Setting Up Custom Fees for CPPCC Services Billed to the Patient

Certain professional services can be provided by a Community Pharmacy Primary Care Clinic but are not reimbursed by Pharmacare (refer to Table 1). For these services, your pharmacy can set a custom fee to charge to the patient.

Table 1. Professional services billed to the patient.

PIN Trade Name
92099641 NS PPCC: COMPLETION OF FORMS NOT COVERED BY AN AGREEMENT
92099707 NS PPCC: SERVICE NOT COVERED FOR OUT-OF-PROV PATIENT
92099709 NS PPCC: INJECTABLE ADMIN FEE
92099725 NS PPCC: MINOR AILMENT
92099567 NS PPCC: FUNGAL INFECTION; NAIL

You can choose to set the fee in Rx Detail at the time of billing the claim or set up Pricing Rules to auto-populate the fee when a particular professional service is billed. This topic covers the creation of Pricing Rules to charge a fixed fee for these professional services.

Part 1: Create a Custom Class

You will use a Custom Class to apply a specific fee to a professional service.

To create a Custom Class:

  1. Select More (...) > List Maint.

  2. From the dropdown, select Custom Class.

  3. Select Add.

  4. Enter a description for the Custom Class. For example, you can enter "MA - Fungal Nail Infection" to bill for Minor Ailment consultations for fungal nail infections.

    If you want to charge the same fee for multiple professional services, you can reuse the Custom Class. Keep the description generic so it's easier for you to locate, such as "CPPCC charge to patient".

  5. Select OK.

Part 2: Assign the Custom Class

For all professional services that you want to apply the same fee, add the Custom Class you created in Part 1.

To assign a Custom Class:

  1. Open the Drug Folder for a professional service listed in Table 1.

  2. Select the Alternatives tab.

  3. In the Custom Class section, select Add.

  4. Enter the following in the new row:

    • Third Party Plan - Cash

    • Custom Class - Custom Class you created in Part 1

  5. Select Save.

Part 3: Create the Pricing Rule

You will now create a Pricing Rule to apply a specific fee for the Custom Class you created in Part 1.

To create a Pricing Rule:

  1. Select More > Pharmacy > Pricing.

  2. Select the Cash row.

  3. Select the Add CC action button at the bottom.

  4. The Select Custom Class window opens. Select the Custom Class you created in Part 1.

  5. Select OK.

  6. A new row is added for you Custom Class below Cash. Enter the following information in the row:

    • Fee - your desired fee.

    • Markup - 0.00%

  7. Select Save.

Next Steps?

Repeat the process above for any other professional services you want to set custom fees for.

Process the professional service claim as per usual. The fee should now auto-populate each time.