UPLOADING PHARMACY FILE | AUTOMATED PROCESS | MANUAL PROCESS | ADD SERVICE CODES | UPDATE AGENCY RATES | UPDATE ORGANIZATION PAYER RATES | ADD PHARMACY BILLING RECORDS - VERIFY SERVICES | PHARMACY UPLOAD EDITS | DELETE UNMATCHED RECORDS | CORRECT AND RE-PROCESS ERRORS | DELETING RECORDS NOT NEEDED
Effective with April, 2014 billing, Hospice locations must report all Hospice covered pharmaceuticals dispensed to patients on their Medicare claims. If the pharmacy that you use can provide you with specific data elements in a .csv (comma separated values) file format, you will be able to upload this information into Careficient to create the following tables of information and billing records:
Data elements needed in the .csv file format include:
If your Pharmacy is able to provide the information to you based on the data elements as outlined above in a .csv format, you can upload this file directly into Careficient using the following path: Processes > Pharmacy Import
Refer to the Processes section in this document to learn more about uploading the file and the reports that are available.
A menu option labeled Pharmacy Import is available that allows you to upload a file you receive from your Pharmacy for billing purposes. You can access this menu option as follows: Processes > Pharmacy Import
After selecting the link, the Imported Pharmacy Records screen displays. This screen contains the following information:
Imported Pharmacy Records - Example
Before using this process for the first time, you must submit a .csv file for testing purposes. If the file meets the format and data elements required, we will notify you that you can start uploading your Pharmacy files. Contact our Careficient support team using the following path from the Help > Support Portal > Create a ticket.
Send a Support Request Complete the Support Request and attach the Pharmacy .csv file. If you do not send us this TEST file for approval prior to automatically uploading the files into Careficient, this will cause a major issue when we process the data from the file you uploaded. When you receive the .csv file from your Pharmacy, save the file to a local drive on your device (PC).
To upload the Pharmacy file, select the Upload Document link. The Upload file pop-up displays with the following:
Upload file example
You will need to change security access for all individuals that will be uploading the file.
Effective with April 2014 billing, Hospice locations must report all Hospice covered pharmaceuticals dispensed to patients on their Medicare claims. The pharmacy that you use will provide you with the information you need to complete the following actions in order to create these billing records:
You can complete these actions as follows:
If you know the first 9 digits of the NDC code, use the following path to add a new service code: Settings > Lookup Tables > General Support Tables > Service Codes > Add NDC Complete the Add NDC entry screen as follows:
Add NDC - example
To add your Agency standard charge rates, use the following path: Settings > Org/Region/Agency > select the Agency (third level in the tree at the left) > Bill Rates tab > Add Bill Rate link > select Pharmaceuticals from the service category listing > Next
When the Add Agency Rates for Pharmaceuticals pop-up displays, enter the following:
After you enter all the rates, select the Save button.
Add Agency Rates for Pharmaceuticals
To add your Organization Payer charge rates, use the following path: Resources > Organization Payers > select your Hospice Medicare payer > Bill Rates tab > Add Bill Rate link > select Pharmaceuticals from the service category listing > select your agency > Next
When the Add Agency Rates for Pharmaceuticals pop-up displays for your Medicare payer, enter the following:
After you enter all the Organization Payer rates, select the Save button. Repeat this process for all other payers that have the same billing requirements as your Medicare payer.
Add Payer Rates for Pharmaceuticals
To include pharmaceuticals on each patient claim, use the following path: Patients > Verifications > Verify Services > select Add Supply from the Select to Add dropdown box
When the Add a Service for Verification screen displays, enter the following information:
Select Verify/Add if you have additional items you need to enter or select Verify/Continue to return to the Verify Services screen.
Add and Verify Service Entry
After entering pharmacy information through the verification process, the products entered will now be included with the invoice.
Invoice Detail – Services tab
The "Pharmacy Import" process now lets you delete any unmatched record if you determine that you do not need to attach the transaction to an invoice. After you upload the spreadsheet, records with errors display on the screen with the "error" icon <icon-exclamationred>xxx<icon-exclamationred>. You can either correct the record or you can delete the record. Uploaded pharmacy records display on the Imported Pharmacy Records screen. Records that did not successfully upload and attach to an invoice will have an error icon <icon-exclamationred>xxx<icon-exclamationred>. Click here to learn more about <udl-blue>Pharmacy Import<udl-blue>.
Hover over the error icon <icon-exclamationred>xxx<icon-exclamationred> to identify the error and determine what information you need to correct the record
Select the "Show Errors" icon <icon-editpencil>xxx<icon-editpencil> to view the uploaded information and make any corrections necessary for posting and select the <btn> Save <btn> button
Select the <btn> Re-Process Errors <btn> button
Records you corrected and successfully attached to an invoice will show the invoice number and the date processed. Records that still have errors will show the error icon <icon-exclamationred>xxx<icon-exclamationred> and require additional changes to the information.
Select the "Delete" icon <icon-trashcan>xxx<icon-trashcan> for the record that you do not want to post to an invoice or a record that you want to remove from an invoice. You will be asked if you are sure you want to delete. Select "OK" to confirm.