Procella HelpdeskPOS Rebates enable rebates to be accounted for and shared with the client or member (or provider). The POS Rebates Edit is used in combination with the POS Rebate Price file and setup in Coverage Rules, POS Rebates.
The POS Rebate EDIT controls how a rebate will be applied to a claim. If there are no Coverage rules setup for the POS Rebate, no rebates will be considered.
Edit Name is the unique name for the edit.
Rebate Method allows control over how the rebate is applied to the claim. The options are as follows:
- Per Rx: The Per Rx method uses the assigned Flat Amount from the Rebate Coverage Rule associated with the Plan. This method does not consider the quantity in its calculation. If there is NO Per Rx rebate amount in the POS Rebate Coverage Criteria, no amount is applied.
- Per Unit: The Per Unit method uses the Rebate Rule Unit Price times the quantity on the claim to calculate the appropriate rebate. If there is NO Per Unit rebate amount in the POS Rebate Coverage Criteria, no amount is applied.
- Lessor Of: The Lessor Of method calculates the rebate using the Per Unit method and compares it to the Per Rx amount. The lower amount will be used for the distribution.
- Higher Of: The Higher Of method calculates the rebate using the Per Unit method and compares it to the Per Rx amount. The higher amount will be used for the distribution.
Min POS Rebate: This is the minimum POS Rebate to apply. The minimal value is $0.01.
Max POS Rebate: This is the maximum POS Rebate to apply. If the calculated rebate is more than this amount, the POS Rebate will be reduced to the MAX.
Message Group is the assigned Message group to be captured each time the edit is used.
Distribution: This section allows control on how the POS rebate is distributed to the relevant parties. It is allowable to have the percentage distribution in excess of 100.00% or lower than 100.00%. The total percent distribution is provided as a reference to the User.
- Client: The Client is the Plan in this respect. This % reflects how much of the calculated rebate will be credited to the Client/Plan.
- Member: This % reflects how much of the calculated rebate will be credited to the member pay amount.
- Provider: This % reflects how much of the calculated rebate will be applies to the Provider.
NOTES:
- Only POS claims are eligible for POS Rebates. DMR, or manual claims, are not eligible.
- While this information is provided in this document, the functionality is not complete.
- If Plan Amount Due is equal to $0.00, then POS Rebates will be bypassed.
- If the Claim Type is DMR/Member submitted claim, POS Rebates will be bypassed (future enhancement may allow).
- Member: The calculated POS rebate for member is applied to the total Patient Paid Amount. If any amount exceeds the Patient Paid Amount, the Member POS Rebate amount is reduced to the Patient Paid Amount.
- Plan: The calculated POS Rebate amount for the Plan is compared to the Total Amount Due. If any amount exceeds the Plan Total Amount Due, the POS Rebate is reduced to the Plan Total Amount Due.