13 - NM Human Services



13.2.4 Provider Windows

This Window section contains a list of the functional groups and a brief description of each. The PDCSOS PLUS Provider subsystem contains two functional groups:

• Physician

• Pharmacy

Each of these is described in detail, beginning below.

13.2.4.1 Physician Functional Group

This functional group provides the user the ability to:

• Inquire on a physician

Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations.

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

• Search

• Provider

• Physician

• License/Specialty

• Review/Cross Ref.

• Misc.

• Affiliations

• Notes

The following data is displayed in the title bar of all tab windows (i.e., not on search windows) in this functional group:

• Provider Name

• Provider ID

• Provider Type

• Provider Source

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Physician Functional Group

Search Tab Page

|Window Name: |

|Physician: Search |

|Description: |

|The Physician Search window is the first window that appears when the Physician option is selected from the PDCS OS PLUS Provider Subsystem Menu .The user may enter selection criteria to |

|locate an existing provider. |

| |

|The Provider Search window is used to search the database for a provider or a list of providers who meet specified selection criteria .A provider search can be performed using sort name, |

|provider ID, or zip code .Any of the various alternate IDs that are applicable for the provider can be used for a provider ID search .A partial information search can also be performed using |

|three or more characters followed by a wild card (%) .The zip code, state, provider ID, and sort name can also be entered to further refine the search results . |

| |

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

| |

|If multiple providers match the search criteria, the first 500 records display in the Physician Search list box .The user may scroll through the list of providers until the desired record is |

|located .To select a provider for display, the user must click the Provider ID link. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking the Physician option on the PDCS OS PLUS subsystem menu .This window takes the user to the Provider window if a single provider matches the search |

|criteria or if a provider is selected from the list. |

|Interface to Other Sub System(s): |

|N/A |

|Interface to Other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider|

|Relations. |

|Presentation Sequence(s): |

|The Search By criteria determines the initial sequence of data presented .The search results may be re-sorted into Provider ID or Sort Name sequence by clicking on the column heading. |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Physician Functional Group

Search Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Physician 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

|R2 |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. |

|R3 |Enter a minimum of three characters in the “Search for” field to perform a wildcard (%) search. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Physician Functional Group

Provider Tab Page

|Window Name: |

|Physician: Provider |

|Description: |

|The Provider Information page displays when an existing physician is selected for inquiry .It contains two panes. |

| |

|The Provider Information pane is used to display key provider information including legal name, type, border information, doing business as (DBA), DEA number, and date added. |

| |

|In case of a physician’s death, the Date of Death field is populated .Also, the License Status on the License/Specialty tab page indicates a status of “Deceased” along with a termination date |

|.This is to avoid potential fraud in the form of claims submitted under the Provider ID of a deceased prescriber. |

| |

|The Address Information pane is used to display provider demographic information .This pane accommodates several address types: physical address, billing address, mail-to address, |

|correspondence address and location address, in addition to others .The provider’s e-mail address is displayed on this pane .Both voice and FAX telephone numbers may exist for each address. |

| |

|Note: Identifying provider information is displayed on each provider window .This information includes provider name and ID, provider ID type and provider source. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by either entering search criteria that are unique for a provider on the Physician Search window, by selecting a provider from the Physician Search list, or by |

|clicking on the Provider tab while on any of the Physician subsystem windows .Clicking on the Show Last Update link displays the Update Information window. |

|Interface to Other Sub System(s): |

|N/A |

|Interface to Other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider|

|Relations. |

|Presentation Sequence(s): |

|Addresses are listed in address type sequence. |

|Remarks: |

|The default address for an existing Provider is the “physical address.” The “Address Type” is a drop-down box that the user can examine to select any other address associated with the |

|Provider . |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Physician Functional Group

Provider Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Physician Functional Group |

|Provider 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Physician Functional Group

Physician Tab Page

|Window Name: |

|Physician: Physician |

|Description: |

|The Physician Information window appears when clicking on the Physician window tab .It contains three panes. |

| |

|The Physician Group Information pane is used to display provider group status information .Statuses include various renditions of terminated, denied, and pending. |

| |

|The Physician Address Information pane is used to display provider demographic information by address type .This pane accommodates several address types: physical address, billing address, |

|mail-to address, correspondence address and location address, in addition to others . |

| |

|The Physician Restrictions pane is currently not used but in the future it could be used to limit the categories of drugs that a Physician can prescribe .For instance, it could be used to |

|restrict a psychiatrist to only prescribing drugs used in psychiatric therapy, but not painkillers. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking on the Physician tab while in the Provider Physician subsystem. |

|Interface to Other Sub System(s): |

|N/A |

|Interface to Other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider|

|Relations. |

|Presentation Sequence(s): |

|Physician Groups are displayed in Group ID and End Date sequence. |

|Physician Addresses are displayed in Address Type sequence. |

|Physician Restrictions are displayed in End Date sequence. |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Physician Functional Group

