The objective of this document is to explain the claim creation workflow for NDC code, set-up required for the same and the output formats.

Transcription

1 Introduction National Drug Codes (NDC) are sometimes required when billing for certain services, such as drugs dispensed directly from within your clinic. There are various workflows presented within the PrognoCIS billing module when processing NDC Codes. Document conventions Icon Note: Important: Description To create awareness about the fact. To emphasize about aspects which are critically important and should be adhered to instruction. Intended audiences Intended audiences for this document are: Clients Front-end Implementers Technical support QA department Training department Objective The objective of this document is to explain the claim creation workflow for NDC code, set-up required for the same and the output formats. Pre-requisite for creating claim with NDC code NDC code can be populated on Claim from following 3 sources: 1. Inhouse Drugs Master when Inhouse Drug is prescribed. 2. CPT OR HCPC Master when a charge code is populated on claim from various sources. 3. CMS Flag of Claim - manual entry Workflow 1: Populating NDC codes from Inhouse Drugs: Pre-requisite: a. In-House drug master should contain NDC code. b. Set property rx.inhousedrugs.support set to Y. c. Set property assessment.addcpt.frominhousedrug set to Y. d. Set property assessment.addhcpc.frominhousedrug set to Y.

2 Workflow 2: Populating NDC code from CPT OR HCPC Master: Pre-Requisite: a. CPT /HCPC from CPT/HCPC master should contain NDC code. b. Set property hcpc.assignndccodes.forstartchars set to J(for Ex). Workflow 3: Manually entering NDC code on CMS Flag of Claim Pre-Requisite: None WORKFLOW 1: Populating NDC codes from Inhouse Drugs: Set-Up details - step-by-step - for populating NDC code from In-House drug 1. Select a drug from In-House Drug master. -Go to Settings>Configuration>In-House Drug master. -To add a new drug in In-House drug master add it from + button. Strength wise entries of Drugs are listed here. - If newly added drug has NDC code on Drug master (FDB) then first NDC code will be populated on In-House drug master but user can change this auto populated NDC code if required. Note: Make sure that NDC code is of 11 digits only. -Associate appropriate CPT OR HCPC code to be billed for dispensing that Inhouse Drug from CPT or HCPC buttons.

3 Fig: Inhouse Drugs Master with selected Drugs strength-wise and associated NDC codes and Billable CPT or HCPC codes. Creation of Claim along with NDC code when Inhouse Drug is dispensed from Prescription screen on EMR 1. Take an appointment for a patient from appointment>schedule screen. 2. Start an encounter for a patient whose appointment has been taken. 3. From TOC menu select Prescription menu to dispense In-House drug. -Select In-House check box as checked. -From dropdown Drug select the inhouse drug. Select correct strength for that drug if multiple entries for different strengths for the same drug are present on Inhouse drugs. -Click on Update button -Click on save button.

4 -Click on Dispense button. Fig: Prescription screen with selected Inhouse Drug. 4. As soon as the Inhouse drug is saved, the associated CPT or HCPC code gets transferred to Assessment. Source for this transferred Charge code will be Rx. Fig : Assessment Screen with Charge code from Inhouse Drug: Source Rx.

5 5. Go to Encounter Close menu and click Mark Encounter Complete or check Create Claim checkbox to explicitly create a claim. Fig: Create claim from Encounter Close Screen. 6. Navigate to billing side and select the claim from claims>edit. 7. Following will be the details populated on claim: - Claim will be created with appropriate data on billing side on Claims>Edit screen. - Diagnosis codes (ICD) and Procedure codes (CPT/HCPC) also show up on claim screen. - NDC code will be populated on CMS flag for the Inhouse Drug s Charge code. - Units of the NDC code will be defaulted to International Units. - Admin Qty will get populated from Units field of that charge code which have been transferred from Assessment screen s Unit Field. - Inhouse Drug Name and strength get auto populated in Comments field.

6 Fig: Claim Created with CMS Flag showing NDC code associated to Inhouse Drugs. Note: While creating claim, system will check the source for each drug. If source is Rx, it will try to fetch the NDC code from In-House Drug Master. If NDC code is not present in In-House drug master for that drug, then it will check Drug master for NDC code and will pull first NDC code associated to that drug. If NDC code is not present on In-House drug & FDB both then it will search in CPT master for corresponding CPT code. Note: Comments get sent on claim only if the charge code is marked as NOC code on CPT or HCPC master. WORKFLOW 2: Populating NDC code from CPT OR HCPC Master: Set-Up details step-by-step for populating NDC code from CPT/HCPC master Following are steps required for populating NDC code from CPT/HCPC master. - Add NDC code to the CPT & HCPC in CPT & HCPC master in field NDC. - Units and Admin Quantity can also be associated to the NDC code on these masters.

7 Fig: NDC code associated to CPT code on CPT Master along with Units and Admin Qty. Fig: NDC code associated to HCPC code on CPT Master along with Units and Admin Qty.

8 Creation of Claim along with NDC code from claims>new 1- Go to Claims >Edit and select New claim option. 2- Create a claim for a patient. 3- Associate Insurance to that claim. 4- Select CPT OR HCPC code with NDC code associated on CPT or HCPC Master. 5- Go to CMS flag button. You will see that NDC code and its associated Units and Admin Quantity will be automatically populated for that charge code. Note: If on EMR side, Inhouse drug is not dispensed but the source for CPT or HCPC code having NDC code is Speciality, Vaccine, Assessment, Labs, radiology, Items, then it will be populated on claim s CMS flag button automatically on claim creation. Fig: Claim with auto populated NDC code, Units and Admin Qty from CPT or HCPC Master.

9 WORKFLOW 3: Manually adding NDC code from CMS flag -If claim is created with CPT/HCPC code having no NDC code and if user needs NDC code to be sent with a charge code in the Claim then NDC code can be added manually on CMS flag button.

10 Processing claim: Paper and EDI claim output with NDC code details: There is a validation for 11 digit NDC code on Ok of CMS flag and Save of claim. CMS 1500:-NDC code is printed on CMS1500 on grey band of charge details: 24A to 24 D. Gray Band: First: N4 followed by 11 digit NDC code gets printed, then code for Unit followed by Admin Qty gets printed and then again, code for unit and Admin Qty with 0s prefixed and suffixed get printed, where F2- International Unit, GR- Gram, ML- Mililiter, UN- Unit, ME- Milligram Fig: CMS 1500 with NDC code details on Gray Band of Box 24.

11 EDI:-When the claim is sent through EDI then NDC code goes in Loop: 2410, Segment: N4. Document Details Created By: Rucha Joshi Created Dt: Aug, 2012 Updated By: Malvika Tarnekar Last upd Dt: Aug, 2012 Verified By: Malvika Tarnekar Version Introduced In: V2 onwards Document Version: NDC code_2012_v2b9