electron ic Type: C OMMERCIAL
	7249	Plan Fi ling TF:
	7250	ePh armacy Pla n ID: VA10 5220
	7251	ePhar macy Plan Name: MINN ESOTA MEDI CAID
	7252	ePharma cy Natl St atus: ACTI VE
	7253	ePharmac y Local St atus: ACTI VE
	7254
	7255
	7256	Utilizat ion Review Info Effective Dates & S ource
	7257	Require UR : NO Effec tive Date: 10/12/07
	7258	Requir e Amb Cert : Expira tion Date:
	7259	Requir e Pre-Cert : NO Sourc e of Info: INTERVIEW
	7260	Exclud e Pre-Cond : NO Policy Not Billable: NO
	7261	Benefits Assignable : YES
	7262
	7263
	7264	Subscrib er Informa tion Subscriber 's Employe r Informat ion
	7265	Whose In surance: V ETERAN E mp Sponsor ed Plan: N o
	7266	Subscrib er Name: E CMEPATIENT ,ONE Employer:
	7267	Relat ionship: S ELF Employment Status:
	7268	Pri mary ID: 5 43252 Retireme nt Date:
	7269	Coord. B enefits: P RIMARY C laims to E mployer: N o, Send to Insurance Company
	7270	Primary P rovider: Street:
	7271	Prim Pro v Phone: Cit y/State:
	7272	Phone:
	7273
	7274	Insure d Person's Informati on (use Su bscriber U pdate Acti on)
	7275	Insured's DOB: XXXXX Str 1:
	7276	Ins ured's Sex : MALE Str 2:
	7277	Insured's Branch: AR MY City:
	7278	Insured's Rank: St/Zip:
	7279	Phone: 2055555555
	7280
	7281	Insuranc e Company ID Numbers (use Subs criber Upd ate Action )
	7282	Subscri ber Primar y ID: 5432 52
	7283
	7284	Plan Cov erage Limi tations
	7285	Coverag e Effecti ve Date Covered? Limit Comments
	7286	------- - ------- ------- -------- ----- ---------
	7287	INPATIE NT 08/04/2 008 YES
	7288	07/11/2 008 YES
	7289	06/26/2 008 YES
	7290	02/26/2 008 YES
	7291	01/28/2 008 YES
	7292	10/12/2 007 YES
	7293	06/19/2 007 YES
	7294	04/13/2 007 YES
	7295	01/08/2 007 YES
	7296	06/17/2 006 YES
	7297	OUTPATI ENT 08/04/2 008 YES
	7298	07/11/2 008 YES
	7299	06/26/2 008 YES
	7300	02/26/2 008 YES
	7301	01/28/2 008 YES
	7302	10/12/2 007 YES
	7303	08/02/2 007 YES
	7304	06/19/2 007 YES
	7305	04/13/2 007 YES
	7306	01/08/2 007 YES
	7307	06/17/2 006 YES
	7308	PHARMAC Y 03/17/2 009 YES
	7309	08/06/2 008 YES
	7310	08/04/2 008 YES
	7311	07/11/2 008 YES
	7312	06/26/2 008 YES
	7313	DENTAL 08/04/2 008 YES
	7314	07/11/2 008 YES
	7315	06/26/2 008 YES
	7316	02/26/2 008 YES
	7317	01/28/2 008 YES
	7318	10/12/2 007 YES
	7319	08/02/2 007 YES
	7320	06/19/2 007 YES
	7321	04/13/2 007 YES
	7322	01/08/2 007 YES
	7323	06/17/2 006 YES
	7324	MENTAL HEALTH 08/04/2 008 YES
	7325	07/11/2 008 YES
	7326	06/26/2 008 YES
	7327	02/26/2 008 YES
	7328	01/28/2 008 YES
	7329	10/12/2 007 YES
	7330	08/02/2 007 YES
	7331	06/19/2 007 YES
	7332	04/13/2 007 YES
	7333	01/08/2 007 YES
	7334	06/17/2 006 YES
	7335	LONG TE RM CARE BY DEFAULT
	7336
	7337
	7338	User Inf ormation Insuranc e Contact (last)
	7339	Entered By : PI I Person Con tacted:
	7340	Ent ered On: 1 0/12/07 Method of Contact: PHONE
	7341	Last Veri fied By: PI I Contact's Phone:
	7342	Last Veri fied On: 0 2/07/08 Call Ref. No.:
	7343	Last Updat ed By: PI I Contact Da te: APR 15 , 2009
	7344	Last Upd ated On: 0 4/15/09
	7345
	7346
	7347	Comment -- Patient Policy
	7348	None
	7349
	7350	Comment -- Group P lan
	7351
	7352
	7353	Personal Riders
	7354
	7355
	7356	TPJI – Cla im Informa tion
	7357
	7358	Claim Info rmation Fe b 08, 2011 @14:36:24 P age: 1 of 1
	7359	K90007We ECMEPATIE NT,ONE O4 529 DOB: 10 /18/63 S ubsc ID:
	7360	TPJI – Cla im Informa tion
	7361
	7362	Claim Info rmation Fe b 08, 2011 @14:36:24 P age: 1 of 1
	7363	K90007We ECMEPATIEN T,ONE O4529 DOB: XXXXX Subsc ID:
	7364	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	7365	Insuranc e Demograp hics Subscrib er Demogra phics
	7366	Bill P ayer: BLUE MOON INSU RANCE Group N umber: 100 01
	7367	Claim Add ress: 321 MOON DRIVE Group Name: T-G ROUP1
	7368	BIRM INGHAM, AL 35209 Subscrib er ID:
	7369	Claim P hone: Emp loyer: USA ARMY CONS ULTANTS
	7370	Insured's Name: ECM EPATIENT,O NE
	7371	Relatio nship: PAT IENT
	7372
	7373	C laim Infor mation
	7374	Bill Typ e: OUTPATI ENT Charge Type:
	7375	Time Fram e: ADMIT T HRU DISCHA RGE Service Dates: 02/ 25/09 - 02 /25/09
	7376	Rate Typ e: REIMBUR SABLE INS. Orig Claim: 68.20
	7377	AR Statu s: ACTIVE Balanc e Due: 10.00
	7378	Sequenc e: PRIMARY
	7379	Purch Sv c: NO
	7380	ECME N o: 1615253
	7381	ECME Ap N o: WEBMD: PAID
	7382	NP I: 1164471 991
	7383	Provider s: NONE
	7384	En tered: 02/ 25/09 by POSTMASTE R
	7385	Autho rized: 02/ 25/09 by POSTMASTE R
	7386	First Pr inted: 02/ 25/09 by POSTMASTE R
	7387
	7388	Related Prescripti on Copay I nformation
	7389	<none f ound>
	7390
	7391
	7392
	7393	TPJI – AR Account Pr ofile
	7394
	7395	AR Account Profile Feb 08, 2011@1 4:46:24 Page: 1 of 1
	7396	K90007We ECMEPATIEN T,ONE O4529 DOB: XXXX Subsc ID:
	7397	AR Status: ACTIVE Orig Amt: 68.2 0 Bal ance Due: 10.00
	7398	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	7399	02/25/0 9 IB Sta tus: PRINT ED (First) 68.20 10.00
