PARx: Online Pharmacy Prior Authorization User Guide

Transcription

1 PARx: Online Pharmacy Prior Authorization User Guide Date of Publication: 7/5/2013 Version: 1.5 PHC Contact Information: Phone: (707) FAX: (707) Pharmacy TAR FAX: (707) PARx

2 Usage Information Documents published herein are furnished As Is. There are no expressed or implied warranties. The content of this document herein is subject to change without notice. HIPAA Notice This PARx Online portal is for the use of authorized users only. Users of the PARx Online portal may have access to protected and personally identifiable health data. As such, the PARx Online portal and its data are subject to the Privacy and Security Regulations within the Health Insurance Portability and Accountability Act of 1996, Public Law (HIPAA). By accessing the PARx Online portal, all users agree to protect the privacy and security of the data contained within as required by law. Access to information on this site is only allowed for necessary business reasons, and is restricted to those persons with a valid user name and password.

3 PARx: Online Pharmacy Prior Authorization User Guide Table of Contents 1. Introduction System Requirements Information You Will Need Sign On For New User How to Register For Registered User How to Reset a Password Prior Authorization Submission How to submit a new TAR Member Search Drug Search Prescriber Search Diagnosis Entry Additional Details TAR Submission Attach Documentation Send Additional Information via FAX TAR Additional Steps Viewing the Status of a TAR TAR Lookup Help Help Menu Contact Us Log Out...25 Parx User Guide V1.5_ Last Updated 7/5/2013 1

4 PARx: Online Pharmacy Prior Authorization User Guide 1. Introduction PARx (Prior Authorization Rx) is a web-based, HIPAA compliant, secured system that allows dispensing pharmacies to submit TARs (Treatment Authorization Requests) electronically. The system uses Secure Socket Layer (SSL) technology which transmits personal log-on and other protected information as encrypted data. The goal of PARx is to help dispensing pharmacies easily submit required information so that PHC can efficiently process requests. This process ensures that the members receive clinically appropriate and costeffective pharmaceutical care in a timely manner. This User Guide will: Summarize the information required to submit prior authorization requests Describe the options and process for submitting prior authorization requests 2. System Requirements To successfully use all the features of the PARx system, ensure that your computer system meets the following minimum requirements: Reliable Online connection Web browser Although this system is compatible with all web browsers, it is recommended that you use the latest version of Microsoft Internet Explorer. Adobe Acrobat Reader 3. Information You Will Need Before you begin the prior authorization submission process, you should first submit the prescription claim online for adjudication, even if you know the product requires a TAR. This step provides necessary information that will supplement the TAR review process. If the claim is not approved for payment, you should then gather the following information: Complete member, provider, prescription, diagnosis and justification information associated with the prior authorization request. PHC Member ID (CIN) or Member name and date of birth. Parx User Guide V1.5_ Last Updated 7/5/2013 2

5 PARx: Online Pharmacy Prior Authorization User Guide 4. Sign On 4.1 For New User Step Action For New User 1 Access PARx by either: (1) typing in your internet browser, or (2) click on the link found at PHC s website, at (the Pharmacy Electronic TAR/PARx page). 2 Click the Sign up button. Parx User Guide V1.5_ Last Updated 7/5/2013 3

6 4.1.1 How to Register Step Action New User Registration 1 Enter requested user details. PARx: Online Pharmacy Prior Authorization User Guide Note: User is optional; however, if included, it should be the user s business associated with the pharmacy, not a personal . Note: Password should have at least 8 characters; it must include 1 upper case letter, 1 number, and 1 special character (!,@,#,$,%,^,&,*,(,),(.)). e.g. Partner2012! 2 Enter the Secret Key with all hyphens and all letters in upper case. Enter the NABP of your pharmacy, omitting all leading zeroes. 3 Read and accept the Terms & Conditions. 4 Click Create User. 5 Check for the message that indicates your account has been successfully created. Parx User Guide V1.5_ Last Updated 7/5/2013 4

7 4.2 For Registered User PARx: Online Pharmacy Prior Authorization User Guide For Registered User 1 Access PARx by either: (1) typing in your internet browser, or (2) click on the link found at PHC s website, (the Pharmacy Electronic TAR/PARx page). 2 Click Login. 3 Enter User Name & Password. 4 Click Login. Parx User Guide V1.5_ Last Updated 7/5/2013 5

