Wednesday, May 26, 2010

eRx for Controlled Substances

The DEA states that electronic prescribing of controlled substances becomes available June 1. This is true only in the most strict sense, in that requirements for eRx will be published.

However, for transmission to actually happen, all parties must be "certified." DEA defines what sort of companies can accomplish this, but these companies need to get processes and procedures in place. Since 3 separate processes will be involved, it will be some time for all the pieces to be in place: 1) doctors will need to be identified and get a hard token of some sort that would be used to access prescribing software. 2) Criterions and its eRx partners will need to be "certified." 3) Pharmacies need to be "certified."

The easiest part of this is the Criterions piece. There will be much confusion for doctors. Pharmacies take a long time to change software.
Bottom line,it will be a while.
Click here for more info from DOJ
Click here for provider specific info

Criterions response to HIPAA 5010

As everyone should be aware, the formats for electronic submission of claims and processing of remittances and eligibility will be changing by 2011.
As a TCMS customer in good standing, you are entitled to a free upgrade to these changes. The upgrades will include changes to the electronic format and automated processing of 999 and 277CA reports.
Criterions will produce a "readable" error report produced from the 999 & 277CA transactions.
Over the next year and a half, Crieterions associates will be notifying all physicians about these changes and how to implement and test the new formats with Medicare and clearinghouses.

The impact on your practice from the TCMS usage perspective should be minimal with some training required. Criterions will prepare documentation to assist our clients during this transition process.

Testing will start around January 1, 2011 till December 31, 2011. You may need to contact Medicare and the Clearinghouses to enroll in their testing process. Those processes are uncertain at this point.
A minimum of 25 claims will be required when testing for claims submission.
As per Medicare,prior to being granted access to submit production 5010 transactions, direct submitters will be required to be:
- 100% compliant for structure/syntax
- 95% compliant for Medicare business rules