	7400
	7401
	7402	Total C ollected: 58 .20
	7403
	7404
	7405	TPJI – AR Comment Hi story
	7406
	7407	Comment Hi story Feb 08, 20 11@14:47:1 0 Page: 1 of 1
	7408	K90007We ECMEPATIE NT,ONE O4 529 DOB: 10 /18/63 S ubsc ID:
	7409	AR Status: ACTIVE Orig Amt: 68.2 0 Bal ance Due: 10.00
	7410
	7411
	7412	No Comment Transacti ons Exist For This A ccount.
	7413
	7414
	7415
	7416	TPJI – ECM E Claim In formation
	7417
	7418	ECME Claim Informati on F eb 08, 201 1@14:48:16 Pag e: 1 of 1
	7419	K90007We ECMEPATIE NT,ONE O4 529 DOB: 10 /18/63 S ubsc ID:
	7420	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	7421	ECME N o: 1615253 Pharmacy NPI: 1164 471991
	7422	ECME Ap N o: WEBMD: PAID Provider NPI: No N PI on file
	7423
	7424	Rx N o: 2055346 / 1 Fill Date: 02/2 5/09
	7425	Drug Nam e: TAMOXIF EN CITRATE 10MG TAB N DC #: 0037 8-0144-91
	7426	Billed Am t: 68.2 0 COB: Prim ary
	7427
	7428	IB Statu s: CANCEL LED (02/25 /09) Reas on: ECME PRESCRIPTI ON REVERSE D
	7429
	7430	Payment I nformation
	7431	Expecte d Payment Amount: 58.20
	7432	Ingredie nt Cost Re im Amt: 0.00 Disp ensing Fee Reim Amt: 0.00
	7433
	7434	Patient R esponsibil ity Amount s
	7435	Deducti ble: 0 .00 Co insurance: 0.00 Amount of Copay: 0.00
	7436	Coverage Gap: 0 .00 Proc essor Fee: 0.00 Exceed Be nefit Max: 0.00
	7437	Health Plan-funde d Assistan ce Amount: 0.00
	7438
	7439	Product S election A mounts
	7440	P rod Sel Am t: 0.0 0 Prod Sel /Non-Pref Formulary: 0.00
	7441	Prod Sel/B rand Drug: 0.00 Prod S el/Brand N on-Pref Fo rmulary: 0.00
	7442	Provider Network Ad j: 0.0 0
	7443
	7444	No COB/Ot her Payer Data on fi le in the ECME Respo nse.
	7445
	7446	ELIGIBIL ITY STATUS DATA, SCR EEN <7>
	7447	ECMEPATIEN T,ONE; 666 -20-4589 ACTIVE DUT Y
	7448	========== ========== ========== ========== ========== ========== ========== =========
	7449	<1> Patient Ty pe: ACTIVE DUTY Ve teran: YES
	7450	S vc Connect ed: YES SC Pe rcent: 20%
	7451	S C Award Da te: OCT 12 ,2007 Unemplo yable: NO
	7452	P &T: NO
	7453	R ated Incom p.: NO
	7454	Claim Numb er: 432432 22
	7455	Folder Lo c.: ALBUQU ERQUE
	7456	<2> Aid & Attendan ce: NO House bound: NO
	7457	VA Pensi on: NO VA Disab ility: NO
	7458	Total Check Amou nt: NOT AP PLICABLE
	7459	GI Insuran ce: NO A mount: UNA NSWERED
	7460	<3> Prima ry Elig Co de: SC LES S THAN 50%
	7461	Other Elig Code( s): NO ADD ITIONAL EL IGIBILITIE S IDENTIFI ED
	7462	Perio d of Servi ce: PERSIA N GULF WAR
	7463	<3.1> Comb at Vet Eli g.: EXPIRE D End Date : OCT 11, 2009
	7464
	7465	<4> Servic e Connecte d Conditio ns as stat ed by appl icant
	7466	------ ---------- ---------- ---------- ---------- -----
	7467	NONE S TATED
	7468
	7469	ELIGIBILIT Y VERIFICA TION DATA
	7470
	7471	EL IGIBILITY VERIFICATI ON DATA, S CREEN <11>
	7472	ECMEPATIEN T,ONE; 666 -20-4589 ACTIVE DUT Y
	7473	========== ========== ========== ========== ========== ========== ========== =========
	7474	<1> Eligib ility Stat us: NOT VE RIFIED Status D ate: NOT A PPLICABLE
	7475	Statu s Entered By: NOT AP PLICABLE
	7476	Inte rim Respon se: UNANSW ERED (NOT REQUIRED)
	7477	V erif. Meth od: NOT AP PLICABLE
	7478	V erif. Sour ce: NOT AV AILABLE
	7479	<2> Mo ney Verifi ed: NOT VE RIFIED
	7480	<3> Serv ice Verifi ed: NOT VE RIFIED
	7481	<4> Rated Disabiliti es: SC%: 20 EFF. DATE OF C OMBINED SC %:
	7482	Orig Curr
	7483	Rated D isability Extr Eff D t Eff Dt
	7484	NONE STATE D
	7485	Enter ?? f or more ac tions >>>
	7486	VW View Rx CR CRI Rep ort CI TPJI Cl aim Info ER TPJI EC ME Rx
	7487	CL Claim L og IN Insuran ce AP TPJI Ac ct Pro ES Elig St atus
	7488	BE Billing Events LB List of Bills CM TPJI AR Comm EV Elig Ve rif
	7489	MP Med Pro file PR Print R eport(s)
	7490	Select Act ion: Quit/ /
	7491
	7492	There are thirteen a ctions at the bottom of the sc reen. Twel ve of thes e actions allow the user to ju mp to any one of the twelve se ctions com prising th e View ePh armacy Rx report. Th e thirteen th action, PR Print Report(s), allows th e user to print one or more se ctions of the report .
	7493
	7494	8.2.6 OPEC C Producti vity Repor t
	7495
	7496	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.
	7497
	7498	You must h old the BP S SUPERVIS OR key to view the O PECC Produ ctivity Re port optio n.
	7499
	7500	Access the OPECC Pro ductivity Report opt ion by ent ering OPR 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.
