EDIT - Other Services Fee

The Other Services Fee edit allows a fee to be charged to the Plan or paid to the Provider for selected Fee Types as identified in the NCPDP standard.

• Edit Name:  This is required.  You have 30 alpha numeric characters.  The Edit Name cannot be duplicated.
• Claim Type:  All claim types, POS (Online) claims only, DMR claims only.
• Message Group:  This is an optional drop down where you would select an established Message Group.

Fee Options

Cost Sharing Method:  Who will be responsible for the payment of the Other Services Fee.

• Member
• Plan

Limitations:  The Other Services Fee limitation allows you to control the Other Services process.  The options allow you to:

• Apply Other Services Fee:  Calculate this Other Services fee and then move on in the transaction process.
• Apply Other Services Fee then Ignore:   Apply this Other Services fee but stop looking for and applying any additional incentive fees.
• Ignore all Other Services Fees:  Do not apply this Other Services fee and do not look for any other incentive fees.  Move on to the next step in the transaction process.

Fee Setup

Fee Type:

• 01 – Delivery
• 02 – Shipping
• 03 – Postage
• 04 – Administrative
• 09 – Compound Preparation Cost Submitted

Fee Basis:

• Amount Submitted in Claim:  Use the amount on the incoming claim subject to the established minimums and maximums.
• Amount Calculated in Edit:  Use the values in the edit and claim to calculate the Other Services fees.

Fee Calculation Method:

• $ then %:  Use the flat amount and then add the % amount.
• % then $:  Use the percentage amount and then add the flat amount.
• Lesser of:  Take the lower of the flat amount and the percentage amount.
• Higher of:  Take the higher of the flat amount and the percentage amount.

$ Amount:  A flat dollar amount for the Other Services Fee.

% Amount:  A percentage of the total claim cost (IG+DF).

Fee Min:  The minimum Other Services Amount to pay (can be zero).

Fee Max:  The maximum Other Services Amount to pay.

When using the Amount on Submitted claim, you have the option to set the minimum and maximum amounts.

When using the Amount Calculated in Edit, define the flat amount and/or percentage and select the method to use them.

Quick Summary of the Fee Calculation Methods

• $ then %:  (Ingredient Cost + Dispense Fee + Flat Amount) x % Amount
• % then $:  (% Amount x (the Ingredient Cost + Dispense Fee)) + Flat Amount
• Lessor Of:  Compares the Flat Amount to the % Amount and uses the lowest amount.
• Higher Of:  Compares the Flat Amount to the % Amount and uses the higher amount.

Once the edit has been created, you can either cancel or Save Draft and Review.  If you cancel the edit, you will lose your work.  If you Save Draft and Review you will be presented with the next step where you have the option to CLOSE or ACTIVATE.  If you close the edit, it will be saved and available in Draft state.  If you activate the edit, it will be saved, locked and ready to use in production.