POS Reference Windows - NM Human Services



13.2.7 Reference Windows

This Window section contains the following Reference subsystem functional groups and a brief description of each.

• The Diagnosis Functional Group contains windows that allow the user to inquire on diagnosis code information.

• The Drug Functional Group contains windows that allow the user to inquire on drug information.

Each of these is described in detail separately, beginning below.

Note: Reference subsystem data is intended for CONDUENT internal use in managing customer programs. For New Mexico, change requests for Reference subsystem information and settings may be made via PCR requests in the production system. The CONDUENT Functional Application Support Team (FAST) is responsible for making the appropriate changes within PDCS OS PLUS.

13.2.7.1 Diagnosis Functional Group

This functional group provides the user the ability to:

• Inquire on diagnosis information

Note: The Diagnosis functional group is not currently utilized for New Mexico.

The following tab windows are used by the Diagnosis Functional Group:

• Search

• Diagnosis

The following data is displayed in the title bar of all tab windows in this functional group:

• Customer Name

New Mexico PDCS OS PLUS Reference Subsystem

Window Specification

Diagnosis Functional Group

Search Tab Page

|Window Name: |

|Diagnosis: Search |

|Description: |

|The Search window is the first window that appears when the Diagnosis functional group is selected from the Reference subsystem menu. The user may enter selection criteria to locate an |

|existing diagnosis code. |

| |

|Search criteria include Diagnosis Code or Description. A partial search is performed by entering any number of characters followed by a wild card (%). A full search is performed by entering a |

|wild card (%) with no other characters. |

| |

|If only one diagnosis record matches the search criteria entered, that record is displayed on the Diagnosis Information window. If multiple diagnosis records match the search criteria, the |

|first 500 records display in the Diagnosis Search results list box. The user may scroll through the list of diagnosis entries until the desired record is located. To select a diagnosis record |

|for display, the user must click the Diagnosis Code link. |

| |

|Note: The Diagnosis functional group is not currently utilized for New Mexico. |

|Window Type: |

|Response window |

|Navigation: |

|The user enters this window by clicking the Reference option on the PDCS OS PLUS menu, then clicking the Diagnosis option. This displays the Diagnosis Search window. |

|Interface to Other Subsystem(s): |

|N/A |

|Interface to Other Application(s): |

|N/A |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|The Search By criteria determines the initial sequence of data presented. The search results may be resorted into Diagnosis Code or Description by clicking on the column heading. |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Layout

Diagnosis Functional Group

Search Tab Page

[pic]

|New Mexico PDCS OS PLUS Reference Subsystem |

|Window Exhibit |

|Diagnosis Functional Group |

|Search Tab Page |

|Field Name |Table Column Name |Table Name |

|A = Always |D = Date Edit |C = Client-specific field or functionality |

|C = Conditionally |N = Numeric Edits |R = Note Reference |

|N = Never |S = System Generated | |

| |V = Valid Value Edit | |

|Ref. No. |Notes |

|N/A |N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Specification

Diagnosis Functional Group

Diagnosis Tab Page

|Window Name: |

|Diagnosis: Diagnosis |

|Description: |

|The Diagnosis Information window appears after selecting a specific Diagnosis record from the search results list. |

| |

|The Diagnosis window is used to display detail information about the diagnosis record selected. The detail information includes effective and end dates, general codes and indicators as well as|

|EPSDT and age range information. |

| |

|Note: The Diagnosis functional group is not currently utilized for New Mexico. |

|Window Type: |

|Response window |

|Navigation: |

|The user enters this window by selecting a specific diagnosis record from the search results list, after performing a search. The Diagnosis Information window is located within the Diagnosis |

|functional group within the Reference subsystem. |

|Interface to Other Subsystem(s): |

|N/A |

|Interface to Other Application(s): |

|N/A |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Layout

Diagnosis Functional Group

Diagnosis Tab Page

[pic]

|New Mexico PDCS OS PLUS Reference Subsystem |

|Window Exhibit |

|Diagnosis Functional Group |

|Diagnosis Tab Page |

|Field Name |Table Column Name |Table Name |

|A = Always |D = Date Edit |C = Client-specific field or functionality |

|C = Conditionally |N = Numeric Edits |R = Note Reference |

|N = Never |S = System Generated | |

| |V = Valid Value Edit | |

|Ref. No. |Notes |

|N/A |N/A |

13.2.7.2 Drug Functional Group

This functional group provides the user the ability to:

• Inquire on drug information

The PDCS OS PLUS Drug tables are maintained via weekly updates from First DataBank and New Mexico SMAC pricing batch loads and via quarterly updates from CMS Tapes.