	7501
	7502	Example 8. 2.6-1: Acc essing the OPECC Pro ductivity Report Opt ion
	7503	*** ****** ****** ****** ****** **
	7504	Elec tronic Cla ims Manage ment Engin e (ECME) V 1.0
	7505	* ALASKA V AHSRO *
	7506	* Other Re ports *
	7507	*** ****** ****** ****** ****** **
	7508
	7509
	7510	CRI ECME Claim s-Response Inquiry
	7511	PAY Payer Shee t Detail R eport
	7512	PHAR ECME Setup - Pharmac ies Report
	7513	TAT Turn-aroun d time sta tistics
	7514	VER View ePhar macy Rx
	7515	OPR OPECC Prod uctivity R eport
	7516
	7517
	7518	Select Oth er Reports Option: VER View ePharmacy Rx
	7519
	7520	Example 8.2.6-2: Prompts fo r the OPEC C Producti vity Repor t
	7521
	7522	Select Oth er Reports <TEST ACC OUNT> Opti on: OPR O PECC Produ ctivity Re port
	7523
	7524	Selec t one of t he followi ng:
	7525
	7526	D DIVISION
	7527	A ALL
	7528
	7529	Select Cer tain Pharm acy (D)ivi sions or ( A)LL: A// LL
	7530
	7531	Selec t one of t he followi ng:
	7532
	7533	V VETERAN
	7534	T TRICARE
	7535	C CHAMPVA
	7536	A ALL
	7537
	7538	Include Ce rtain Elig ibility Ty pe or (A)l l: A// LL
	7539
	7540	Selec t one of t he followi ng:
	7541
	7542	U USER
	7543	A ALL
	7544
	7545	Display EC ME (U)ser or (A)LL: A// LL
	7546
	7547	START WITH TRANSACTI ON DATE: T -1// (OC T 28, 2015 )
	7548	GO TO TR ANSACTION DATE: T// (OCT 29, 2015)
	7549
	7550	Selec t one of t he followi ng:
	7551
	7552	S Summary
	7553	D Detail
	7554
	7555	Display (S )ummary or (D)etail Format: De tail//
	7556
	7557	Enter a co de from th e list to indicate t he sort or der.
	7558
	7559	Selec t one of t he followi ng:
	7560
	7561	D Division
	7562	U User Name
	7563
	7564	Sort: (D/ U): User N ame// Divi sion
	7565
	7566	Do you wan t to captu re report data for a n Excel do cument? NO //
	7567
	7568	WARNING - THIS REPOR T REQUIRES THAT A DE VICE WITH 132 COLUMN WIDTH BE USED.
	7569	IT WILL NO T DISPLAY CORRECTLY USING 80 C OLUMN WIDT H DEVICES
	7570
	7571	DEVICE: HO ME//0;132
	7572
	7573
	7574
	7575	Example 8. 2.6-3: Dis play of th e Detailed OPECC Pro ductivity Report
	7576	OPECC PROD UCTIVITY D ETAIL REPO RT Prin t Date: Oc t 29, 2015 @10:15:57 Page: 1
	7577	DIVISION(S ): ALL
	7578	ELIGIBILIT Y: ALL
	7579	USERS: ALL
	7580	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 9/29/1 5 through 10/29/15
	7581	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	7582	# TRA NSACTIONS
	7583	USER STAT US DT RA NGE TOTAL ELIG R X# REF/ECME# DOS TRA NS DATE P AID AMT
	7584	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	7585	DIVISION: DIVISION O NE
	7586	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	7587	USER,EIGHT REJE CTED 1 1 CVA 1 00888 0/0000001 12004 09/ 29/15 09/ 29/15 6 .62
	7588	USER,EIGHT REJE CTED 1 1 CVA 1 00889 0/0000001 12005 09/ 29/15 09/ 29/15 10 .00
	7589	USER,NINE PAYA BLE 1 1 VET 1 00840G 0/0000001 11960 09/ 30/15 09/ 30/15 10 .00
	7590	USER,NINE REVE RSAL REJEC TED 1 1 VET 1 00845 0/0000001 11942 08/ 25/15 10/ 01/15 10 .00
	7591	USER,NINE REJE CTED 1 1 CVA 1 00895 0/0000001 12012 10/ 01/15 10/ 01/15 7 .43
	7592	USER,NINE REJE CTED 1 1 CVA 1 00895A 0/0000001 12013 10/ 01/15 10/ 01/15 7 .43
	7593	USER,NINE REJE CTED 1 1 CVA 1 00895D 0/0000001 12017 10/ 01/15 10/ 01/15 7 .43
	7594	USER,NINE REJE CTED 1 1 CVA 1 00896 0/0000001 12018 10/ 01/15 10/ 01/15 10 .00
	7595	USER,NINE REJE CTED 1 1 CVA 1 00895F 0/0000001 12020 10/ 01/15 10/ 01/15 7 .43
	7596	USER,NINE REVE RSAL REJEC TED 1 1 VET 1 00840H 0/0000001 12025 10/ 01/15 10/ 01/15 10 .00
	7597	USER,EIGHT REVE RSAL ACCEP TED 1 1 VET 1 00904 0/0000001 12032 10/ 06/15 10/ 06/15 10 .00
	7598	USER,EIGHT REJE CTED 1 1 VET 1 00905 0/0000001 12033 10/ 06/15 10/ 06/15 10 .00
	7599	USER,TWO REVE RSAL ACCEP TED 1 1 TRI 1 00872 0/0000001 11986 09/ 23/15 10/ 08/15 10 .00
	7600	USER,NINE REVE RSAL ACCEP TED 1 1 CVA 1 00896A 0/0000001 12024 10/ 08/15 10/ 08/15 10 .00
	7601	USER,NINE REVE RSAL ACCEP TED 1 1 TRI 1 00917 0/0000001 12046 10/ 14/15 10/ 14/15 10 .00
	7602	USER,NINE REJE CTED 1 1 TRI 1 00917A 0/0000001 12049 10/ 14/15 10/ 14/15 10 .00
	7603	USER,NINE REJE CTED 1 1 TRI 1 00917B 0/0000001 12050 10/ 14/15 10/ 14/15 10 .00
	7604	USER,NINE PAYA BLE 1 1 CVA 1 00881 0/0000001 11997 10/ 15/15 10/ 15/15 5 .23
	7605	USER,FOUR REJE CTED 1 1 TRI 1 00923 0/0000001 12055 10/ 15/15 10/ 15/15
	7606	USER,NINE REVE RSAL REJEC TED 1 1 TRI 1 00922 0/0000001 12054 10/ 15/15 10/ 16/15 10 .00
	7607	USER,FOUR REJE CTED 1 1 TRI 1 00927 0/0000001 12059 10/ 16/15 10/ 16/15
	7608	USER,FOUR REJE CTED 1 1 TRI 1 00929 0/0000001 12061 10/ 16/15 10/ 16/15
	7609	USER,FOUR REJE CTED 1 1 TRI 1 00933 0/0000001 12065 10/ 17/15 10/ 18/15
	7610	USER,FOUR REJE CTED 1 1 TRI 1 00936 0/0000001 12068 10/ 18/15 10/ 18/15
	7611	USER,FOUR REJE CTED 1 1 TRI 1 00832 0/0000001 11902 09/ 25/15 10/ 20/15
	7612	USER,THREE 1 1 TRI 1 00938 0/0000001 12070 10/ 28/15 10/ 28/15 10 .00
	7613
	7614	SUBTOTALS FOR DIVISI ON ONE PHA RMACY
	7615	REJE CTED AND N OT REJECTE D AND PAYA BLE
	7616	USER RESO LVED TO PA YABLE ( POSSIBLE B ACK-BILL) TRANS IN DT RANGE AMOUNT PAID
	7617	USER,EIGHT 0 0 4 36.62
	7618	USER,THREE 0 0 1 10.00
	7619	USER,TWO 0 0 1 10.00
	7620	USER,FOUR 0 0 6 0.00
	7621	USER,NINE 2 0 14 124.95
	7622
	7623	GRAND TOTA L
	7624	REJE CTED AND N OT REJECTE D AND PAYA BLE
	7625	USER RESO LVED TO PA YABLE ( POSSIBLE B ACK-BILL) TRANS IN DT RANGE AMOUNT PAID
	7626	USER,EIGHT 0 0 4 36.62
	7627	USER,THREE 0 0 1 10.00
	7628	USER,TWO 0 0 1 10.00
	7629	USER,FOUR 0 0 6 0.00
	7630	USER,NINE 2 0 14 124.95
	7631
	7632	Example 8. 2.6-4: Dis play of th e Summary OPECC Prod uctivity R eport
	7633	OPECC PROD UCTIVITY S UMMARY REP ORT Prin t Date: Oc t 29, 2015 @10:32:13 Page: 1
	7634	DIVISION(S ): ALL
	7635	ELIGIBILIT Y: ALL
	7636	USERS: ALL
	7637	ALL PRESCR IPTIONS BY TRANSACTI ON DATE: F rom 9/29/1 5 through 10/29/15
	7638	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	7639	# TRA NSACTIONS
	7640	USER STAT US DT RA NGE TOTAL ELIG R X# REF/ECME# DOS TRA NS DATE P AID AMT
	7641	========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== ========== =========
	7642	DIVISION: DIVISION O NE
	7643	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	7644
	7645	SUBTOTALS FOR DIVISI ON ONE PHA RMACY
	7646	REJE CTED AND N OT REJECTE D AND PAYA BLE
	7647	USER RESO LVED TO PA YABLE ( POSSIBLE B ACK-BILL) TRANS IN DT RANGE AMOUNT PAID
	7648	USER,ONE 0 0 4 36.62
	7649	USER,TWO 0 0 1 10.00
	7650	USER,THREE 0 0 1 10.00
	7651	USER,FOUR 0 0 6 0.00
	7652	USER,FIVE 2 0 14 124.95
	7653
	7654	GRAND TOTA L
	7655	REJE CTED AND N OT REJECTE D AND PAYA BLE
	7656	USER RESO LVED TO PA YABLE ( POSSIBLE B ACK-BILL) TRANS IN DT RANGE AMOUNT PAID
	7657	USER,ONE 0 0 4 36.62
	7658	USER,TWO 0 0 1 10.00
	7659	USER,THREE 0 0 1 10.00
	7660	USER,FOUR 0 0 6 0.00
	7661	USER,FIVE 2 0 14 124.95
	7662	(This page included for two-si ded copyin g.)
