In the fast-paced world of pharmacy, efficiency and accuracy are paramount. Pioneer Software Pharmacy understands these critical needs, which is why they pioneered the integration of Pre-/Post-Edit features into their pharmacy system. This innovative solution is designed to streamline prescription filling while ensuring the highest level of accuracy, minimizing costly errors before they impact your bottom line or patient care.
Pioneer Software Pharmacy’s Pre-/Post-Edit functionality acts as a sophisticated safety net, working in two key phases to optimize prescription processing. Pre-Edit acts as a proactive measure, evaluating prescription data before submission. This crucial step identifies potential issues requiring correction upfront, preventing claim rejections and delays. Post-Edit then takes over after claim adjudication, scrutinizing claim data to catch discrepancies and errors that may have slipped through. This dual-layered approach gives pharmacies unparalleled control over their dispensing process, allowing them to choose to reject, review, or ignore specific edit issues based on their operational needs.
Let’s explore how Pioneer Software Pharmacy’s Pre-/Post-Edit features can be applied in practical pharmacy scenarios:
Ensuring Contract Compliance and Profitability
- Base Limited (Post-Edit): Pharmacy contracts are complex, often based on formulas like AWP – X% + Fee or MAC + Fee. If a claim is transmitted below the contracted basis, Pioneer Software Pharmacy’s Post-Edit immediately flags it. This ensures you are always paid according to your agreements, protecting your revenue.
- Cash Limited (Post-Edit): Pricing errors can significantly impact profitability. This Post-Edit is designed to identify and rectify mistakes that could limit third-party payments, ensuring accurate cash handling.
- Low Profit (Post-Edit): Set your minimum profit margins, and Pioneer Software Pharmacy will monitor every prescription. If a prescription falls below your defined threshold, a Low Profit Post-Edit is triggered, allowing for review and adjustment, incorporating rebates and last cost considerations for smart decision-making.
- Third Party Remitted a Negative Amount (Post-Edit): Avoid losing money on prescriptions. This critical Post-Edit alerts you when a claim results in a negative remittance, meaning you owe the third party. Quickly switch to cash or alternative discount plans to avoid these unnecessary fees.
Optimizing Dispensing Accuracy and Efficiency
- Package Size (Pre-/Post-Edit): Dispensing medications in incorrect package sizes can lead to errors and financial losses. This edit is triggered when an item that should not be broken down is filled with an incompatible size. Correcting these errors can add hundreds of dollars to your monthly revenue.
- Obsolete NDC (Pre-/Post-Edit): Expired NDCs lead to claim rejections and potential audits. Pioneer Software Pharmacy prevents this by triggering an edit when an obsolete NDC is used, safeguarding reimbursements and compliance.
- Dispensing Item Out of Stock (Pre-/Post-Edit): Maintain accurate inventory and avoid dispensing out-of-stock items with Pioneer Software Pharmacy. Real-time inventory tracking prevents errors and saves money by ensuring accurate dispensing.
- DAW Code (Pre-/Post-Edit): When dispensing a brand name drug when a generic is available, a DAW code is crucial for proper reimbursement. This edit ensures a DAW code is selected, preventing reimbursement reductions.
Enhancing Patient Safety and Data Integrity
- Patient ID Missing (Pre-/Post-Edit): For prescriptions requiring patient identification, this edit ensures necessary information like driver’s license or social security number is collected, enhancing patient data integrity.
- Patient Information Missing (Pre-/Post-Edit): Patient safety is paramount. This Pre-/Post-Edit triggers if critical patient information like allergies, medications, or medical conditions are missing or outdated, prompting pharmacists to update records and ensure safe dispensing.
- Missing or Invalid DEA (Pre-/Post-Edit): Ensure prescriber validity. This edit flags prescriptions with missing or invalid DEA numbers, crucial for controlled substances and regulatory compliance.
- Missing or Invalid DPS (Pre-/Post-Edit – Texas): Specifically for Texas pharmacies, this edit verifies the DPS number of prescribers when required, ensuring compliance with state regulations.
Managing Copays and Payer Issues
- High Copay (Post-Edit): Maintain patient satisfaction by managing high copays. Define a high copay threshold, and Pioneer Software Pharmacy will alert you when a copay exceeds this amount, allowing you to verify with the patient before filling.
- Higher Secondary Copay (Post-Edit): In multi-payer scenarios, this edit identifies situations where the secondary payer has a higher copay than the primary, often caused by configuration errors in coupons or payer settings. This allows for quick correction and accurate billing.
Pioneer Software Pharmacy’s Pre-/Post-Edit features are not just about error detection; they are about proactive pharmacy management. By integrating these intelligent edits, Pioneer Software Pharmacy empowers pharmacies to operate more efficiently, reduce financial losses, enhance patient safety, and ultimately thrive in a complex healthcare landscape. Embrace the future of pharmacy operations with Pioneer Software Pharmacy and experience the peace of mind that comes with truly intelligent software.