The following tab windows are used by the Drug Functional Group:

• Search

• Drug

• Classification

• Pricing

• Formulary

• Indications/Contraindications

• Precautions

• Coverage

• Rebate Status

The following data is displayed in the title bar of all tab windows in this functional group:

• Customer Name

The following data is displayed in the header of every tab window except the Search tab:

• NDC

• GCN

• GSN

• Generic Name

• GTL, STL, HICL

• STR, DOSE, RT

• Brand Name

• Date Added

• Batch Date

• BGI

• GTI

• GAI

New Mexico PDCS OS PLUS Reference Subsystem

Window Specification

Drug Functional Group

Search Tab Page

|Window Name: |

|Drug: Search |

|Description: |

|The Search window is the first window that appears when the Drug functional group is selected from the PDCS OS PLUS Reference Subsystem Menu. The user may enter selection criteria to locate an|

|existing drug. |

| |

|A drug search can be performed using NDC, Generic Code, Generic Sequence Number, Therapeutic Class Specific, or Drug Name. A partial information search can also be performed using three or |

|more characters followed by a wild card (%). The drug search can be further refined to search for active drugs and/or rebate drugs only, |

| |

|If only one drug record matches the search criteria entered, that record is displayed on the Drug Information window. |

| |

|If multiple drug records match the search criteria, the first 500 records displays in the Drug Search list box. The user may scroll through the list of drugs until the desired record is |

|located. To select a drug for display, the user must click the NDC link. |

|Window Type: |

|Response window |

|Navigation: |

|The user enters this window by clicking the Reference subsystem option on the PDCS OS PLUS menu and then choosing the Drug functional group. |

|This search window takes the user to the Drug information window if a single drug record matches the search criteria or if a drug is selected from the search results list. |

|Interface to Other Subsystem(s): |

|N/A |

|Interface to Other Application(s): |

|The PDCS OS PLUS Drug tables are maintained via weekly updates from First DataBank and New Mexico SMAC pricing batch loads and via quarterly updates from CMS Tapes. |

|Special Security Requirements: |

|Add, Update, and Delete functionality is restricted to authorized users. |

|Presentation Sequence(s): |

|The Search By criteria determines the initial sequence of data presented. The search results may be resorted into NDC, Generic Code or Drug Name by clicking on the column heading. |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Layout

Drug Functional Group

Search Tab Page

[pic]

|New Mexico PDCS OS PLUS Reference Subsystem |

|Window Exhibit |

|Drug Functional Group |

|Search Tab Page |

|Field Name |Table Column Name |Table Name |

|A = Always |D = Date Edit |C = Customer-specific field or functionality |

|C = Conditionally |N = Numeric Edits |R = Note Reference |

|N = Never |S = System Generated | |

| |V = Valid Value Edit | |

|Ref. No. |Notes |

|R1 |If no records are found based on search criteria, the following message is displayed. “No records were found that meet your search criteria. Make sure you used valid “Search by”|

| |and “Search for” values.” |

|R2 |Smart Key search allows users to search by different keys of the Smart Key. Users can search by GTL and STL, or GTL, STL and HICL or GTL, STL, HICL and STR or the entire HICL. |

New Mexico PDCS OS PLUS Reference Subsystem

Window Specification

Drug Functional Group

Drug Tab Page

|Window Name: |

|Drug: Drug |

|Description: |

|The Drug page displays specific drug information when an existing drug is selected for inquiry. |

|Window Type: |

|Response window |

|Navigation: |

|The user enters this window either by entering search criteria that is unique for a drug on the Drug Search window, or by selecting a drug from the Drug Search results list or by clicking on |

|the Drug tab while on any of the Drug subsystem windows. |

|Interface to Other Subsystem(s): |

|N/A |

|Interface to Other Application(s): |

|The PDCS OS PLUS Drug tables are maintained via weekly updates from First DataBank and New Mexico SMAC pricing batch loads and via quarterly updates from CMS Tapes. |

|Special Security Requirements: |

|Add, Update, and Delete functionality is restricted to authorized users. |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Layout