	7663
	7664	9BPS Night ly Backgro und Job
	7665	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.
	7666
	7667	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.
	7668
	7669	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.
	7670
	7671	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.
	7672
	7673	Example 9. 1-1 Displa ying the A uto-Revers al Bulleti n
	7674	Subj: ECME AUTO-REVE RSAL PROCE SS [#2473 ] 03/05/05 @01:00 29 lines
	7675	From: BPS PACKAGE I n 'IN' bas ket. Pag e 1 New
	7676	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	7677	The ECME N ightly Pro cess compl eted auto- reversing e-Pharmacy claims fo r prescrip tions not released w ithin the specified timeframe.
	7678
	7679	TOTAL AUTO -REVERSED CLAIMS: 3
	7680
	7681	Claims Aut o-Reversed on 03/06/ 05:
	7682	# RX/FI LL STA TUS DATE ELIG PA TIENT BPS PHAR M DRUG NA ME
	7683	---------- ---------- ---------- ---------- ---------- ---------- ---------- --------
	7684	1 908955 /1 W/N R 03/01/0 6 V ECME patient,On e ANC DRUG NAME ONE
	7685	2 909225 /1 W/N R 03/04/0 6 V ECME patient,Tw o ANC DRUG NAME TWO
	7686	3 41581/ 0 W/N R 03/04/0 6 V ECME patient,Th ree ANC DRUG NAME THREE
	7687
	7688	(This page included for two-si ded copyin g.)
	7689
	7690
	7691	10Glossary
	7692
	7693	Accredited Standards Committee (ASC)An o rganizatio n that has been accr edited by American N ational St andards In stitute (A NSI) for t he develop ment of Am erican Nat ional Stan dards.
	7694
	7695
	7696	Administra tive Code SetsCode s ets that c haracteriz e a genera l business situation rather th an a medic al conditi on or serv ice.
	7697
	7698
	7699	Administra tive Simpl ification (A/S)Title II, Subti tle F, of HIPAA, whi ch gives t he Departm ent Of Hea lth And Hu man Servic es (DHHS) the author ity to man date the u se of stan dards for the electr onic excha nge of hea lth care d ata; to sp ecify what medical a nd adminis trative co de sets sh ould be us ed within those stan dards; to require th e use of n ational id entificati on systems for healt h care pat ients, pro viders, pa yers (or p lans), and employers (or spons ors); and to specify the types of measur es require d to prote ct the sec urity and privacy of personall y identifi able healt h care inf ormation.
	7700
	7701
	7702	American M edical Ass ociation ( AMA) A pro fessional associatio n that rep resents th e voice of the Ameri can medica l professi on and con stitutes t he partner ship of ph ysicians a nd their p rofessiona l associat ions dedic ated to pr omoting th e art and science of medicine and the be tterment o f public h ealth.
	7703
	7704
	7705	American N ational St andards (A NS)Standar ds develop ed and app roved by o rganizatio ns accredi ted by ANS I.
	7706
	7707
	7708	American N ational St andards In stituteAn organizati on that ac credits va rious
	7709	(ANSI)stan dards-sett ing commit tees, and monitors t heir compl iance with the open rule-makin g process that they must follo w to quali fy for ANS I accredit ation.
	7710
	7711
	7712	American S ociety for Testing a nd A stand ards group that has published general
	7713	Materials (ASTM)gui delines fo r the deve lopment of standards , includin g those fo r health c are identi fiers.
	7714
	7715
	7716	Back DoorS ystem acce ss via the roll and scroll, ch aracter an d Mumps ba sed VistA applicatio n.
	7717
	7718
	7719	Blue Cross and Blue Shield Ass ociation A n associat ion that r epresents the common
	7720	(BCBSA)int erest of B lue Cross and Blue S hield heal th plans. The BCBSA maintains the Claim Adjustment Reason Co des code s et.
	7721
	7722
	7723	Business M odelA mode l of a bus iness orga nization o r process.
	7724
	7725
	7726	CHAMPVA Pa tientA CHA MPVA patie nt is a pa tient that is receiv ing servic es due to being elig ible for t he CHAMPVA health be nefits pro gram. His/ her CHAMPV A health b enefit pro gram will be billed for the pr escription .
	7727
	7728
	7729	Clean Clai mAn insura nce claim that has n o defect, impropriet y (includi ng any lac k of any s ubstantial documenta tion) or p articular circumstan ce requiri ng special treatment that prev ents timel y payment from being made.
	7730
	7731
	7732	Clearingho use For he alth care, an organi zation tha t
	7733	(or Health Care Clea ringhouse) translates health ca re data to or from a standard format.
	7734
	7735
	7736	Centers fo r Medicare & Medicai dCenters f or Medicar e & Medica id Service s,
	7737	Services ( CMS)former ly Health Care Finan cing Admin istration (HCFA). Th e administ ration wit hin the De partment o f Health a nd Human S ervices (H HS) that i s responsi ble for th e national administr ation of t he Medicai d and Medi care progr ams.
	7738	CMS-1450CM S’s name f or the ins titutional uniform c laim form, or UB-92.
	7739	CMS-1500CM S’s name f or the pro fessional uniform cl aim form. Also known as the UC F-1500.
	7740
	7741
	7742	Coordinati on of Bene fits (COB) 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.
	7743
	7744
	7745	Code SetUn der HIPAA "codes use d to encod e data ele ments, tab les of ter ms, medica l concepts , diagnost ic codes, or medical procedure s. A code set includ es the cod es and des criptors o f the code s." [45 CF R 162.103]
	7746
	7747
	7748	Covered En tityUnder HIPAA, a h ealth plan , healthca re clearin ghouse or health car e provider who trans mits infor mation in electronic form in c onnection with a tra nsaction c overed by this subch apter 160. 103 of 45 CFR.
