We know that covered entities often have several different IT systems where prescriptions from various pharmacies you work with are stored. If you’re having trouble finding a medical claim across your systems, here are several tips:
- First, review your purchasing records. If 100% of drug units purchased for a particular NDC are purchased on your 340B account and used on 340B-qualified patients, you may respond “Yes” for this claim.
- If the medication is mixed use, try creating an ICN crosswalk to the patient record. Your reimbursement/billing department(s) or director of pharmacy may be able to assist with this crosswalk. The ICN (Internal Control number) is also known as the Claim Control Number (CCN) which appears on the Remittance Advice from the payor.
- If your facility utilizes Epic for its electronic medical record, you may create a report from Clarity to link the ICN supplied by Kalderos to the patient.
- Lastly, check utilization reports to review dispensations for the date range around the Date of Service provided for the claim in Review. If you are able to identify the patient receiving the 340B drug administered as a 340B eligible patient, then respond “Yes”.