Drug Functional Group

Drug Tab Page

[pic]

|New Mexico PDCS OS PLUS Reference Subsystem |

|Window Exhibit |

|Drug Functional Group |

|Drug Tab Page |

|Field Name |Table Column Name |Table Name |

|A = Always |D = Date Edit |C = Customer-specific field or functionality |

|C = Conditionally |N = Numeric Edits |R = Note Reference |

|N = Never |S = System Generated | |

| |V = Valid Value Edit | |

|Ref. No. |Notes |

|R1 |Rebate End Date must be greater than Rebate Begin Date. If not, the following error message is displayed: “The End Date is before the Begin Date. Change one of the Dates.” |

New Mexico PDCS OS PLUS Reference Subsystem

Window Specification

Drug Functional Group

Classification Tab Page

|Window Name: |

|Drug: Classification |

|Description: |

|The Classification window appears when clicking on the Classification window tab within the Drug functional group. |

| |

|The Classification window is used to display CMS effective dates, Generic and CMS classifications, route of administration, and dosage information used in DUR processing. |

|Window Type: |

|Response window |

|Navigation: |

|The user enters this window by clicking on the Classification tab while in the Drug functional group of the Reference subsystem. |

|Interface to Other Subsystem(s): |

|N/A |

|Interface to Other Application(s): |

|The PDCS OS PLUS Drug tables are maintained via weekly updates from First DataBank and New Mexico SMAC pricing batch loads and via quarterly updates from CMS Tapes. |

|Special Security Requirements: |

|Add, Update, and Delete functionality is restricted to authorized users. |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Layout

Drug Functional Group

Classification Tab Page

[pic]

|New Mexico PDCS OS PLUS Reference Subsystem |

|Window Exhibit |

|Drug Functional Group |

|Classification Tab Page |

|Field Name |Table Column Name |Table Name |

|A = Always |D = Date Edit |C = Customer-specific field or functionality |

|C = Conditionally |N = Numeric Edits |R = Note Reference |

|N = Never |S = System Generated | |

| |V = Valid Value Edit | |

|Ref. No. |Notes |

|N/A |N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Specification

Drug Functional Group

Pricing Tab Page

|Window Name: |

|Drug: Pricing |

|Description: |

|The Pricing window appears when clicking on the Pricing tab in the Drug functional group of the Reference subsystem. |

| |

|The Pricing window is used to display Average Wholesale Price (AWP), State Maximum Allowed Cost (SMAC), Federal Maximum Allowed Cost (FMAC), Direct Price, Medicaid Average Wholesale Price |

|(MCD), Base Line Price, Wholesale Net Package (WNP) Price, Wholesale Net Unit (WNU), Alternative Benchmark Price (ABP), Average Manufacturers Price (AWP), DRP (Direct Package) Price, SPP (SWP |

|Package) Price, APP (Average Wholesale Price Package) Price, and SWP (SWP Unit) Price pricing spans and effective dates. |

|Window Type: |

|Response window |

|Navigation: |

|The user enters this window by clicking on the Pricing tab while in the Drug functional group of the Reference subsystem. |

|Interface to Other Subsystem(s): |

|N/A |

|Interface to Other Application(s): |

|The PDCS OS PLUS Drug tables are maintained via weekly updates from First DataBank and New Mexico SMAC pricing batch loads and via quarterly updates from CMS tapes. |

|Special Security Requirements: |

|Add, Update, and Delete functionality is restricted to authorized users. |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Layout

Drug Functional Group

Pricing Tab Page

[pic]

[pic]

|New Mexico PDCS OS PLUS Reference Subsystem |

|Window Exhibit |

|Drug Functional Group |

|Pricing Tab Page |

|Field Name |Table Column Name |Table Name |

|A = Always |D = Date Edit |C = Customer-specific field or functionality |

|C = Conditionally |N = Numeric Edits |R = Note Reference |

|N = Never |S = System Generated | |

| |V = Valid Value Edit | |

|Ref. No. |Notes |

|R1 |End Date must be greater than Rebate Begin Date. If not, the following error message is displayed: “The End Date is before the Begin Date. Change one of the Dates.” |

|R2 |Field displays results based on the value in the R_DRUG_PRC_TY_CD field in the R_DRUG_PRC_TB table. The values permitted are “AWP”, “AMP”,”ABP,” “WNU”, “WNP”, “MCD”, etc. |