	7749
	7750
	7751	Current Pr ocedural T erminology 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.
	7752
	7753
	7754	Data Dicti onary (DD) A document or system that char acterizes the data c ontent of a system.
	7755
	7756
	7757	Data Eleme ntUnder HI PAA, this is "…the s mallest na med unit o f informat ion in a t ransaction ." [45 CFR 162.103]
	7758
	7759
	7760	Data Mappi ngThe proc ess of mat ching one set of dat a elements or indivi dual code values to their clos est equiva lents in a nother set of them.
	7761	Data Model A conceptu al model o f the info rmation ne eded to su pport a bu siness fun ction or p rocess.
	7762
	7763
	7764	Data SetUn der HIPAA, this is " …a semanti cally mean ingful uni t of infor mation exc hanged bet ween two p arties to a transact ion." [45 CFR 162.10 3]
	7765
	7766
	7767	Designated Code SetA medical o r administ rative cod e set, whi ch DHHS ha s designat ed for use in one or more of t he HIPAA s tandards.
	7768
	7769
	7770	Designated Data Cont ent Commit teeAn orga nization, which DHHS has
	7771	or Designa ted DCCdes ignated fo r oversigh t of the b usiness da ta content of one or more of t he HIPAA-m andated tr ansaction standards.
	7772
	7773
	7774	Designated StandardA standard that DHHS has design ated for u se under t he authori ty provide d by HIPAA .
	7775
	7776
	7777	Department of Health and Human Per the w ebsite add ress provi ded below,
	7778	Services ( DHHS) or ( HHS)'The D epartment Of Health And Human Services i s the Unit ed States government 's princip al agency for protec ting the h ealth of a ll America ns and pro viding ess ential hum an service s, especia lly for th ose who ar e least ab le to help themselve s.' The w ebsite is available at <http:/ /www.os.dh hs.gov/>.
	7779
	7780
	7781	Electronic Commerce (EComm)The exchange of busines s informat ion by ele ctronic me ans.
	7782
	7783
	7784	Electronic Data Inte rchange (E DI)The tra nsfer of d ata betwee n differen t companie s using ne tworks, su ch as the Internet. As more an d more com panies are connected to the In ternet, ED I is becom ing increa singly imp ortant as an industr y standard for compa nies to bu y, sell, a nd trade i nformation . ANSI has approved a set of E DI standar ds known a s the X12 standards.
	7785
	7786
	7787	FinishTerm used for completing orders fr om Order E ntry/Resul ts Reporti ng V. 3.0.
	7788
	7789
	7790	‘Finish’ a Prescript ionThis pr ocess with in VistA O utpatient Pharmacy V . 7.0 wher e a pharma cy prescri ption orde r has been reviewed by either a pharmacy technicia n or pharm acist and is the fir st step in processin g a prescr iption in Pharmacy. If perform ed by a ph armacist w ith the ap propriate security k ey, the pr escription can be ‘V erified’ a s well. Se e ‘Verify a Prescrip tion’ for more infor mation.
	7791
	7792
	7793	Flat FileT his term u sually ref ers to a f ile that c onsists of a series of fixed-l ength reco rds that i nclude som e sort of record typ e code.
	7794
	7795
	7796	Front Door System acc ess via th e Delphi, Graphical User Inter face (GUI) based Vis tA applica tion.
	7797
	7798
	7799	Graphical User Inter face (GUI) A graphica l method o f controll ing how a user inter acts with a computer to perfor m various tasks.
	7800
	7801	HCFA Commo n Procedur al Coding A medical code set t hat identi fies healt h care
	7802	System (HC PCS)proced ures, equi pment, and supplies for claim submission purposes. It is mai ntained by Health Ca re Financi ng Adminis tration (H CFA), and has been s elected fo r use in t he HIPAA t ransaction s. HCPCS L evel I con tain numer ic CPT-4 c odes, whic h are main tained by the AMA. H CPCS Level II contai ns alphanu meric code s used to identify v arious ite ms and ser vices that are not i ncluded in the CPT-4 code set. These are maintaine d by HCFA, BCBSA, an d Health I nsurance A ssociation of Americ a (HIAA). HCPCS Leve l III cont ains alpha numeric co des that a re assigne d by Medic aid State agencies t o identify additiona l items an d services not inclu ded in lev els I and II. These are usuall y called " local code s”, and mu st have "W ", "X", "Y ", or "Z" in the fir st positio n. They ar e not name d as HIPAA standard codes. HCP CS Procedu re Modifie r Codes ca n be used with all t hree level s, with th e WA-ZY ra nge used f or locally assigned procedure modifiers.
	7803
	7804
	7805	Health Car e Clearing houseUnder HIPAA, th is is "… a public or private e ntity that does eith er of the following: (1) proce sses or fa cilitates the proces sing of in formation received f rom anothe r entity i n a nonsta ndard form at or cont aining non standard d ata conten t into sta ndard data elements or a stand ard transa ction, or (2) receiv es a stand ard transa ction from another e ntity and processes or facilit ates the p rocessing of [that] informatio n into non standard f ormat or n onstandard data cont ent for a receiving entity." [ 45 CFR 160 .103]
	7806
	7807
	7808	Health Car e Financin g Administ ration The DHHS agen cy respons ible for M edicare
	7809	(HCFA) and parts of Medicaid. HCFA has h istoricall y maintain ed the UB- 92 institu tional Ele ctronic Me dia Claims (EMC) for mat specif ications, the profes sional EMC National Standard F ormat (NSF ) specific ations, as well as s pecificati ons for va rious cert ifications and autho rizations used by th e Medicare and Medic aid progra ms. HCFA a lso mainta ins the HC PCS medica l code set .
	7810
	7811
	7812	Health Car e Provider 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]
	7813
	7814
	7815	Health Inf ormationUn der HIPAA this is "… any infor mation, wh ether oral or record ed in any form or me dium that (a) is cre ated or re ceived by a health c are provid er, health plan, pub lic health authority , employer , life ins urer, scho ol or univ ersity, or health ca re clearin ghouse; an d (b) rela ted to the past, pre sent or fu ture physi cal or men tal health or condit ion of an individual , the prov ision of h ealth care to an ind ividual, o r the past , present or future payment fo r the prov ision of h ealth care to an ind ividual." [45 CFR 16 0.103]
	7816
	7817
	7818	Health Ins urance Ass ociation o f An indus try associ ation that represent s the
	7819	America ( HIAA)inter ests of co mmercial h ealth care insurers. The HIAA participat es in the maintenanc e of some code sets, including HCPCS Lev el II code s.
	7820
	7821
	7822	Health Ins urance Por tability a ndA Federa l law that makes a n umber of
	7823	Accountabi lity Act o f 1996 (HI PAA)change s that hav e the goal of allowi ng persons to qualif y immediat ely for co mparable h ealth insu rance cove rage when they chang e their em ployment r elationshi ps. Title II, Subtit le F, of H IPAA gives 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. Also known as t he Kennedy -Kassebaum Bill, the Kassebaum -Kennedy B ill, K2, o r Public L aw 104-191 .
	7824
	7825
	7826	Health Pla nUnder HIP AA this is "…an indi vidual or group plan that prov ides, or p ay the cos t of, medi cal care”. [45 CFR 1 60.103]
	7827
	7828
	7829	Healthcare Financial Managemen t An organ ization fo r the impr ovement
	7830	Associatio n (HFMA)of the finan cial manag ement of h ealthcare- related or ganization s. The HFM A sponsors some HIPA A educatio nal semina rs.
