340B Rx Correlate | 340B RxCorrelate

340B RxCorrelate Page

Overview

Once 340B RxCorrelate has been enabled for a Covered Entity (CE), the menu option will be available under the Data Review tab. Only users with an Admin or Pharmacy Manager User Role will have access. This feature is set up at the HID level, and the page will display system-matched prescriptions to referrals for all retail PIDs within the CE.

This feature identifies possible referral prescription matches using CE-provided Patient Encounter and Patient Referral data along with Dispensing data provided by the Contracted Pharmacy (CP).

The first time a user selects 340B RxCorrelate a product disclaimer must be acknowledged before accessing the feature.

Getting Started/Navigating the page

For the first three referral tabs (Potential, Dismissed, and Qualified) the details of the matched referrals are listed in a grid similar to Utilization Manager at the bottom of the page. For each matched referral selected, the Claim Details section in the middle of the page contains the Encounter, Referral, and Prescription Details.

The following section are also included: Notes, Attachments, Testing Elements and Referral Matching. Details about these sections are listed further below.

Referral Tabs

Listed below are the names and descriptions of each tab on the 340B RxCorrelate page. The details of the matched referrals for each tab will be listed at the bottom of the page to select for review:

Potential Referrals - Displays unqualified, non-frozen prescriptions that have been matched to referral data for each retail PID associated with the CE. The Potential Referrals by default are sorted at the bottom of the page by Value in descending order. in descending order.

Dismissed Referrals - Displays prescriptions that have been matched to referral data that the user has marked as Dismiss-Not A Referral.

Qualified Referrals - Displays all prescriptions that have been matched to referral data and have a 340B status. Regardless if the prescription qualified naturally, manually, or by the user within 340B RxCorrelate. The Qualified Referrals by default are sorted at the bottom of the page by Rx Number in descending order.

Referral Match Settings - Displays setting(s) that when the value is set, affects the Potential Referral data.

Claim Details

The Claim Details section includes Encounter Details, Referral Details, and Prescription Details for each referral tab, except Referral Match Settings. Depending on the referral tab selected the user will have the options to Qualify Referral, and/or Dismiss-Not A Referral. To assist the user in their decision to qualify or dismiss a referral, the Testing Elements and Referral Matching Elements are available in the left panel.

For audit purposes, this section also includes Attachments and Notes sections.

To add an attachment, click Attach File. Locate your file and click Open from your file explorer and the file will be added. Details of the attachment can also be found in the Pharmacy Settings/Transaction Log.
To add a note, simply type in the Notes section up to 250 characters and click Save Notes. Details of the Note can also be found in the Pharmacy Settings/Transaction Log, and in Utilization Manager-Add/View Notes. These will start with "Referral Note:".

Testing Elements

[need an explanation of the table here]

Testing Element	Indicator	UM Column	Indicator
340B Pricing Available	X Check mark	MHI 340B Drug	No Yes
Not a Medicaid Payor	Check mark X	MHI Medicaid	No Yes
Not an Orphan Drug	Check mark X	MHI Orphan	No Yes
Orphan Drug Exception On File	X Check mark	Exp Orphan	No Yes
Drug is not 340B Exclude	Check mark X	MHI Drug Exclude	No Yes
Diagnosis Code Match	X Check mark	MHICode Match	No Yes
Passed Other Match Rules	X Check mark	MHI Other Match	No Yes

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Referral Matching Elements

Referral Matching Element	Indicator
Prescriber Match	Check mark - The Referred to and the Written Prescriber are a match X - No match between the Referred to and Written Prescriber
Written date within range	Check mark - when the CE visit date is within the Referral Match Setting X - Is not within the date range
Meets minimum value	Check mark - the prescription value is within the referral match setting. X - the prescription does not meet the minimum value

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Reviewing Referrals

Click the links below to review the processes for the following:

Referral Match Settings

Potential Referrals