New Mexico PDCS OS PLUS Reference Subsystem

Window Specification

Drug Functional Group

Formulary Tab Page

|Window Name: |

|Drug: Formulary |

|Description: |

|The Formulary window appears when clicking on the Formulary tab in the Drug functional group of the Reference subsystem. |

| |

|Note that the Formulary tab is not being utilized for New Mexico. |

| |

|The Formulary window is used to display drug coverage and effective dates for each formulary number. It also displays whether the drug is covered under the Formulary number assigned (if |

|applicable). Formulary numbers are listed on the Plan File. |

|C indicates a covered drug ONLY IF the Plan File does not exclude coverage |

|G indicates a generic substitution |

|N indicates a non-covered drug regardless of the Plan File setting |

|P indicates a drug that requires prior authorization regardless of the Plan File setting |

|R indicates a drug that is preferred by the Plan and is used in 3-tier pricing arrangements |

|X indicates Restrictive Formulary |

|Window Type: |

|Response window |

|Navigation: |

|The user enters this window by clicking on the Formulary tab while in the Drug functional group of the Reference subsystem. |

|Interface to Other Subsystem(s): |

|N/A |

|Interface to Other Application(s): |

|The PDCS OS PLUS Drug tables are maintained via weekly updates from First DataBank and New Mexico SMAC pricing batch loads and via quarterly updates from CMS Tapes. |

|Special Security Requirements: |

|Add, Update, and Delete functionality is restricted to authorized users. |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Layout

Drug Functional Group

Formulary Tab Page

[pic]

|New Mexico PDCS OS PLUS Reference Subsystem |

|Window Exhibit |

|Drug Functional Group |

|Formulary Tab Page |

|Field Name |Table Column Name |Table Name |

|A = Always |D = Date Edit |C = Customer-specific field or functionality |

|C = Conditionally |N = Numeric Edits |R = Note Reference |

|N = Never |S = System Generated | |

| |V = Valid Value Edit | |

|Ref. No. |Notes |

|R1 |End Date must be greater than Rebate Begin Date. If not, the following error message is displayed: “The End Date is before the Begin Date. Change one of the Dates.” |

New Mexico PDCS OS PLUS Reference Subsystem

Window Specification

Drug Functional Group

Indications/Contraindications Tab Page

|Window Name: |

|Drug: Indications/Contraindications |

|Description: |

|The Indications/Contraindications window appears when clicking on the Indications/Contraindications tab in the Drug Functional Group of the Reference Subsystem. |

| |

|The Indications/Contraindications window is used to display Indications (disease states) and contraindications for the drug selected, with severity levels. |

| |

|This window is intended for internal clinical reference only, to view details about a drug’s usage. |

|Window Type: |

|Response window |

|Navigation: |

|The user enters this window by clicking on the Indications/Contraindications tab while in the Drug functional group of the Reference subsystem. |

|Interface to Other Subsystem(s): |

|N/A |

|Interface to Other Application(s): |

|The PDCS OS PLUS Drug tables are maintained via weekly updates from First DataBank and New Mexico SMAC pricing batch loads and via quarterly updates from CMS Tapes. |

|Special Security Requirements: |

|Add, Update, and Delete functionality is restricted to authorized users. |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Layout

Drug Functional Group

Indications/Contraindications Tab Page

[pic]

|New Mexico PDCS OS PLUS Reference Subsystem |

|Window Exhibit |

|Drug Functional Group |

|Indications/Contraindications Tab Page |

|Field Name |Table Column Name |Table Name |

|A = Always |D = Date Edit |C = Customer-specific field or functionality |

|C = Conditionally |N = Numeric Edits |R = Note Reference |

|N = Never |S = System Generated | |

| |V = Valid Value Edit | |

|Ref. No. |Notes |

|N/A |N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Specification

Drug Functional Group

Precautions Tab Page

|Window Name: |

|Drug: Precautions |

|Description: |

|The Precautions window appears when clicking on the Precautions tab in the Drug functional group of the Reference subsystem. |

| |

|Precaution data is available by clicking on one of the following precaution code subjects: Pediatric, Geriatric, Pregnancy, Lactation, Allergy Code, Interaction, Side Effects and CMS Exclude.|

|The resulting data contains the precaution codes and description associated with the selected drug. |

| |

|The information on this page is intended for internal clinical reference only, to view details about a drug’s usage. |

|Window Type: |

|Response window |

|Navigation: |

|The user enters this window by clicking on the Precautions tab while in the Drug functional group of the Reference subsystem and then selecting the specific precaution subject area, i.e.: |

|Pediatric, Geriatric, Pregnancy, Lactation, Allergy Code, Interaction, Side Effects and CMS Exclude. |

|Interface to Other Subsystem(s): |

|N/A |

|Interface to Other Application(s): |

|The PDCS OS PLUS Drug tables are maintained via weekly updates from First DataBank and New Mexico SMAC pricing batch loads and via quarterly updates from CMS Tapes. |

|Special Security Requirements: |

|Add, Update, and Delete functionality is restricted to authorized users. |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Layout

