Rx Manager Formulary Eligibility Changes

Surescripts has outlined several new requirements for checking patient formulary eligibility from the Rx Manager. To certify with these requirements, SOAPware has created a dialog in the Rx Manager that will check for the new Surescripts requirements prior to retrieving Rx formulary eligibility.

This new feature will check the provider and patient information to ensure that they meet the required character minimum and maximum constraints that are defined by Surescripts.  If there are any fields that need to be corrected or verified prior to checking the patient's formulary eligibility, the user will be presented with this new dialog.  The dialog will notify the user of the fields that must be corrected or verified prior to retrieving the patient's formulary eligibility information.

Provider Requirements

Provider Requirements

The table above lists the provider character minimum and maximum constraints that are required to check patient formulary eligibility.  This information can be entered or corrected for the provider by going to Tools > Provider Manager.

Patient Requirements

Patient Requirements

The table above lists the patient character minimum and maximum constraints that are required to check patient formulary eligibility.  This information can be entered or corrected for the patient by opening the chart and going to the Demographics tab.

Retrieving Eligibility in Rx Manager

Retrieving Eligibility in Rx Manager

When retrieving Rx Eligibility by clicking the Retrieve Eligibility Info button, SOAPware will review the patient demographics and provider information.  If there are items that need to be corrected prior to retrieving Rx eligibility, the above dialog will appear. This alert means that some required demographic information is either missing or has exceeded the maximum character length for Rx eligibility requests.

  1. Invalid Data: To correct the invalid information, click the Cancel button and modify the information for the patient or provider as needed. After correcting the invalid information, return to this window to retrieve Rx eligibility.
  2. Shortened Data: If there are items that have exceeded the maximum character length for Rx eligibility requests, the values will be displayed above. These values will be shortened upon submission. Click the Retrieve Eligibility button to request eligibility based on the shortened value.

Formulary Eligibility Display

Once Rx eligibility has been retrieved for the selected patient, the information will display within the Rx Manager (as shown in the screenshot above).