RxConnect Setup

User Permissions

Confirm that the RxConnect user is assigned to one of the following groups:

• Enterprise Administrator with specific hospital rights

• Facility Administrator

• Supervisor

• Pharmacist1

• Pharmacist2

• Technician1

• Technician2

RXLDBG1_WebServices_Modify Script

Set the NCPDP web service URL to a valid value in the RXLDBG1_WebServices_Modify script. This information is needed to communicate NCPDP responses to myAvatar . ​To access this script, follow the steps below.

Netsmart recommends that only a Netsmart Administrator should set the RXLDBG1_WebServices_Modify URL.

• Run RxConnect in a manner that displays an address bar. Do this by entering a URL similar to the following in the address bar of the browser: localhost:54221/Webforms/Diag...x?ScriptType=1

• Replace 'localhost:54221' with the name of the RxConnect host configured for the facility's system.

• In the script name drop down list, select the script.

Payor Pricing Screen

Configuration > Payor Pricing

Set the payor pricing to one of the following: Container Price (AWP) or Contract Price (Cost). The pricing value is used as the cost basis for billing and is included in outbound DFT charge messages sent from RxConnect to myAvatar PM.

Avatar PM stores the pricing value in the Additional Drug Information section of the National Drug Code Reporting form and uses it to determine how to populate the Basis of Cost Determination (423-DN) field in the Pricing Segment of the NCPDP D.0 file format.

The user should generally set the Payor Pricing to use AWP pricing plus 10%. Using less than this means that money that could be paid will be lost.

The 'Unknown Payor' is the default payor and should be what is used for all payors. The above screen shows that he 'Unknown Payor' is set to use the AWP price and the Accessory is set to mark up by ten percent (1.1 multiplier). This setting should be "cloned" by clicking on the Clone button and then clicking on each of the Drug Forms to make sure that from 1 to 1 million dollars AWP price, they are all being marked up ten percent.

If the user would like to use cost, then change the Pricing field on the left side to use Contract Cost.

Drug Edit (Actual) Screen

Enterprise > Configuration

This screen allows the user to manually update the AWP price or actual cost for any one item (NDC number). If the user is following the best practice of having the wholesaler send a file of their ENTIRE LOAD each month and updating each month to the latest prices for all NDC numbers that the wholesaler stocks, then it is not possible to have any items that do not have a cost or AWP price.

Cardinal Wholesaler does not provide the AWP price, so the user should set the Attribute in RxConnect to update the AWP price from the RedBook updates if the wholesaler is Cardinal.

Drug Edit (Template)

Enterprise > Configuration

Assign charge codes for drugs. The charge codes in RxConnect must match the service codes entered in myAvatar PM in order to be added to the client ledger. The service codes will dictate liability distribution to the correct guarantor. This will be done using the Insurance Charge Category and the Benefit Plan setup in myAvatar PM.

The HL7 2015 Update 6 introduced a feature that will automatically add charge codes into myAvatar if they are new to myAvatar . It is recommended that the user has this update.

Templates are based on the generic name, and strength, and form of the medication being used. They also set the package size and unit dose status as well. This is very helpful in Medicare Part D as when billing is occurring RxConnect uses the information from the template to indicate to Medicare Part D if the item was purchased in bulk and unit dosed or if it was purchased in unit dose to begin with.

The template is important. It allows the user to easily change from one NDC number to another inside the template. This means that if this is a unit dose template, then all the manufacturers (NDC number) that are unit dose will be able to be set using the Last Actual Drug in the drug master file.

In the above case, the user has clicked on the Last Actual button in the drug master file and then unchecked Limit to Inventory so that all NDC numbers in the system are shown. The user should always use items that are Active = Yes (red square above). The items that are No are no longer available commercially and are provided only for completeness.

Scrolling to the right on this screen when choosing an NDC number to default to will display the costs and AWP prices for each of the NDC numbers. This will further prevent the user from choosing an item that has no cost.

The user will find that any dispense for an item that has no cost will make an entry into the ALERTS tab on the RxSummary screen.

There will only be one item allowed for each NDC number so that multiple dispenses will not create many records on screen. Clicking on the line will take the user to the Drug Edit (Actual) screen referred to above in this document so that the price can be manually entered. Upon clicking the RETURN button the user will return to this screen.

To re-state – the method used by RxConnect to prevent billing with no pricing attached is:
1.    It is required to update the pricing for ALL NDC number each month. This is achieved by a full load price update from the wholesaler.
2.    Showing the price for each NDC umber upon selecting it manually
3.    Sending an alert to the pharmacist any time a dispense has occurred that had no price attached. This should be monitored on a regular (daily) basis.

The service codes will dictate liability distribution to the correct guarantor. This will be done using the Insurance Charge Category and the Benefit Plan Setup in myAvatar PM.

Configuration > Hospital Screen

Select the Enable NCPDP checkbox to enable NCPDP functionality in RxConnect and include NCPDP-related information in outbound DFT-P03 charge messages sent to myAvatar PM via the HL7 integration. 

Set the Default Bulk Days Supply. This value is used for the Fill Days Supply for bulk medications if no Fill Days Supply is calculated on the NCPDP Billing section (Print Labels and Take Home Label). This value is required when migrating RxConnect to the NCPDP billing model. This is in Version 6.3 and higher of RxConnect.

To set billing to bill on administration, set the Billing Type field to Administration.

Netsmart Product Management recommends using the bill on administration model to eliminate the concern of managing credits. This functionality needs to be set up at install. If it needs to be changed after production use has begun, please coordinate with your Netsmart RxConnect Solution Architect.

Edit Screens and Drug Edit Screens

Enterprise > Configuration > Drug Edit screens

The Drug Master Template MUST be set up correctly in order to have successful billing. The Allow Price Updates field must be checked if the cost and AWP data are to be updated and kept accurate.

The Billable field must be checked or the billing for any medication associated with this template will not be sent to billing. (This can be useful for Over the Counter products that should NOT be billed.)

The DEA Schedule is critical in order to have the required medication re-orders and rollups work correctly.
The unit dose status will make a large difference on how an item is bylined on Administration or on Dispense. 

The Dispensing Quantity and how many doses are gotten out of a container is critical. If you indicate that you purchase 100 tablets in a bottle for $100, then they cost you $1 each. If you indicate that you get 1 dose out of the bottle you are saying that if the pharmacist indicates “3” then 300 were sent for a cost of $300.00. The number of doses per container is used to take the package cost and come up with a per dose cost.