	7831
	7832
	7833	Health Lev el Seven ( HL7)An ANS I-accredit ed group t hat define s standard s for the cross-plat form excha nge of inf ormation w ithin a he alth care organizati on. HL7 is responsib le for spe cifying th e Level Se ven Open S ystem Inte rconnectio n (OSI) st andards fo r the heal th industr y. Some HL 7 standard s will be encapsulat ed in the X12 standa rds used f or transmi tting clai m attachme nts.
	7834
	7835
	7836	HIPAA Data Dictionar yA data di ctionary t hat define s and cros s-
	7837	or HIPAA D Dreference s the cont ents of al l X12 tran sactions i ncluded in the HIPAA mandate. It is main tained by X12N/TG3.
	7838
	7839
	7840	Implementa tion Guide (IG)A doc ument expl aining the proper us e of a sta ndard for a specific business purpose. T he X12N HI PAA IGs ar e the prim ary refere nce docume nts used b y those im plementing the assoc iated tran sactions, and are in corporated into the HIPAA regu lations by reference .
	7841
	7842
	7843	Implementa tion Speci ficationUn der HIPAA, this is " … the spec ific instr uctions fo r implemen ting a sta ndard [45 CFR 160.10 3]
	7844
	7845
	7846	Informatio n ModelA c onceptual model of t he informa tion neede d to suppo rt a busin ess functi on or proc ess.
	7847
	7848
	7849	Internatio nal Classi fication o f Diseases A medical code set maintained by the
	7850	(ICD)World Health Or ganization (WHO). Th e primary purpose of this code set is to classify causes of death. A U nited Stat es (US) ex tension of this codi ng system, maintaine d by the N ational Ce nter for H ealth Stat istics (NC HS) within the Cente rs for Dis ease Contr ol (CDC), is used to identify morbidity factors, o r diagnose s. The ICD -9-CM (Rev ision 9 Cl inical Mod ification) codes hav e been sel ected for use in the HIPAA tra nsactions.
	7851
	7852
	7853	Internatio nal Standa rds Organi zationAn o rganizatio n that coo rdinates t he
	7854	(ISO) or I nternation al Organiz ation deve lopment an d adoption of numero us
	7855	for Standa rdization internatio nal standa rds.
	7856
	7857
	7858	Joint Comm ission on Accreditat ion In the future, t he JCAHO m ay play a role in
	7859	of Healthc are Organi zations (J CAHO)certi fying thes e organiza tions comp liance wit h the HIPA A A/S requ irements.
	7860
	7861
	7862	J-CodesPre viously HC PCS Level II has con tained a s et of code s with a h igh-order value of " J" to iden tify some drugs and some other items. Th e final HI PAA transa ctions and code set rule state s that any J-codes i dentifying drugs wil l be dropp ed from th e HCPCS an d NDC code s will be used to id entify all drug prod ucts.
	7863
	7864
	7865	Maintain o r Maintena nceUnder H IPAA, this is "…acti vities nec essary to support th e use of a standard adopted by the Secre tary, incl uding tech nical corr ections to an implem entation s pecificati on, and en hancements or expans ion of a c ode set. T his term e xcludes th e activiti es related to the ad option of a new stan dard or im plementati on specifi cation, or modificat ion to an adopted st andard or implementa tion speci fication." [45 CFR 1 62.103]
	7866
	7867
	7868	Maximum De fined Data SetUnder HIPAA, thi s is "… al l of the r equired da ta element s for a pa rticular s tandard ba sed on a s pecific im plementati on specifi cation." [ 45 CFR 162 .103]. A f ramework u nder HIPAA whereby a n entity c reating a transactio n is free to include whatever data any r eceiver mi ght want o r need. Th e recipien t of a max imum data set is fre e to ignor e any port ion of the data not needed to conduct th eir part o f the asso ciated bus iness tran saction, u nless the nonessenti al data is needed fo r coordina tion of be nefits.
	7869
	7870
	7871	Medical Co de SetsCod es that ch aracterize a medical condition or treatm ent. The c ode sets a re usually maintaine d by profe ssional so cieties an d public h ealth orga nizations.
	7872	Memorandum of Unders tanding (M OU)A docum ent provid ing a gene ral descri ption of t he kinds o f responsi bilities t hat are to be assume d by two o r more par ties in th eir pursui t of some goal(s). M ore specif ic informa tion may b e provided in an ass ociated St atement Of Work (SOW ).
	7873
	7874
	7875	Modify or Modificati onUnder HI PAA, refer s to "a ch ange adopt ed by the Secretary, through r egulation, to a stan dard or an implement ation spec ification. " [45 CFR 160.102]
	7876
	7877
	7878	National C enter for Health Sta tisticsAn administra tion of HH S and CDC that
	7879	(NCHS)over sees ICD c oding.
	7880
	7881
	7882	National C ouncil for Prescript ion DrugAn ANSI-accr edited gro up that ma intains
	7883	Programs ( NCPDP)a nu mber of st andard for mats for u se by the retail pha rmacy indu stry, some of which are includ ed in the HIPAA mand ates.
	7884
	7885
	7886	National D rug Code ( NDC)A medi cal code s et that ha s been sel ected for use in the HIPAA tra nsactions.
	7887
	7888
	7889	National E mployer ID A system f or uniquel y identify ing all sp onsors of health car e benefits .
	7890
	7891
	7892	National P atient IDA system fo r uniquely identifyi ng all rec ipients of health ca re service s.
	7893
	7894
	7895	National P ayer IDA s ystem for uniquely i dentifying all organ izations t hat pays f or health care servi ces. Also known as H ealth Plan ID or Pla n ID.
	7896
	7897
	7898	National P rovider Fi le (NPF)Th e database envisione d for use in maintai ning a nat ional prov ider regis try.
	7899
	7900
	7901	National P rovider ID A system f or uniquel y identify ing all pr oviders of health ca re service s, supplie s, and equ ipment.
	7902
	7903
	7904	National P rovider Re gistryThe organizati on envisio ned for as signing th e National Provider IDs.
	7905
	7906
	7907	National P rovider Sy stem (NPS) The admini strative s ystem envi sioned for supportin g a nation al provide r registry .
	7908
	7909
	7910	National S tandard Fo rmat (NSF) 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 .
	7911
	7912
	7913	National U niform Bil ling Commi tteeThe co mmittee es tablished by the Ame rican
	7914	(NUBC)Hosp ital Assoc iation (AH A) to deve lop a sing le billing form and standard d ata set th at could b e used nat ionwide by instituti onal provi ders and p ayers for handling h ealth care claims.
	7915
	7916
	7917	NCPDP Batc h Standard 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.
	7918
	7919
	7920	NCPDP Tele communicat ion Standa rdsAn NCPD P standard designed for use by high-volu me dispens ers of pha rmaceutica ls, such a s retail p harmacies. Version D 0 is the t ransaction standard under HIPA A.
	7921
	7922
	7923	Non-Formul ary DrugsT he medicat ions, whic h are defi ned as com mercially available drug produ cts not in cluded in the VA Nat ional Form ulary.
	7924	Notice of Intent (NO I)A docume nt that de scribes a subject ar ea for whi ch the Fed eral Gover nment is c onsidering developin g regulati ons. It ma y describe what the government considers to be the relevant considerat ions and i nvite comm ents from interested parties. These comm ents can t hen be use d in devel oping a No tice of Pr oposed Rul emaking (N PRM) or a final regu lation.
