HL7 Financial Transactions For Pharmacy Billing
The filing of pharmacy charges and related data is done via the myAvatar HL7 module.
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After medication orders are entered in myAvatar OE, they are sent to RxConnect via the myAvatar HL7 interface, and to the eMAR with values from OE.
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The medication is dispensed from RxConnect.
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The fill details are sent to eMAR and the descriptions of the order are changed to match the description in RxConnect.
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For bulk and outpatient (leave and discharge medications), the charges are created upon dispense and are queued up in the Billing HL7 at the scheduled time in RxConnect.
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Medications set to bill upon administration flow from eMAR back to RxConnect once a successful administration is completed. The charges are queued up in the HL7 during the scheduled process.
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Charges are compiled in the Inbound HL7 into myAvatar .
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Pharmacy-specific data received via the inbound HL7 charge interface is filed in the National Drug Code Reporting form in myAvatar PM as well as the Client Ledger. All services are stored in the SQL tables.
Compile Inbound HL7 Charge Batch File
- Use the Compile Inbound HL7 Charge Batch File form to compile the charges.
- A report will display the charges that will be created and displayed on the client's ledger after posting.
Crediting Process
Charges and credits are received once a day from RxConnect and placed in temporary storage. The batch compile process can be configured to allow credits to be applied to the client ledger if no matching charge is found within the same batch. To enable this functionality, select the Post Credits Against The Client Ledger field in the Default Settings For Processing An Inbound HL7 Charge Batch form. This field display is controlled through the Allow Credits To Be Posted Against Client Ledger registry setting. This applies to pharmacy charges only and only to those that are filing pharmacy supplemental data within the National Drug Code Reporting form (specifically the Prescription Number).
For a credit to be applied, there must be a match on the following:
- Client
- Episode
- Service Code
- Service Provider
- NDC #
- Rx #
- Service Units >/= Credit Units
- Service Dollars >/= Credit Dollars
The following additional restrictions apply:
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Credits must have a specified prescription number.
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Services must have supplemental pharmacy data filed through the National Drug Code Reporting form (specifically, there must be a prescription number).
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Regardless as to how the configuration setting Match On Order Number When Applying Credits? is valued there must be a match on the Order/Prescription Number.
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No credit will be applied to a charge on the ledger that has one or more payments and/or adjustments posted against it, that has already been claimed, or that has been deleted, or that has been included in a roll-up charge or is a roll-up charge itself.
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If the charge is credited in full, the charge will be deleted from the system.
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If the charge is partially credited, then the service units/dollars will be changed to reflect the adjusted amount. In addition, for any matching National Drug Codes, the NDC Quantity will be adjusted as well as Days Supply.
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If a credit is applied to a charge that is already on the client ledger, the charge will be included in the report but will have an asterisk (*) appended to the service code. The asterisk indicates that the posting of that line item will not result in the creation of a new charge, but the application of one or more credits to an existing charge.
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Post Inbound HL7 Charge Batch File
- After the file has been compiled, use the Post Inbound HL7 Charge Batch File form to post the charges.
- This will create the charges on the client's ledger and in the National Drug Code Reporting form.
National Drug Code Reporting
The National Drug Code Reporting form can be used to make modifications to any of the posted charges that will appear on the client's ledger after posting. This form can also be used to enter pharmacy-specific information for charges manually entered into myAvatar using Client Charge Input. When NCPDP is enabled, the Service to Record Information For field will only show pharmacy services as defined in the Service Code Definition form.
- You can modify the NDC information received from RxConnect.
- The Additional Drug Information section can be used to modify the additional information received from the pharmacy.
- This screen is used to make corrections to charges for billing and rebilling.
- NOTE: You should set the Enable Additional Drug Information Fields registry setting to 'Y' to enable the additional drug information fields for editing.