Switch Problems


There is a video regarding this issue available here.

What is a Billing Switch

A billing switch in pharmacy software terms is an intermediary that routes insurance claims billed from the pharmacy to the appropriate insurance third parties or PBMs.  Most insurance companies are billable only through a switch.

Pathway of a Claim

Pathway of a Claim

Transmitting a claim to an insurance company through a switch has specific fees associated with the switching service.  Although the fees incurred with each transmission are billed by the different switching company themselves, all fees from the possible switching companies are compiled by FSI and billed to your pharmacy in your monthly statement.

My Current Switch is Down, What Can I Do?

Fortunately you’re not entirely dependent on one switching company. We have two major options for claims billing in the FSI system. The two main switches we use are “RSI” and “NDCI” and when one may be having issues, the second may be working appropriately.

Change for Specific Insurance

  1. 3-7-1-1
  2. Enter Specific Insurance Code
  3. Go to “Switch Code” field, and replace it with switch code to use instead

Oftentimes when a switch goes down, the easiest thing to do is to use an alternate switch. Each insurance company record in your FSI system can be set for a specific switch by going to the record amendments. You can reach that option from main menu by selecting 3-7-1-1, and then entering the code associated with that insurance company.

Insurance Maintenance (3-7-1-1)

Insurance Maintenance (3-7-1-1)

You could then go to the “Modem Switch Code” field and change it from the current switch to your alternate switch.  In the case showed above, you could change it from RSI to NCDI and billing attempts from that moment on would be routed through NDCI.

Change for ALL Insurances

  1. 3-7-9-4
  2. Switch Code to replace on top, Switch Code to replace with on bottom.

Instead of going into each individual insurance company, you can switch all insurances from one switch to another through a simple process.  You can reach this from the main menu with the selections 3-7-9-4

Change All Insurance Switch Codes (3-7-9-4)

Change All Insurance Switch Codes (3-7-9-4)

This option will allow you to first select the Switch Code you want to replace, and then the switch code you would like to put in its place.  In the example above, the software would then scan through all insurances and change them from using RSI to NDCI instead.  If you were currently using NDCI but wanted to use RSI instead, you would simply reverse the two fields and hit enter to accept the change.

Once this happens, you can attempt to process your claims again, and if it works, then you know that your alternate switching company is working, and you can either then continue to process and bill prescriptions through the secondary switch or reverse the process and wait to process until the problem with the switch is resolved.

What are the Differences Between the Switch Codes?

RSI and NDCI are two independent switching companies. There are benefits to that, since if the infrastructure to NDCI goes down, RSI may still be functioning properly and vice-versa, but you should be aware of differences between the switching companies.

RSI

RSI processes through the company Emdeon.

NDCI

NDCI will process through Relay Health.