In the fast-paced world of pharmacy, efficiency and accuracy are paramount. Pioneer Rx Pharmacy Software understands these critical needs, offering innovative solutions to optimize daily operations. One standout feature that sets PioneerRx apart is its integrated Pre-/Post-Edit functionality. This powerful tool is designed to revolutionize how pharmacies handle prescriptions, ensuring speed, accuracy, and ultimately, improved profitability by minimizing costly errors before they impact your bottom line.
PioneerRx was the first to introduce a system equipped with comprehensive Pre-/Post-Edit capabilities. Let’s delve into how this system works and the significant benefits it brings to your pharmacy.
Pre-Edit: Proactive Prescription Error Prevention
Pre-Edit is all about catching potential issues before a prescription claim is submitted. This proactive approach analyzes prescription data in real-time, flagging items that require attention or correction. By identifying and resolving errors upfront, pharmacies can significantly reduce claim rejections and delays, streamline the dispensing process, and enhance patient safety.
Imagine the time saved by automatically identifying issues like missing DAW codes or incompatible package sizes before they cause problems. Pre-Edit empowers your pharmacy staff to address these details efficiently, leading to a smoother workflow and fewer interruptions.
Post-Edit: Optimizing Claim Adjudication and Accuracy
Post-Edit takes error detection a step further by evaluating claim data after adjudication. This feature focuses on identifying discrepancies and potential financial losses that may occur after a claim has been processed. With Post-Edit, pharmacies gain valuable insights into claim rejections, underpayments, and pricing errors, allowing for timely corrections and revenue recovery.
For example, Post-Edit can alert you to situations where a third party has remitted a negative amount or when a dispensed item has an obsolete NDC. By quickly identifying and addressing these post-adjudication issues, you can prevent financial losses and maintain accurate records.
Key Examples of Pre-/Post-Edit Functionality in Pioneer Rx Pharmacy Software
Pioneer Rx pharmacy software’s Pre-/Post-Edit features cover a wide range of potential issues, ensuring comprehensive error detection and prevention. Here are some key examples:
Base Limited (Post-Edit): Pharmacy contracts often rely on formulas like AWP – X% + Fee or MAC + Fee. If a claim is transmitted with a basis lower than the contracted rate, PioneerRx’s Base Limited Post-Edit is triggered. This helps ensure you receive the correct reimbursement according to your agreements.
Cash Limited (Post-Edit): Pricing errors can negatively impact third-party payments. The Cash Limited Post-Edit helps identify and rectify these mistakes, safeguarding your revenue.
DAW Code (Pre-/Post-Edit): When a brand-name drug is dispensed while a generic alternative is available, a DAW (Dispense As Written) code is usually required. This edit alerts staff if a brand is dispensed without a reason code, helping avoid reimbursement reductions.
Package Size (Pre-/Post-Edit): Dispensing medications in incorrect package sizes, especially for items that should not be broken down, can lead to errors. This edit flags such instances, ensuring accurate dispensing and potentially adding hundreds of dollars to your monthly revenue by correcting these overlooked errors.
Third Party Remitted a Negative Amount (Post-Edit): In rare cases, a prescription claim might result in a negative remitted amount, meaning the pharmacy owes money to the third party. This Post-Edit identifies these situations, allowing you to switch to cash or another discount plan and avoid unnecessary fees.
Obsolete NDC (Pre-/Post-Edit): Dispensing medications with expired National Drug Codes (NDCs) can lead to reimbursement reductions and audits. This edit prevents submission of claims with obsolete NDCs, ensuring accurate billing and compliance.
Dispensing Item Out of Stock (Pre-/Post-Edit): PioneerRx’s inventory management system integrates seamlessly with Pre-/Post-Edit. This feature helps prevent dispensing out-of-stock items, saving money, avoiding patient inconvenience, and minimizing errors.
Low Profit (Post-Edit): Pharmacies can set minimum profit margins. If a prescription falls below this threshold, the Low Profit Post-Edit is triggered. Smart Profit Reject further enhances this by considering rebates and last cost prices before prompting the edit.
Patient ID Missing (Pre-/Post-Edit): For certain medications, patient identification (like a driver’s license) is required. This edit ensures patient ID is collected when necessary, promoting compliance and accurate record-keeping.
Patient Information Missing (Pre-/Post-Edit): Up-to-date patient information, including allergies and medications, is crucial for patient safety. This Pre-/Post-Edit flags prescriptions dispensed when vital patient data is missing or outdated.
Missing or Invalid DEA (Pre-/Post-Edit): For controlled substances, a valid DEA number for the prescriber is mandatory. This edit alerts staff if a prescription is linked to a prescriber with a missing or invalid DEA number, preventing regulatory issues.
High Copay (Post-Edit): Pharmacies can define a threshold for high copays. If a copay exceeds this amount, a High Copay Post-Edit is triggered, allowing staff to verify with the patient before filling the prescription, improving patient communication and satisfaction.
Higher Secondary Copay (Post-Edit): When a secondary insurance payer results in a higher copay than the primary, this Post-Edit is triggered. This often indicates issues with coupon configurations or third-party settings that need to be addressed.
Missing or Invalid DPS (Pre-/Post-Edit) (Texas): Specifically for Texas pharmacies, this edit verifies the prescriber’s DPS number when required, ensuring compliance with state regulations.
Conclusion: Embrace Efficiency and Accuracy with Pioneer Rx Pharmacy Software
Pioneer Rx pharmacy software’s Pre-/Post-Edit features represent a significant leap forward in pharmacy management. By proactively preventing errors and optimizing claim adjudication, this system not only enhances efficiency and accuracy but also contributes directly to improved profitability and patient care. For pharmacies seeking a comprehensive solution to streamline workflows and minimize costly mistakes, Pioneer Rx pharmacy software with its Pre-/Post-Edit capabilities is an invaluable asset.