	7925
	7926
	7927	Notice of Proposed R ulemaking (NPRM)A do cument tha t describe s and expl ains regul ations tha t the Fede ral Govern ment propo ses to ado pt at some future da te, and in vites inte rested par ties to su bmit comme nts relate d to them. These com ments can then be us ed in deve loping the final rul es.
	7928
	7929
	7930	Office of Management & Budget (OMB)A Fed eral Gover nment agen cy that ha s a major role in re viewing pr oposed Fed eral regul ations.
	7931
	7932
	7933	Open Syste m Intercon nection (O SI)A multi -layer ISO data comm unications standard. Level Sev en of this standard is industr y-specific , and HL7 is respons ible for s pecifying the level seven OSI standards for the he alth indus try.
	7934
	7935	Outpatient Pharmacy Electronic Claims Th is is a de signated i ndividual at each si te
	7936	Coordinato r (OPECC)w ho will be responsib le for mon itoring NC PDP claims using the ECME modu le. The OP ECC will r esolve cla im rejecti on issues with the a ppropriate parties, make data correction s, and res ubmit clai ms.
	7937
	7938	Orderable ItemAn Ord erable Ite m name and dosage fo rm that ha s no stren gth attach ed to it ( e.g., Acet aminophen) . The name with a st rength att ached is t he Dispens e Drug nam e (e.g., A cetaminoph en 325mg).
	7939
	7940
	7941	PayerIn he alth care, an entity that assu mes the ri sk of payi ng for med ical treat ments. Thi s can be a n uninsure d patient, a self-in sured empl oyer, or a health ca re plan or Health Ma intenance Organizati on (HMO).
	7942
	7943
	7944	PAYERIDHCF A’s term f or their N ational Pa yer ID ini tiative.
	7945
	7946
	7947	PBMA Pharm acy Benefi t Manager (PBM) is a third par ty adminis trator of prescripti on drug pr ograms. Th ey are pri marily res ponsible f or process ing and pa ying presc ription dr ug claims.
	7948
	7949
	7950	Placeholde rsPhysical and/or lo gical data elements that are r eferenced and placed within a data struc ture that have a dat a definiti on but may or may no t currentl y exist wi thin the s ystem. The value of these data elements are not cu rrently ma intained b y the soft ware but a re establi shed for f uture iter ations of system dev elopment r elated to Billing Aw are.
	7951
	7952
	7953	Potentiall y Billable EventA se rvice, whi ch has all required data eleme nts associ ated with it. These data eleme nts are co llected in the VistA Clinical Applicatio n.
	7954
	7955
	7956	Profession al Compone ntCharges for physic ian servic es. Exampl es include physician who reads the Elect rocardiogr am (EKG) a nd an Emer gency Room physician who provi des treatm ent.
	7957
	7958
	7959	Provider T axonomy Co desA code set for id entifying the provid er type an d area of specializa tion for a ll health care provi ders. A gi ven provid er can hav e several Provider T axonomy Co des. The B CBSA maint ains this code set.
	7960
	7961
	7962	SecretaryU nder HIPAA , this ref ers to the Secretary of the US Departmen t of Healt h and Huma n Services or his/he r designat ed represe ntatives. [45 CFR 16 0.103].
	7963	SegmentUnd er HIPAA, this is "… a group of related d ata elemen ts in a tr ansaction” . [45 CFR 162.103]
	7964
	7965
	7966	ServiceMed ical care and items such as me dical diag nosis and treatment, drugs and biologica ls, suppli es, applia nces, and equipment, medical s ocial serv ices, and use of hos pital Regi onal Prima ry Care Ho spital (RP CH) or Ski lled Nursi ng Facilit y (SNF) fa cilities.
	7967
	7968
	7969	StandardUn der HIPAA, this is " … a prescr ibed set o f rules, c onditions, or requir ements des cribing th e followin g informat ion for pr oducts, sy stems, ser vices or p ractices ( 1) Classif ication of component s, (2) Spe cification of Materi als, perfo rmance or operations , (3) Deli neation of procedure s. [45 CFR 160.103]
	7970
	7971
	7972	Standard S etting Org anization (SSO)Under HIPAA, th is is "…an organizat ion accred ited by AN SI that de velops and maintains standards for infor mation tra nsactions or data el ements, or any other standard that is ne cessary fo r, or will facilitat e the impl ementation of this p art." [45 CFR 160.10 3]
	7973
	7974
	7975	Standard T ransaction 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]
	7976
	7977
	7978	Statement of Work (S OW)A docum ent descri bing the s pecific ta sks and me thodologie s that wil l be follo wed to sat isfy the r equirement s of an as sociated c ontract or MOU.
	7979
	7980	Third Part y Administ rator (TPA )An entity that proc esses heal th care cl aims and p erforms re lated busi ness funct ions for a health pl an.
	7981	Third (3rd ) Party Cl aimsHealth care insu rance clai ms submitt ed to an
	7982	Transactio n entity f or reimbur sement of health car e bills. U nder HIPAA , this is "…the exch ange of in formation between tw o parties to carry o ut financi al or admi nistrative activitie s related to health care." [45 CFR 160.1 03]
	7983
	7984
	7985	TRICARE Pa tientA TRI CARE patie nt is a pa tient that is receiv ing servic es due to being cove red by TRI CARE . His /her TRICA RE insuran ce will be billed fo r the pres cription.
	7986
	7987	UB-92A uni form insti tutional c laim form developed by the Nat ional Unif orm Billin g Committe e (NUBC) t hat has be en in use since 1993 .
	7988
	7989
	7990	Unstructur ed DataThi s term usu ally refer s to data that is re presented as free-fo rm text, a s an image , etc., wh ere it is not practi cal to pre dict exact ly what da ta will ap pear where .
	7991
	7992
	7993	‘Verify’ a Prescript ionAfter a prescript ion order has been ‘ Finished’ the prescr iption mus t be ‘Veri fied’ by a n authoriz ed VistA u ser, throu gh the adm inistratio n of the s ystem secu rity key S OP. This i s a critic al step in the proce ss of gene rating an electronic claim.
	7994
	7995
	7996	Veterans H ealth Info rmation Sy stems Acro nym for Ve terans Hea lth Inform ation
	7997	and Techn ology Arch itecture ( VistA)Syst ems and Te chnology A rchitectur e, the new name for Decentrali zed Hospit al Compute r Program (DHCP).
	7998
	7999
	8000	Workgroup for Electr onic DataA health ca re industr y group th at lobbied
	8001	Interchang e (WEDI)fo r HIPAA A/ S, and tha t has a fo rmal consu ltative ro le under t he HIPAA l egislation .
	8002
	8003	(This page included for two-si ded copyin g.)
