Pharmacy Point-of-Sale: General Information
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| BIN Number | Paper Claims | Format for Claims | Format for Recipient Cardholder ID Number | Name Verification | Drug File Converted to First Data Bank | Batch on Diskette and Tape Claims | Switch Connections | POS Format |

BIN Number

South Dakota Medicaidís processor BIN number is 601574. This number has been assigned to the South Dakota Medicaid Program by the American National Standards Institute (ANSI). The BIN number must be included in all NCPDP transactions routed to the South Dakota Medicaid (SDMCD) POS system.

Paper Claims

South Dakota medical assistance will continue to accept paper claims, but prefers that claims are sent via the POS.

Format For Claims

Paper claims must be billed by using the NCPDP Universal Claim Form. Claims submitted via point-of-sale must follow NCPDP guidelines. Please visit with your software companies if you have questions.

Format for Recipient Cardholder
Identification Number

Pharmacies may continue to send recipient cardholder identification numbers in the same format as in the past. Please notify your software developer that no change in recipient identification number format is required. Whatever format you are currently using for recipient identification numbers can be continued via point-of-sale.

Name Verification

Names submitted on claims must match with the name on the recipient cardholder identification number. Names that do not match with the recipient cardholder identification number will be denied. Please check your claim and data base to ensure an exact match. Example: Nicknames that do not match the identification cardholders name will also cause a denied claim.

Drug File Converted From Medispan
to First Data Bank (FDB)

We ask for your support during the file transition. FDB file is required to provide the necessary ProDUR alert information. The coverage status for more that 150,000 drugs must be converted individually to the new file. In addition, the new data file will identify NDC numbers that are obsolete or discontinued. This will assist in accurate rebate collections. We hope for a smooth transition as drug files are converted. Again, we ask for your support while this file conversion is implemented.

Batch on Diskette and Tape Claims

Batch claims on diskette and tape will continue to be accepted by SDMCD through September 1997. Beginning October 1, 1997 all claims must be submitted via POS or on paper. However, MIDCO and OmniSYS, and perhaps other vendors will have the capability of converting batches of claims into the NCPDP format and submitting them via POS. Information regarding MIDCO and OmniSYS is enclosed. Pharmacies that batch bill claims for nursing home residents may want to check with these or other companies.

Midco Data
1906 E Broadway
Box 1102
Bismarck, North Dakota  58501
(701) 255-3663
Omni Sys
2824 Terrell Rd, Ste 602
Greenville, Texas  75402
(903) 455-0461

Switch Connections

Direct switch connections are being established with Timeshare Computer Systems and NDC.  The Emdeon network is arranging to route services for its pharmacies through the Timeshare network.

Timeshare Computer Systems
230 River Ridge Circle
Burnsville, MN  55337
(800) 333-3672
National Data Corporation (NDC)
National Data Plaza
Atlanta, GA  30329-2010
(404) 728-2000
Fax: (404) 728-2551
Help Desk: (800) 388-2316
Emdeon
Two Lakeview Place
15 Century Boulevard, Ste 600
Nashville, TN  37214
(800) 366-5716
Help Desk: (800) 333-6869

The NDC and Timeshare (Envoy)networks are capable of receiving data from providers/vendors at up to 9600 BPS.  Those providers/vendors that handle a substantial number of claims may want to take this into consideration if contemplating new hardware (modems) in the future.

POS Format

POS/ProDUR system will be compatible with most pharmacy computer systems, but some may need software changes.  (Please pay special attention to the override process.)

The SDMCD POS/ProDUR system will accept claims in the NCPDP Version 5.1 format.

 

For each of the SDMCD supported POS claim transactions, the table list:


1.

The NCPDP elements needed from the pharmacy's system in order to process a SDMCD claim.

2.

The SDMCD required/conditional/optional data elements that are required to the pharmacy via the NCPDP format (conditional means that the data element is required if certain conditions are true).

Pharmacy software vendors and programmers should assure that:

1.

All the information required for submitting transactions are transmitted in the NCPDP format;

2.

All information in each SDMCD return transaction is made available to the pharmacist at the time the prescription is dispensed.

Other important implementation considerations:

1.

Pharmacists must be able to see the contents of the message fields returned with the various transactions by SDMCD.  The message fields will be used to pass information about:

a.

Recipient eligibility;
b. Recipient liability;
c. Drug coverage;
d. Coordination of benefits with primary insurance - third party liability (TPL);
e. Primary Care Provider (PCP) information;
f. Prior Authorization; and
g. Drug utilization review and early refill alerts.

All dates must be submitted and received in CCYYMMDD format (century dates.)

Pharmacy Point-of-Sale