Physician Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Physician Functional Group |

|Physician 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Physician Functional Group

License/Specialty Tab Page

|Window Name: |

|Physician: License/Specialty |

|Description: |

|The License/Specialty window appears when clicking on the License/Specialty window tab .It contains two panes. |

| |

|The Physician License Information pane is used to display state physician license information along with provider eligibility history and enrollment status with associated effective and end |

|dates. |

| |

|The Physician Specialty Information pane is used to display primary and secondary specialties. A maximum of 12 physician specialties and 12 physician sub-specialties can be displayed. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking on the License/Specialty tab while in the Provider Physician subsystem. |

|Interface to Other Sub System(s): |

|N/A |

|Interface to Other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider|

|Relations. |

|Presentation Sequence(s): |

|Physician License information is displayed in End Date sequence. |

|Physician Specialty is displayed in End Date sequence. |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Physician Functional Group

License/Specialty Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Physician Functional Group |

|License/Specialty 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Physician Functional Group

Review/CrossRef. Tab Page

|Window Name: |

|Physician: Review/CrossRef. |

|Description: |

|The Review/Cross Reference window appears when clicking on the Review/CrossRef. window tab .It contains two panes. |

| |

|The Review Information pane is used to display physician review information including sanctions .Rules are applied to incoming claims from providers under review depending on the action code |

|assigned to the physician’s review status. |

| |

|The Cross Reference Information pane is used to display, add, update, and archive alternate IDs for the physician. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking on the Review/CrossRef. tab while in the Provider Physician subsystem. |

|Interface to other sub system(s): |

|N/A |

|Interface to other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider|

|Relations. |

|Presentation Sequence(s): |

|The Review Information pan results may be re-sorted by Group ID or End date by clicking on the column heading. |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Physician Functional Group

Review/CrossRef. Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Physician Functional Group |

|Review/CrossRef. 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Physician Functional Group

Misc. Tab Page

|Window Name: Physician: Misc. |

|Description: |

|The Miscellaneous window appears when clicking on the Misc. window tab .It contains two panes and three sections. |

| |

|The Miscellaneous Information pane is used to display miscellaneous information such as print suspense, remit sequence, and tax discount information. This pane applies to Pharmacy provider |

|types and is not used for Physician provider types. |

| |

|The EFT Information pane is used to display electronic funds transfer information for the physician. This pane applies to Pharmacy provider types and is not used for Physician provider types. |

| |

|The Audit Information pane is used to display audit information for the physician .This pane is not currently being utilized for any Conduent Customers but could be used to track Physician |

|audits. |

|Window Type: Response window |

|Navigation: |

|The user enters this window by clicking on the Misc. tab while in the Provider Physician subsystem . |

|Interface to other sub system(s): |

|N/A |

|Interface to other Application(s): |

|N/A |

|Special Security Requirements: |

|Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Physician Functional Group

Misc. Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Physician Functional Group |

|Misc. Tab Page |

| |Table | |

|Field Name |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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

|R2 |The EFT Begin Date cannot be greater than the EFT End Date .If the EFT Begin Date is greater than the EFT End Date, the following error message is displayed: |

| |The End Date is before the Begin Date. Change one of the dates. |

|R3 |There cannot be two EFT records with have overlapping dates .If an attempt to create a second record with the same key value of an overlapping date of an |

| |existing record, the following two messages is displayed: 1) Date field conflict .2) A begin date on one record cannot prior to the end date of another with |

| |the same key values. The begin date of the record you are saving is before the end date on an existing record. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Physician Functional Group

Affiliations Tab Page

|Window Name: |

|Physician: Affiliations |

|Description: |

|The Group Affiliations window appears when clicking on the Affiliations window tab .It contains group affiliations with which the physician is associated .All group affiliations for an |

|individual provider are displayed . |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking on the Affiliations tab while in the Provider Physician subsystem. |

|Interface to Other Sub System(s): |

|N/A |

|Interface to Other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider|

|Relations. |

|Presentation Sequence(s): |

|The search results are sorted by the Provider Group ID . |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Physician Functional Group

Affiliations Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Physician Functional Group |

|Affiliations 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Physician Functional Group

Notes Tab Page

|Window Name: |

|Physician: Notes |

|Description: |

|The Notes window appears when clicking on the Notes window tab .It contains information recorded from conversations with the physician .The “Recorded” section of the window displays the date |

|and time the note was created and the user ID of the person who created it .The “Note” section of the window displays the text of one note. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking on the Notes tab while in the Provider Physician subsystem. |

|Interface to Other Sub System(s): |

|N/A |

|Interface to Other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider|

|Relations. |

|Presentation Sequence(s): |

|The Notes pane is sorted in descending date sequence under the Recorded date field. |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Physician Functional Group

Notes Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Physician Functional Group |

|Notes 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

13.2.4.2 Pharmacy Functional Group

This functional group provides the user the ability to:

• Inquire on pharmacy

Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations staff.

