Billing NIHB for a Dispensing Fee Only

When a patient does not pick up his or her prescriptions, and the stock is re-inserted into the pharmacy’s inventory, NIHB will reimburse the pharmacy for the original dispensing fee. To submit a claim for the dispensing fee, it is necessary to fill a new prescription using a Freeform Drug. This will ensure that billing for the dispensing fee has no effect on your inventory.

NIHB will pay the dispensing fee provided the following criteria is met:

  • The stock is returned to inventory.
  • The billing for the original claim must be reversed.
  • The claim for the dispensing fee must be submitted using the pseudo DIN 55555555.
  • DIN 55555555 can only be used once each day per client per prescription.
  • For prescriptions containing multiple items, it is necessary to resubmit the reversals on consecutive days within the 30-day claim resubmission window.

To add the NIHB Drug to the Drug File:

Before this type of claim can be submitted, the Freeform Drug must be added to the Drug File. It is only necessary to add this drug ONCE!

  1. Press the Drug button.
  2. If the Drug Search window does not appear, press the Search button.
  3. In the Drug Search window, search for NIHB in the Trade Name or Generic Name fields.
  4. Since no records will be found, press the New button.
  5. Enter NIHB DISPENSING FEE in the Generic Name field.
  6. Enter NIHB DISPENSING FEE in the Trade Name field.
  7. In the Schedule dropdown list, select Schedule IV.
  8. Press the Alternatives tab at the top of the screen.
  9. Press the Add button beside the Alternatives box in the middle of the window.
  10. A row is added to the Alternatives box. Select *All* from the Third Party dropdown list.
  11. Enter 55555555 in the PIN field.
  12. Press the Inventory tab.
  13. Press the Add button located in Packs Available.
  14. The Add New Pack Size window appears. Enter 1 in the Pack Size field.
  15. Deselect the Monitor flag if it is ON.
  16. Enter 0.0001 in the Acq Cost (ut) field.
  17. Press the OK button in the Add New Pack Size window.
  18. Press the Save button in the Drug Folder.

To refuse the original prescription and submit a claim for the dispensing fee:

  1. Go to the Workbench.
  2. Press the Correct button.
  3. Press Refuse in the Correct Rx window.
  4. Enter the prescription number for the medication that was returned to stock.
  5. Press the OK button. The billing is reversed and the prescription is Cancelled.
  6. Press the New button on the Workbench.
  7. Enter the patient’s name in the patient field.
  8. Enter NIHB DISPENSING FEE in the Drug(s) field.
  9. In the Doctor field, enter the doctor’s name from the original prescription.
  10. Enter 1 in the Qty Auth field.
  11. Enter 1 in the Qty field.
  12. Use the SIG field to cross-reference the prescription and indicate that it is a claim for medication returned to stock (Ex. NIHB RX RETURNED TO STOCK RX#500504).
  13. Enter 1 in the Days Supl field.
  14. Press the Process button.
  15. The prescription opens in Rx Detail. The Cost and Markup should both be $0.00 and the Fee should be your regular NIHB dispensing fee.
  16. Press the Fill or Queue button to submit the claim.