FROM THE MAIN MENU OF THE PHARMACY MANAGEMENT SYSTEM
3- Utility Programs
7- Third Party Processing
1- Insurance Company Maint.
1- Add/Amend Third Party Record
These 4 steps will bring you to this screen:
You will need to come up with a new “Insurance Company Code”. This is the code that you will enter in the field on the above screen to search for your insurance. YOU MUST BE CERTAIN THAT YOU DO NOT USE A CODE THAT ALREADY EXISTS. If you don’t know if a code has been used or not, simply search it, if an Insurance Profile comes up with populated fields, you know that profile is in use.
(FOR THIS EXAMPLE I WILL CREATE A NEW INSURANCE PROFILE, AND I WILL USE THE CODE “NEW”.)
You will then be given a blank Insurance Profile template.
INSURANCE COMPANY CODE: Code identifying the insurance plan. (CANNOT BE CA, SC, CASH, or UNBIL)
GRP CODE: This field is used to group individual plans together for reporting, and billing purposes.
COMPANY/PLAN NAME: Enter the name of the insurance plan in this field.
SUBMITTER (PHARMACY) NAME: This is where your pharmacy name goes.
PHARMACY PROVIDER #: Enter the identification number assigned to your pharmacy by the insurance. (This will most likely be the pharmacy’s NCPDP OR NPI number) QUAL.: Most commonly used will be a 5,7, or 1 5- Medicaid ID Number; 7- NCPDP Number; 1- NPI Number.
GENERIC REQUIRED: If the insurance plan requires a generic product when available, entering a “Y” will force you to select a generic product within the script pathway.
FOR THIRD PARTY BILLING: A “Y” in this field allows the third party to be used for billing. If an “N” is entered, the insurance will not be able to be billed.
ONLINE BILLED: A “Y” will allow you to bill online. A “N” will insure that this insurance will not bill online claims. A “M” will bill multiple scripts for internet billing.
USE DOCTOR ID NUMBER: A “D” will submit the Doctor’s DEA. An “n” will submit the Doctor’s NPI, (IT NEEDS TO BE A LOWERCASE “n”).
Ql: This field is used to enter the qualifier of the Doctor Id Number. This should be a “1”.
USE DRUG ID NUMBER: Most commonly transmitted is the Drugs NDC. You transmit the NDC with a “N” in this field.
QUAL.: This field is used to enter the qualifier of the Drug Id Number. This should be a “3”.
ELECTRONIC CF#: Electronic CF#’s refer to the different ways of arranging the data when submitting to a third party electronically. This should be a “D0”. (That is “D” and “ZERO”).
MODEM SWITCH CODE: The modem switch code will call upon the network access information needed to send the claim to the switch or processor. (Most common Switch Codes: RSI, NDCI, eRX, NDC).
ANSI BIN NUMBER: This number identifies the processor. It is a 6 Digit Number.
PROCESSOR CONTROL #: IF NEEDED, this number will be given to you by the Insurance or processor.
CERTIFICATION #: IF NEEDED, This field is used to identify the FSI software to the insurance company.
COST SELECTIONS: (Pressing F2 from the Insurance Profile will display the values for COST SELECTIONS)
Populate the fields with the correct information, press ENTER to save.
Keep in mind that all insurances are different. Some insurances may require, for example, a Certification #, and some may not. If you have any additional questions or need assistance, feel free to call our support office 1-(801)-785-7720.