8 4.2.1 How to Reset a Password Step Action How to Reset a Password PARx: Online Pharmacy Prior Authorization User Guide 1 Click Reset Password link in Log In page. 2 Enter Secret Key & NABP of your Pharmacy and your User Name. Note: Enter the Secret Key with all hyphens and all letters in upper case. Omit all leading zeroes in NABP. 3 Click Request Password Reset. 4 Enter New Password and Confirm Password. 5 Click Reset Password. 6 Check for the message that indicates your password was successfully reset. Parx User Guide V1.5_ Last Updated 7/5/2013 6

9 PARx: Online Pharmacy Prior Authorization User Guide Password Reset Screens: Parx User Guide V1.5_ Last Updated 7/5/2013 7

10 5. Prior Authorization Submission 5.1 How to submit a new TAR Step Action How to Submit a new TAR PARx: Online Pharmacy Prior Authorization User Guide 1 Login with your registered User Name & Password (Refer to Section 4.3). 2 Click New Pharmacy TAR. 3 Search for PHC Members by CIN (Client Identification Number/Member ID) or a combination of name and DOB. (Refer to Section 5.1.1) 4 Enter NDC (National Drug Code) of the medication requested (recommended). Alternatively, if the NDC is not available, you can search by a drug/product name by entering the name in the NDC field. (Refer to section 5.1.2) 5 Enter the TAR Start Date: This should be the pharmacy s requested TAR start date, if other than the current default date (such as TAR renewals for future fills or retroactive requests). 6 Enter Physician s NPI, DEA, or last name. (Refer to section ) 7 Click Continue. Parx User Guide V1.5_ Last Updated 7/5/2013 8

11 5.1.1 Member Search Member Search PARx: Online Pharmacy Prior Authorization User Guide 1 Perform the Member Search with one of following: 3. CIN (Member ID) 4. SSN: If necessary, SSN may be used for member search, when it is already part of the pharmacy s records; however, PHC does not recommend requesting the SSN from a member for search or Rx claim processing purposes. The tool searches as the criteria are given. Upon the completion of the search, click the row that matches your search criteria to auto-populate the member information. To start your search over, clear your entry in the search criteria and re-enter. Please Note the following: DOB must be entered in MM/DD/YYYY format. Full name is not necessary for search; 1 st 3 letters of first or last name, with DOB is sufficient for member search. PartnershipAdvantage members (PHC Medi-Care B/D) will show 2 profiles in the search result, one for PartnershipAdvantage and another one for their secondary PHC Medi-Cal coverage. Pharmacy should select the PartnershipAdvantage profile. Parx User Guide V1.5_ Last Updated 7/5/2013 9

12 PARx: Online Pharmacy Prior Authorization User Guide View Member Eligibility Step Action Member Details: 1 Click View Member Eligibility link to bring up a window which shows additional member eligibility information. Parx User Guide V1.5_ Last Updated 7/5/

13 PARx: Online Pharmacy Prior Authorization User Guide Drug Search Drug Search 1 Perform the Drug Search with one of the following: 1. NDC (preferred) 2. Product Name 3. GCN (generic code number) The tool searches as the criteria are given. Upon the completion of the search, click the row that matches your search criteria to auto-populate the drug information. The selected drug, whether searched by NDC or name, should be for the product that is intended to be dispensed and matches the submitted Rx claim. To start your search over, clear your entry in the search criteria and re-enter. 2 Enter TAR Start Date, # Refills on Rx, Rx Quantity (or actual dispensed quantity if request is for less than prescribed) and Directions. Parx User Guide V1.5_ Last Updated 7/5/

14 PARx: Online Pharmacy Prior Authorization User Guide Formulary Status Formulary Status information is shown in PARx, although pharmacy providers may already know the status from the POS message received when the Rx claim is transmitted (which should always be done prior to submitting a TAR). However, in case the provider is not a pharmacy (therefore has no claim adjudication to check status), or the pharmacy does not receive adequate POS messaging, the formulary status in PARx may be used to check or verify status. Formulary Status Check 1 Based on drug & member s eligibility, Formulary? will be shown as Y, N or N/A. 1. Y means Drug IS on PHC Formulary 2. N means Drug IS NON-Formulary 3. N/A means either (1) member is not eligible or (2) the NDC was not found in the formulary file and no information is available at this time. (Check POS message in claim adjudication for status). Detailed message will be shown under Please Note. 2 Based on drug & member s eligibility, TAR Required? will be shown as Y, N, TAR not Accepted or N/A. 1. Y means TAR IS required 2. N means TAR IS NOT required 3. TAR Not Accepted means the request is for a product that is not covered through PHC (e.g., State Carve-Out drugs). 4. N/A means no information is available for the NDC submitted, or the status is known but may or may not require a TAR depending on other factors (e.g., Step, Quantity, Age, Code 1, etc). The POS claim rejection message will help to clarify actual status and need for TAR. 3 Based on Drug & member s eligibility, Carve-Out Drug? will be shown as Y or N. 5. YES means Drug IS Carve-out i.e., billable to State Medi-Cal. 6. NO means Drug IS NOT Carve-out Note: TAR will not be accepted if the Drug is Carve-out. Parx User Guide V1.5_ Last Updated 7/5/

