Transferred prescriptions are at high risk for audit recoupment. The PBMs are hitting pharmacies on incomplete transferred prescriptions based on missing required elements. In many cases, these discrepancies are flagged as “law violations” and are difficult to appeal. Your state has specific elements that must be documented on the transferred prescription. Don’t let a simple mistake cost you big money!
- Always double check your transferred prescriptions against your state’s transfer requirements to avoid these recoupments. Contact PAAS (608) 873-1342 or email@example.com if you need assistance obtaining a copy of your state transfer elements.
- Consider utilizing a dedicated transfer prescription pad with blanks for required elements specific to your state.
- If your pharmacy has a “transfer screen” where information is recorded, be sure to provide this information during a desk or on-site audit.
- Section 3.14 of NCPDP Version D Questions and Answers states , all transfers should be billed with origin code 5 regardless of how you receive the prescription from the other pharmacy.
- Be sure the original written date, not the transfer date, is entered into your pharmacy system to avoid refilling beyond the legal expiration date.
- Ensure staff involved in receiving and typing transferred prescriptions are familiar with the required elements of a valid transfer in your state.
- Please see our May 2021 Newsline article Forwarding Unfilled Electronic Prescriptions for best practice when pharmacies are under common ownership or combo shop pharmacies.
- Routinely perform a self-audit for prescriptions with an origin code of 5 and check the hard copies for accuracy.
- Catch up on this year’s self-audit series:
- Update: Medicare Part D Mandatory E-Prescribing Requirements for Controlled Substances – Final Rule - January 11, 2023
- DMEPOS Mini-Series #8 – The Six Medicare Auditing Entities and Their Purpose - December 20, 2022
- Be on the Lookout for OptumRx Unannounced Onsite Audits - December 18, 2022