	8004
	8005	11Acronyms
	8006	Acronym
	8007	Descriptio n
	8008	AITC
	8009	Austin In formation Technology Center
	8010	ADPAC
	8011	Automated Data Proce ssing Appl ication Co ordinator
	8012	AMA
	8013	American M edical Ass ociation
	8014	ANS
	8015	American N ational St andards
	8016	ANSI
	8017	American N ational St andards In stitute
	8018	A/S
	8019	Administra tive Simpl ification
	8020	ASC
	8021	Accredited Standards Committee
	8022	ASTM
	8023	American S ociety for Testing a nd Materia ls
	8024	BCBSA
	8025	Blue Cross and Blue Shield Ass ociation
	8026	CDES
	8027	ECME User Screen
	8028	CMOP
	8029	Consolidat ed Mail Ou tpatient P harmacy
	8030	CMS
	8031	Centers fo r Medicare & Medicai d
	8032	COB
	8033	Coordinati on of Bene fits
	8034	DD
	8035	Data Dicti onary
	8036	DEA
	8037	Drug Enfor cement Adm inistratio n
	8038	DHHS
	8039	Department of Health and Human Services
	8040	DUR
	8041	Drug Utili zation Rev iew
	8042	ECME
	8043	Electronic Claims Ma nagement E ngine
	8044	EComm
	8045	Electronic Commerce
	8046	EDI
	8047	Electronic Data Inte rchange
	8048	FILEMAN
	8049	VistA File Man
	8050	GUI
	8051	Graphical User Inter face
	8052	HCFA
	8053	Health Car e Financin g Administ ration
	8054	HCPCS
	8055	HCFA Commo n Procedur al Coding System
	8056	HFMA
	8057	Healthcare Financial Managemen t Associat ion
	8058	HHS
	8059	Department of Health and Human Services
	8060	HIAA
	8061	Health Ins urance Ass ociation o f America
	8062	HIPAA
	8063	Health Ins urance Por tability a nd Account ability Ac t
	8064	HL7
	8065	Health Lev el Seven
	8066	IB
	8067	Integrated Billing
	8068	ICD
	8069	Internatio nal Classi fication o f Disease
	8070	ICD-9-CM
	8071	Internatio nal Classi fication o f Disease, 9th revis ion, Clini cal Modifi cation
	8072	ICD-9-PCS
	8073	Internatio nal Classi fication o f Disease, 9th revis ion, Proce dure Codin g System
	8074	IG
	8075	Implementa tion Guide
	8076	IRMS
	8077	Informatio n Resource s Manageme nt Service
	8078	ISO
	8079	Internatio nal Standa rds Organi zation
	8080	JCAHO
	8081	Joint Comm ission on Accreditat ion of Hea lthcare Or ganization s
	8082
	8083	Acronym
	8084	Descriptio n
	8085	MOU
	8086	Memorandum of Unders tanding
	8087	NCHS
	8088	National C enter for Health Sta tistics
	8089	NCPDP
	8090	National C ouncil for Prescript ion Drug P rograms
	8091	NDC
	8092	National D rug Code
	8093	NDF
	8094	National D rug File
	8095	NOI
	8096	Notice of Intent
	8097	NPF
	8098	National P rovider Fi le
	8099	NPI
	8100	National P rovider Id entifier
	8101	NPRM
	8102	Notice of Proposed R ulemaking
	8103	NPS
	8104	National P rovider Sy stem
	8105	NSF
	8106	National S tandard Fo rmat
	8107	NUBC
	8108	National U niform Bil ling Commi ttee
	8109	OMB
	8110	Office of Management and Budge t
	8111	OPECC
	8112	Outpatient Pharmacy Electronic Claims Co ordinator
	8113	OSI
	8114	Open Syste m Intercon nection
	8115	OTC
	8116	Over the C ounter
	8117	POS
	8118	Point of S ale
	8119	SOW
	8120	Statement of Work
	8121	SSO
	8122	Standard S etting Org anization
	8123	TPA
	8124	Third Part y Administ ration
	8125	VA
	8126	Department of Vetera ns Affairs
	8127	VAMC
	8128	Department of Vetera ns Affairs Medical C enter
	8129	VHA
	8130	Veterans H ealth Admi nistration
	8131	VistA
	8132	Veterans H ealth Info rmation Sy stems and Technology Architect ure
	8133	WEDI
	8134	Workgroup for Electr onic Data Interchang e
	8135
	8136
	8137
	8138	12Index
	8139
	8140	A
	8141	Accessing Pharmacy E CME Manage r Menu, 87
	8142	Accessing the ECME P harmacy CO B Menu, 79
	8143	Acronyms, 199
	8144	Add/View C omments, 4 0, 47
	8145	B
	8146	BPS Nightl y Backgrou nd Job, 18 1
	8147	C
	8148	Change Vie w, 19
	8149	Claim Resu lts and St atus, 108
	8150	Claims Sub mitted, No t Yet Rele ased, 128
	8151	Claims Tra cking, 47
	8152	Close Clai m, 35
	8153	Closed Cla ims Report , 135
	8154	CMOP/ECME Activity R eport, 122
	8155	D
	8156	Display Up date, 76
	8157	Display Up date, 103
	8158	E
	8159	ECME Claim s-Response Inquiry, 152
	8160	ECME Main Menu, 12
	8161	ECME Menu Options, 8
	8162	ECME Menu Structures , 7
	8163	ECME Setup - Pharmac ies, 160
	8164	ECME Trans action Mai ntenance O ptions, 87
	8165	ECME User Screen, 14
	8166	Edit Basic Pharmacy ECME Param eters, 92
	8167	Edit ECME Pharmacy D ata, 94
	8168	Exit from ECME User Screen, 78
	8169	F
	8170	Further Re search Scr een, 42
	8171	G
	8172	Glossary, 183
	8173	Group Plan Menu, 57
	8174	I
	8175	IB (Integr ated Billi ng) Events Report, 5 3
	8176	Insurance Details, 4 3
	8177	Introducti on, 1
	8178	N
	8179	Non-Billab le Status Report, 13 8
	8180	O
	8181	On-Hold Co pay Listin g, 50
	8182	Online Hel p, 4
	8183	OPECC Prod uctivity?? , 174
	8184	Orientatio n, 3
	8185	Other Repo rts, 152
	8186	P
	8187	Payable Cl aims, 110
	8188	Payable Re jected Cla ims, 116
	8189	Payer Shee t Detail, 155
	8190	Pharmacy E CME Setup Menu, 91
	8191	Pharmacy E CME User S creen, 10
	8192	Pharmacy E lectronic Claims Rep orts, 107
	8193	Pharmacy E lectronic Claims Rep orts Menu Structure, 10
	8194	Potential Claims Rep ort for Du al Eligibl e, 81
	8195	Potential Secondary Rx Claims Report, 79
	8196	Print Clai m Log, 60
	8197	Process Se condary/Tr icare Rx t o ECME, 83
	8198	R
	8199	Recent Tra nsactions, 129
	8200	Related Ma nuals, 5
	8201	Release Co pay, 51
	8202	Reopen Clo sed Claims (hidden o ption), 66
	8203	Resubmit C laim, 32, 73
	8204	Resubmit w ith Edits (hidden op tion), 68
	8205	Reversal C laims Repo rt, 124
	8206	Reverse Pa yable Clai m, 29
	8207	S
	8208	Send to Wo rklist, 63
	8209	Sort List, 27
	8210	Spending A ccount Rep ort, 146
	8211	Statistics Screen, 1 00
	8212	Submitting Primary C laims for TRICARE an d Dual Eli gibility P atients, 8 5
	8213	Submitting Secondary Claims, 8 4
	8214	T
	8215	Third Part y Inquiry, 49
	8216	Totals by Date, 134
	8217	Turn-aroun d time sta tistics, 1 62
	8218	U
	8219	Update Con tinuously, 102
	8220	V
	8221	Variations to the Cl ose claim process, 3 8, 40, 90
	8222	View Eligi bility, 44
	8223	View Presc ription, 4 5, 58
	8224	View/Unstr and Claims , 88
	8225	Z
	8226	Zero (clea r) Statist ics, 103
	8227