15 5.1.3 Prescriber Search Prescriber Search PARx: Online Pharmacy Prior Authorization User Guide 1 Perform the Prescriber Search by any of the following: 1. NPI 2. DEA 3. Prescriber Name The tool searches as the criteria are given. Upon the completion of the search, click the row that matches your search criteria to auto-populate the prescriber information. To start your search over, clear your entry in the search criteria and re-enter. 2 Enter the Prescriber Phone# and Fax# even if the Prescriber is found in the system. Note: The phone & fax shown by PARx are only default values per PHC provider records, and these numbers may not be the actual current/preferred contact numbers for the prescriber. The pharmacy should always verify the contact info for accuracy and input the numbers that are the best means for PHC staff to contact the prescriber in the event additional information is needed. Parx User Guide V1.5_ Last Updated 7/5/

16 Prescriber Not Found in PARx Enter Prescriber Information on TAR PARx: Online Pharmacy Prior Authorization User Guide 1 If a prescriber is not found in PARx, the pharmacy can manually enter the Prescriber Name, NPI, Specialty, Phone number, & Fax number for the purpose of TAR submission. This information will be saved on the TAR only, not within the PARx provider data base. Parx User Guide V1.5_ Last Updated 7/5/

17 5.1.4 Diagnosis Entry Diagnosis Search PARx: Online Pharmacy Prior Authorization User Guide 1 The diagnosis entered on a TAR should always be provided to the pharmacy by the prescriber. The diagnosis search function is not intended to allow pharmacy staff to identify a diagnosis without first confirming with the prescriber. Indicating an inaccurate diagnosis can result in TAR delays. Accuracy of the submitted diagnoses will be monitored via PHC TAR audits. 2 Perform the Diagnosis Search by ICD-9 code: Enter ICD-9 as provided by the prescriber. The tool searches as the criteria are given. Upon the completion of the search, click the row that matches your search criteria to auto-populate the diagnosis information. To start your search over, clear your entry in the search criteria and re-enter. Note: Whenever possible, please obtain the diagnosis from the prescriber in BOTH name/description and ICD-9 forms. That way, if the ICD-9 is not found (such as a prescriber mistakenly writing an incorrect #), the diagnosis name can be used to verify the #. 3 ICD-9 Unknown or not found: Diagnosis name search is available, but is not recommended without knowing the ICD-9 code, due to the multiple ICD-9 variants available for any given diagnosis, and choosing the wrong one can affect TAR review. If you cannot find the ICD-9 in the search function, or do not know the ICD-9, you are encouraged to enter the dummy diagnosis code for Rx claims, The specific diagnosis name/description can then be entered in the Medical Justification field. NOTES: All TARs should include a diagnosis for use of the medication, as provided by the prescriber-- whether in the form of an ICD-9 or as a word description in the justification field in combination with in the ICD-9 field. Pharmacy staff should not make a best guess of the many ICD-9 variations available in the data base. An ICD-9 should always originate from the prescriber. Multiple Diagnoses: Enter one diagnosis in the ICD-9 section, and list any additional in the justification field. Parx User Guide V1.5_ Last Updated 7/5/

18 PARx: Online Pharmacy Prior Authorization User Guide Diagnosis code search screen: Parx User Guide V1.5_ Last Updated 7/5/

19 5.1.5 Additional Details Additional Details: Use Check-Boxes PARx: Online Pharmacy Prior Authorization User Guide 1 Select the appropriate check box(es) to identify the nature of the TAR. Note: Check all that apply and provide supporting information wherever required. 2 If Retroactive is checked, then provide service date(s) showing dates and quantity dispensed in the given text box. 3 If Copay > $50 is selected, then submit the additional ecob form either as an attachment or via fax. 4 If Continuing Care from Previous plan is selected, provide First and Last Fill Dates from your pharmacy profile or from prescriber s information, to document Rx is not new to member. Note that this does not guarantee approval, but is very helpful in the TAR review process and can help avoid a pended status. Screen prints from the member s Rx profile can also be sent as additional information for further documentation. 5 If SNF/LTC is selected under Member s Residence, then provide Admit Date. Parx User Guide V1.5_ Last Updated 7/5/