Drug Functional Group

Precautions Tab Page

[pic]

|New Mexico PDCS OS PLUS Reference Subsystem |

|Window Exhibit |

|Drug Functional Group |

|Precautions Tab Page |

|Field Name |Table Column Name |Table Name |

|A = Always |D = Date Edit |C = Customer-specific field or functionality |

|C = Conditionally |N = Numeric Edits |R = Note Reference |

|N = Never |S = System Generated | |

| |V = Valid Value Edit | |

|Ref. No. |Notes |

|N/A |N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Specification

Drug Functional Group

Coverage Tab Page

|Window Name: |

|Drug: Coverage |

|Description: |

|The Coverage window appears when clicking on the Coverage tab in the Drug functional group of the Reference subsystem. |

| |

|The Coverage window is used to display additional coverage information and as a reference for special pricing rules. |

| |

|Note that the Coverage tab is not being utilized for New Mexico. |

|Window Type: |

|Response window |

|Navigation: |

|The user enters this window by clicking on the Coverage tab while in the Drug functional group of the Reference subsystem. |

|Interface to Other Subsystem(s): |

|N/A |

|Interface to Other Application(s): |

|The PDCS OS PLUS Drug tables are maintained via weekly updates from First DataBank and New Mexico SMAC pricing batch loads and via quarterly updates from CMS Tapes. |

|Special Security Requirements: |

|Add, Update, and Delete functionality is restricted to authorized users. |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Layout

Drug Functional Group

Coverage Tab Page

[pic]

|New Mexico PDCS OS PLUS Reference Subsystem |

|Window Exhibit |

|Drug Functional Group |

|Coverage Tab Page |

|Field Name |Table Column Name |Table Name |

|A = Always |D = Date Edit |C = Customer-specific field or functionality |

|C = Conditionally |N = Numeric Edits |R = Note Reference |

|N = Never |S = System Generated | |

| |V = Valid Value Edit | |

|Ref. No. |Notes |

|R1 |End Date must be greater than Begin Date. If not, the following error message is displayed: “The End Date is before the Begin Date. Change one of the Dates.” |

New Mexico PDCS OS PLUS Reference Subsystem

Window Specification

Drug Functional Group

Rebate Status Tab Page

|Window Name: |

|Drug: Rebate Status |

|Description: |

|The Rebate Status window appears when clicking on the Rebate Status tab in the Drug functional group of the Reference subsystem. |

| |

|The Rebate Status window is used to display information about CMS Labeler, CMS Term Date, CMS DESI Code and FDB Rebate. |

|Window Type: |

|Response window |

|Navigation: |

|The user enters this window by clicking on the Rebate Status tab while in the Drug functional group of the Reference subsystem. |

|Interface to Other Subsystem(s): |

|N/A |

|Interface to Other Application(s): |

|The PDCS OS PLUS Drug tables are maintained via weekly updates from First DataBank and New Mexico SMAC pricing batch loads and via quarterly updates from CMS Tapes. |

|Special Security Requirements: |

|Add, Update, Delete and Void functionality is restricted to authorized users. |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Reference Subsystem

Window Layout

Drug Functional Group

Rebate Status Tab Page

[pic]

Please see updates that were made to add CMS Category field

[pic]

| |

| |

|New Mexico PDCS OS PLUS Reference Subsystem |

|Window Exhibit |

|Drug Functional Group |

|Rebate Status Tab Page |

|Field Name |Table Column Name |Table Name |

|A = Always |D = Date Edit |C = Customer-specific field or functionality |

|C = Conditionally |N = Numeric Edits |R = Note Reference |

|N = Never |S = System Generated | |

| |V = Valid Value Edit | |

|Ref. No. |Notes |

|R1 |If entered, End Date must be greater than Effective Date. If not, the system defaults the date to “9998-12-31” |

|R2 |The system defaults the source cd to 1 (Manual) if changes are done using GUI. If not, it defaults to 2 (System). |

|R3 |If end date is entered and not a high date, the system defaults the term date that is a day before the date. i.e., term date = end date – 1. If the end date is not entered and/ |

| |or a high date the system default the term date to “9999-12-31” |

|R4 |The void date is always defaulted to “9999-12-31”. If the void button is clicked the void dt is set to the current date. |

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