I didn't see a response, so here goes.
I am not a 278 expert, so I cannot directly answer
your question. I am in the pharmacy industry, however, and can tell you
that another named transaction, NCPDP Version 5.1 can handle the prior
authorization in real time. If you do not have a pharmacy practice
management system handy, I also know that there are software companies that have
applications for people with very limited needs for submitting drugs, getting
authorizations, performing COB, etc.
Ken Steen
----- Original Message -----
Sent: Monday, September 23, 2002 12:35
PM
Subject: Prior Authorizations of
Non-formulary Drugs
Can/should the 278 transaction be used for
authorizations for non-formulary drugs?
The transaction does not seem to be designed to
perform this function (a cursory view of the IG does not indicate anywhere to
record drug prescription as the reason for the request and nowhere to record
drug dosage, etc.). I cannot find any guidance in the regulations on
this issue.
Has anyone dealt with this issue? If so, can
you please share your conclusions?
Thank you,
Ellen Tatge
IS
Project Manager
Presbyterian Healthcare
Services
505/923-6882
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