20 5.1.6 TAR Submission TAR Submission PARx: Online Pharmacy Prior Authorization User Guide 1 Clicking the SUBMIT button is final! Review TAR information for any necessary corrections, and to make sure all information provided is accurate and true to the best of your knowledge, before clicking submit. 2 Click Submit to submit the TAR. 3 A successful submission will return a confirmation screen with a TAR reference number on the TAR Confirmation Screen. NOTE: Please use this TAR reference # when communicating with PHC regarding the TAR. Alternatively, once a MedImpact PA# is assigned, the PA# may also be used to reference the TAR. New TAR Screen: Parx User Guide V1.5_ Last Updated 7/5/

21 TAR Submission Confirmation Screen: PARx: Online Pharmacy Prior Authorization User Guide Parx User Guide V1.5_ Last Updated 7/5/

22 PARx: Online Pharmacy Prior Authorization User Guide Attach Documentation Attaching documentation is possible only when your pharmacy has the ability to save and retrieve documents (e.g., MS Word or PDF files) from the pharmacy s computer. If your pharmacy does not have this ability, see section 5.1.8, regarding sending additional information via FAX. Attach Documentation (upload documents to PHC) 1 Click View/Attach Documentation to add additional documentation 2 Select the document that you would like to attach 3 Click Submit 4 View the attached document if desired Parx User Guide V1.5_ Last Updated 7/5/

23 PARx: Online Pharmacy Prior Authorization User Guide Send Additional Information via FAX FAX Additional Information 1 IMPORTANT: Print the submitted TAR to use as a cover sheet. 2 Write See Additional Information, attached on the TAR/cover sheet. 3 FAX TAR/cover and the additional pages together as a single FAX to PHC at (707) TAR Additional Steps TAR Additional Steps 1 In order to print a TAR confirmation, click Print 2 In order to submit a new TAR for the same member (but different prescriber), click New TAR for Same Member. 3 In order to submit a new TAR for the same member & prescriber, click New TAR for Same Member & Prescriber. 4 In order to submit a new TAR for a different member, click New TAR. 5 In order to attach additional documentation to the TAR, click Attach Supporting Documentation. (See 5.1.7) Parx User Guide V1.5_ Last Updated 7/5/

24 6. Viewing the Status of a TAR PARx: Online Pharmacy Prior Authorization User Guide There is currently no TAR status-check function; however, this concept will be designed and implemented in future versions. At this point in time, pharmacies may use the TAR lookup feature to find previous TARs submitted and verify that they have been received. A specific TAR may be found by Reference # or searched for by prescriber, by member, or even by drug. The results shown will only be those submitted by your store (or your group of stores if part of a chain). If a provider needs information relating to a TAR submitted by another provider, PHC Pharmacy Services department is available for assistance (see Contact Us, 7.2). 6.1 TAR Lookup TAR Lookup 1 To view a specific TAR, enter the TAR Reference # 2 For a group of TARs or when the TAR Reference # is unknown, enter a date range and one of the following: Member CIN, NDC, NABP, NPI or Status. 3 Upon clicking search, result set will be shown based on search criteria. 4 Click on the TAR s Reference # in order to bring up the detailed TAR summary. Look Up Screen: Parx User Guide V1.5_ Last Updated 7/5/

25 PARx: Online Pharmacy Prior Authorization User Guide Look Up Results screen: TAR Detail Screen: Parx User Guide V1.5_ Last Updated 7/5/

26 PARx: Online Pharmacy Prior Authorization User Guide 7. Help 7.1 Help Menu Access Help Documents 1 Click Help. 2 Click the User Guide link for the latest User Guide. 3 Click the Privacy Policy link for the privacy policy of this system. 4 Click the Terms & Conditions link for the terms & conditions to use this site. Parx User Guide V1.5_ Last Updated 7/5/

27 PARx: Online Pharmacy Prior Authorization User Guide 7.2 Contact Us If your PARx question cannot be answered by using any of the Help Menu items, you may contact PHC for assistance. PHC Pharmacy Services staff are available M-F, 8am 5pm. Phone: (707) FAX: (707) Pharmacy TAR FAX: (707) PARx Step Contact Us Action 1 Click the Contact Us Link from the top tool bar to find required information to contact PHC Pharmacy Services Department. 8. Log Out Log Out 1 Click the Logout button to exit the system. Parx User Guide V1.5_ Last Updated 7/5/