Pioneer Rx Software has long been at the forefront of pharmacy technology, consistently delivering innovative solutions to enhance pharmacy operations. Among its groundbreaking features, the integrated Pre-/Post-Edit functionality stands out as a revolutionary tool designed to optimize prescription processing and minimize costly errors. This system was the first to offer such integrated capabilities, setting a new standard in pharmacy software. Pioneer Rx Software’s Pre-/Post-Edit solution empowers pharmacies to achieve both speed and accuracy in dispensing medications, providing crucial peace of mind by proactively identifying and preventing potential errors before they impact patients or profitability.
The Pre-/Post-Edit system within Pioneer Rx Software operates on two key stages of the prescription fulfillment process:
Pre-Edit: Proactive Error Prevention
Pre-Edit is an intelligent evaluation of prescription data conducted before the claim is submitted to the third party payer. This proactive step is critical for identifying and rectifying potential issues that could lead to claim rejections or dispensing errors. Pioneer Rx Software’s Pre-Edit feature acts as a virtual safety net, catching errors before they can cause problems.
Post-Edit: Claim Adjudication Analysis
Post-Edit takes place after the claim has been adjudicated by the third party payer. This stage analyzes the claim data returned, allowing pharmacies to identify discrepancies or issues that may have occurred during processing. With Pioneer Rx Software, pharmacies have the flexibility to customize their response to each type of Rx Edit issue – choosing to reject, review, or ignore alerts based on their specific needs and priorities.
Let’s explore specific examples of how Pioneer Rx Software’s Pre-/Post-Edit features can be utilized to enhance pharmacy efficiency and accuracy:
Key Pre-/Post-Edit Examples in Pioneer Rx Software
Pricing and Reimbursement Accuracy
- Base Limited (Post-Edit): Pharmacy contracts with third-party payers are often based on formulas like AWP – X% + Fee or MAC + Fee. The “basis” refers to the pricing benchmark. If a pharmacy inadvertently submits a claim with a basis lower than their contracted rate, the payer will typically reduce the reimbursement. Pioneer Rx Software’s Base Limited Post-Edit immediately flags these instances, ensuring pharmacies are paid correctly according to their agreements and preventing revenue loss.
- Cash Limited (Post-Edit): Pricing errors can significantly impact profitability. The Cash Limited Post-Edit in Pioneer Rx Software is designed to detect and correct pricing mistakes that could limit third-party payments, safeguarding revenue and ensuring accurate financial transactions.
- Low Profit (Post-Edit): Maintaining profitability on every prescription is crucial. Pioneer Rx Software allows pharmacies to set minimum gross profit thresholds (percentage or dollar value). If a prescription falls below this threshold, the Low Profit Post-Edit is triggered. Furthermore, the Smart Profit Reject feature intelligently considers rebates and the last paid cost before alerting the pharmacy, providing a sophisticated profit protection mechanism.
- Third Party Remitted a Negative Amount (Post-Edit): In rare cases, a claim adjudication might result in a negative remitted amount, meaning the pharmacy would owe money to the third party. This often indicates an error in claim processing. Pioneer Rx Software’s Post-Edit immediately alerts to these situations, allowing pharmacies to switch the prescription to cash or a different discount plan, avoiding unnecessary fees and financial complications.
Compliance and Regulatory Adherence
- DAW Code (Pre-/Post-Edit): When dispensing a brand-name drug when a generic equivalent is available, a Dispense As Written (DAW) code is required to justify the medical necessity. Failure to include a DAW code can lead to reimbursement reductions. Pioneer Rx Software’s DAW Code Pre-/Post-Edit ensures that if a brand is dispensed without a valid reason code, the system prompts the user to select one, ensuring compliance and maximizing reimbursement.
- Obsolete NDC (Pre-/Post-Edit): Dispensing medications with expired National Drug Codes (NDCs) can lead to claim rejections and potential audits. Pioneer Rx Software proactively prevents this with the Obsolete NDC Pre-/Post-Edit, flagging prescriptions with expired NDCs before submission, ensuring regulatory compliance and preventing reimbursement issues.
- Missing or Invalid DEA (Pre-/Post-Edit): For controlled substances and certain other medications, a valid Drug Enforcement Administration (DEA) number for the prescriber is mandatory. The Missing or Invalid DEA Pre-/Post-Edit in Pioneer Rx Software verifies the DEA number, preventing dispensing errors and ensuring compliance with regulations.
- Missing or Invalid DPS (Pre-/Post-Edit – Texas Specific): In Texas, a valid DPS (Department of Public Safety) number may be required for prescribers. Pioneer Rx Software includes a Missing or Invalid DPS Pre-/Post-Edit specifically for Texas pharmacies, ensuring adherence to state-specific regulations.
Inventory and Dispensing Accuracy
- Package Size (Pre-/Post-Edit): Certain medications should not be broken down from their original packaging. Dispensing an incompatible package size can lead to errors and potential waste. Pioneer Rx Software’s Package Size Pre-/Post-Edit triggers when an item that should not be broken down is filled with an incorrect dispensed size. Correcting these errors can significantly boost pharmacy revenue, with average pharmacies gaining an additional $100-$400 per month by addressing these issues.
- Dispensing Item Out of Stock (Pre-/Post-Edit): Dispensing out-of-stock medications leads to patient inconvenience and potential errors. Pioneer Rx Software’s integrated perpetual inventory management system works seamlessly with Pre-/Post-Edits to prevent dispensing out-of-stock items. This saves money, improves inventory accuracy, and enhances patient satisfaction.
Patient Safety and Data Integrity
- Patient ID Missing (Pre-/Post-Edit): For certain prescriptions, patient identification, such as a driver’s license or social security number, may be required. Pioneer Rx Software’s Patient ID Missing Pre-/Post-Edit ensures that this critical information is captured, enhancing patient safety and record-keeping accuracy.
- Patient Information Missing (Pre-/Post-Edit): Complete and up-to-date patient information, including allergies, medications, and medical conditions, is vital for safe and effective dispensing. Pioneer Rx Software’s Patient Information Missing Pre-/Post-Edits alert pharmacists if this crucial data is missing or outdated when filling a prescription, promoting patient safety and informed decision-making.
Copay Management
- High Copay (Post-Edit): Unexpectedly high copays can lead to patient dissatisfaction and abandoned prescriptions. Pioneer Rx Software allows pharmacies to define a “high copay” threshold. If a copay exceeds this amount, the High Copay Post-Edit is triggered, allowing the pharmacy to verify with the patient before dispensing, improving patient communication and reducing prescription abandonment.
- Higher Secondary Copay (Post-Edit): In cases with primary and secondary insurance, a higher copay from the secondary payer than the primary is often an error, typically caused by misconfigured coupons or payer settings. Pioneer Rx Software’s Higher Secondary Copay Post-Edit immediately identifies these discrepancies, enabling quick correction and accurate billing.
Conclusion
Pioneer Rx Software’s Pre-/Post-Edit features represent a significant advancement in pharmacy management. By proactively identifying and addressing potential errors at both the pre-claim submission and post-adjudication stages, Pioneer Rx Software empowers pharmacies to optimize workflow, enhance accuracy, ensure regulatory compliance, maximize reimbursement, and ultimately improve patient care. For pharmacies seeking to elevate their operational efficiency and minimize errors, Pioneer Rx Software and its innovative Pre-/Post-Edit system are indispensable tools in today’s complex pharmacy landscape.
