Reversing NMS Prescriptions

You can reverse NMS transactions in one of the following three ways:

  • Cancel the prescription
  • Rebill the prescription
  • Use the Wrong Patient function

Cancelling Prescriptions

When a prescription is cancelled, the NMS transaction is reversed along with the financial billing. However, it is possible that the NMS transaction could become Reversal Failed or Reversal Rejected. In this situation, the user will have the option to resend the reversal to NMS using the Submit function button in the Rx Detail NMS claim, which resubmits the reversal to NMS.

To resubmit a failed or rejected NMS reversal:

  1. Highlight the prescription on the Workbench Completed tab.
  2. Select the Detail button.
  3. The NMS claim opens in Rx Detail. If the reversal was rejected, take the necessary corrective action.
  4. Select the Submit button to resubmit the reversal.

Note: It is not necessary to notify NMS of the reason for cancelling a prescription. If you choose to document why a prescription is being cancelled, the information can be added as a prescription note.

Rebilling Prescriptions

Existing rebill functionality allows a prescription to be cancelled and rebilled to third parties while keeping the same prescription number. This functionality will continue to work the same way with the inclusion of the NMS transactions. This means, if a prescription is rebilled the NMS transaction will be reversed along with the financial billing; a new NMS transaction will be submitted along with the financial billing once the rebill completes.

If you encounter a scenario where the NMS reversal is rejected or failed during the rebill process, the NMS reversal must be resubmitted before the new transaction can be sent to the NMS. Follow the steps provided above for submitting a failed or rejected NMS reversal.

Alternatively, you can choose to skip the NMS reversal once it has come back as rejected or failed. In this case, the prescription will be Cancelled and will be required to create a new fill, as the NMS requires accurate dispensing data.

To process a rebill with a rejected or failed NMS reversal:

  1. With Rx Detail open, during the reversal process, go to the NM claim in the Third Party tab. The prescription reversed to the Third Parties, but the NMS claim either Reversal Rejected or Reversal Rejected.
  2. Select the Submit button in the NMS claim. The reversal is resubmitted.
  3. If the reversal continues to fail or reject, select the Skip TP button in the NMS claim. The prescription becomes Cancelled.
  4. Create a new/refill prescription for submission to the third parties and the NMS.

Using the Wrong Patient Function

When the Wrong Patient function is used for an NMS prescription, a reversal is sent to the NMS when the billing is reversed for the wrong patient. Since it is necessary to keep a record of the NMS transaction, the prescription WILL NOT be removed from the wrong patient’s profile.

  • The NMS prescription is placed on HOLD in the Wrong Patient’s profile.
  • All repeats are removed from the HOLD prescription.
  • The prescription is flagged as Discontinued.