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Listed below are some of the common questions that are
asked of our support specialists. We offer them here, along
with the answers to attempt to answer any questions you may
have. You can
contact us directly
with any questions you might have.
Medicare Part D
| 1. |
What is an E1
Transaction? |
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E1 transactions are eligibility queries
that have always been part of the NCPDP v5.1
telecommunication specification. The intent is to
use this transaction to query a third party plan to see
if a patient is eligible for that plan on a particular
date of service. |
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| 2. |
How do E1
transactions apply to Medicare Part D? |
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It has been known since the beginning that
pharmacies would need a way to query the plan
information for Medicare Part D eligible patients,
especially as it applies to auto-enrollees. The
TrOOP facilitator was tasked with this
responsibility. Specifically, the TrOOP
facilitator will respond to E1 transactions and return
to the pharmacy the information necessary to determine
what Part D plan a patient is enrolled in. |
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| 3. |
What information is
returned by the E1 query to the TrOOP facilitator? |
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The TrOOP facilitator will return the
following fields for each plan the patient is enrolled
in.
- Bin Number
- Processor Control Number
- Group Number
- Cardholder ID number
- Person Code
- Help Desk Phone Number
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| 4 |
What information
does the pharmacy need to supply in the E1 Transaction? |
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FrameworkLTC® will automatically create the
E1 transaction request from the following fields:
- Last 4 digits of SSN
- Patient Last Name
- Patient First Name
- Patient Gender Code
- Patient Date of Birth
- Zip Code taken from Facility Record
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| 5. |
How does
FrameworkLTC® make use of this information? |
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If a E1 transaction is submitted for a
single patient from the patient method of payment
screen, FrameworkLTC® will automatically update the
patient's profile to match the information returned in
the response from the TrOOP facilitator. The plans
MUST exist in your list of insurance plans for the
patients profile to be updated. If the plan does
not exist, an alert will be displayed with the Bin/PCN
that was returned.
If E1 transactions are submitted in batch, the user
can decide how to process the responses. You may:
- Print a report of responses
- Print a report and save responses to a file
- Print a report and modify patients profiles
If the responses are saved to a file, those responses
can be processed at a later date and used to modify the
patients profiles. |
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| 6. |
When will this be
available? |
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The modifications to FrameworkLTC® are
complete and are included in version 2.0.220 and higher
of FrameworkLTC®.
Updated Information as of 01/05/06:
CMS has delivered slightly more that 6 million
enrollment records available for E1 queries. This
represents a mixture of auto-enrollees and those
enrolled through open enrollments. CMS has
identified many plans where the PCN's, cardholder ID's,
etc. have been incorrect. CMS is working with the
plans to get this data corrected and re-submitted to the
TrOOP facilitator.
Further, NDC has worked through the issues that were
causing timeouts on E1 queries. According to NDC,
this should no longer be an issue.
You can check for updates posted on the TrOOP
facilitators web site at:
http://medifacd.ndchealth.com/Support/MediFacD_Support.asp |
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| 7. |
Why do I get the
following error message? |
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This is due to a blank message being
returned by the TrOOP facilitator. |
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| 8. |
What do I do if the
E1 Query returns with an unmatched patient, but the
patient should have been auto-enrolled in a part D plan? |
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While CMS has done its best to insure that
all who where eligible were auto-enrolled, there is
recourse for the pharmacy if an error has been
made. Claims can be submitted to Wellpoint.
Wellpoint will capture the claim and auto-enroll the
patient. The following document discusses this
process and provides instructions on how and where to
submit the claim.
POS
Facilitated Enrollment in 4 Steps for Pharmacists
This document was published by CMS and has been
provided here for your convenience. If you need
assistance in performing the steps described in this
document using FrameworkLTC®, please contact product
support. |
FrameworkLTC® Questions
| 1. |
Do
I have to download product updates on each
workstation? |
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You only have to DOWNLOAD the product updates ONE TIME. We
recommend saving the update file to a shared location on your
network. You MUST EXECUTE the update program ON EACH
WORKSTATION that is using FrameworkLTC®. If you are not sure of
how to do this, ask your network administrator, or call SoftWriters
for assistance. |
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| 2. |
What
is the difference between "Reversing" a
prescription and "Crediting" a
prescription? |
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Reversing a prescription is intended to be used when a
prescription is never used by the patient. For example, if a
prescription is never picked up from a retail pharmacy, or if
an LTC facility refuses a prescription. In this case 100% of
the quantity dispensed is returned to inventory and all
revenues from this script are reversed. If the script was
being paid for by a third party and was electronically
adjudicated, a reversal transaction will be submitted to the
third party payor (or payors).
Crediting a prescription is intended to be used only by LTC
pharmacies when a facility returns some portion of the
quantity originally dispensed because the patient will no
longer be taking the drug. For example, assume that 28 day
supply prescription was dispensed and after 3 days of
administration the patient had an adverse reaction to the
medication. In some states, if clean packaging is used, the
facility may return the unused portion to the pharmacy. In
this case, you can enter a credit for the unused 25 days worth
of the drug. Only that quantity will be returned to inventory
(89% of what was dispensed). Usually, the facility and the
pharmacy have an arrangement stating something like "...
80% of the ingredient costs of the unused portion of any
returned drugs will be credited...". If our original
ingredient cost for the drug was $10.00, a credit amount of
$7.12 would be applied to the facility:
Credit Amount = $10.00 * 89% * 80% = $7.12
The original dispensing fee is not credited.
Because crediting is intended for partial returns (otherwise
you would be reversing) it should never be used for third
party claims where the third party is the only payor as there
is no way to do a partial reversal of a script. However, you
can credit a third party script if their is a copay amount and
only the copay will be credited to the patients private method
of payment.
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| 3. |
Why
can't I find this NDC number in the database? |
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If you find an NDC number that is not in the database, it
is because it has not yet been added to MediSpan's drug
knowledge base.
Call SoftWriters
with the NDC number and we will contact MediSpan to request that it
be added.
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| 4. |
How
can I print an MAR, POF, Treatment Sheet, ADL Sheet, or
Antipsychotic flow record for just one patient? |
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From the menu, select
<File><Facility><Patients>.
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Press the "Medical Records" button.
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Check off the medical records you wish to print and
select the appropriate printer for each medical record.
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Select the appropriate effective date.
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Press OK.
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Server/Workstation Questions
| 1. |
What is Microsoft
SQL Server? |
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Microsoft SQL Server is one of the most popular database
server products on the market today, and is the database
engine used for FrameworkLTC® for Windows. It is
responsible for housing all of your data and making it
available to you when you need it. You can read all about this
product on the Microsoft SQL Server Web Site.
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