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

• Search

• Pharmacy

• Network/Alt ID/EFT

• Notes

• Review/Audit

• Affiliations

The following data is displayed in the title bar of all tab windows (i.e., not on search windows) in this functional group:

• Provider Name

• Provider ID

• Provider Type

• Provider Source

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Pharmacy Functional Group

Search Tab Page

|Window Name: |

|Pharmacy: Search |

|Description: |

|The Pharmacy Search window is the first window that appears when the Pharmacy subsystem is selected from the PDCS OS PLUS Provider Subsystem Menu .The user may enter selection criteria to |

|locate an existing pharmacy. |

| |

|The Pharmacy Search window is used to search the database for a pharmacy or a list of pharmacies that meet specified selection criteria .A pharmacy search can be performed using sort name, |

|pharmacy ID, or zip code .Any of the various alternate IDs that are applicable for the pharmacy can be used for a pharmacy ID search .A partial information search can also be performed using |

|three or more characters followed by a wild card (%) .The zip code, county, state, pharmacy ID, and sort name can also be entered to further refine the search results . |

| |

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

| |

|If multiple pharmacies match the search criteria, the first 500 records will display in the Pharmacy Search list box .The user may scroll through the list of pharmacies until the desired |

|record is located .To select a pharmacy for display, the user must click the Pharmacy ID link. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking the Pharmacy option on the PDCS OS PLUS subsystem menu .This window will take the user to the Pharmacy window if a single provider matches the search |

|criteria or if a provider is selected from the list. |

|Interface to Other Sub System(s): |

|N/A |

|Interface to Other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. |

|Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

|Presentation Sequence(s): |

|The Search By criteria determine the initial sequence of data presented .The search results may be re-sorted by Provider ID, Sort Name, or Provider Type Code sequence by clicking on the column|

|heading . |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Pharmacy Functional Group

Search Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Pharmacy 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

|R2 |If no records are found based on search criteria, the following message will be displayed: “No records were found meet your search criteria .Make sure you used valid “Search |

| |by” and “Search for” values.” |

|R3 |Enter a minimum of three characters in the “Search for” field to perform a wildcard (%) search. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Pharmacy Functional Group

Pharmacy Tab Page

|Window Name: |

|Pharmacy: Pharmacy |

|Description: |

|The Pharmacy Information page displays when an existing pharmacy is selected for inquiry. It contains three panes. |

| |

|The Pharmacy Information pane is used to display key pharmacy information including name, type, border information, and Federal Tax ID number . |

| |

|The Address Information pane is used to display provider demographic information as well as phone and fax numbers along with e-mail address. |

| |

|The Misc. Information pane displays pharmacy class code and pharmacy bulletin information .This pane is not currently utilized by Conduent Provider Relations. |

| |

|Note: Identifying provider information will be displayed on each provider window .This information includes provider name and ID, provider ID type, and provider source. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking on the Pharmacy tab while in the Provider Pharmacy subsystem. |

|Interface to other sub system(s): |

|N/A |

|Interface to other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. |

|Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

|Presentation Sequence(s): |

|The address information is sorted by Address type . |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Pharmacy Functional Group

Pharmacy Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Pharmacy Functional Group |

|Pharmacy 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Pharmacy Functional Group

Network/Alt ID/EFT Tab Page

|Window Name: |

|Pharmacy: Network/Alt ID/EFT |

|Description: |

|The Network/Alt ID/EFT page displays when clicking on this tab .It contains two panes and three sections. |

| |

|The Alternate Provider ID section is used to display, add, update, and archive alternate ID cross-referencing information for the pharmacy .Searches can be performed on any of these IDs. |

| |

|The Electronic Funds Transfer (EFT) section is used to maintain bank account information for pharmacy providers paid by EFT. |

| |

|The Network Information pane is used to display the network(s) to which the pharmacy belongs, the network begin and end dates, brand and generic discount percentages, dispensing fee |

|information, and any reason for termination from a network. Pricing levels can be assigned at this level as well, providing an additional layer of customization. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking on the Network/Alt ID/EFT tab while in the Provider Pharmacy subsystem. |

|Interface to other sub system(s): |

|N/A |

|Interface to other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. |

|Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

|Presentation Sequence(s): |

|The Alternate ID pane is sorted by Alternate ID, and the Electronic Fund Transfer pane is sorted by Begin Date .The Network Information pane may be resorted by Network ID or End Date. |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Pharmacy Functional Group

Network/Alt ID/EFT Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Pharmacy Functional Group |

|Network/Alt ID/EFT 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

|R2 |The EFT Begin Date cannot be greater than the EFT End Date .If the EFT Begin Date is greater than the EFT End Date, the following error message will be displayed: The End Date |

| |is before the Begin Date. Change one of the dates. |

|R3 |There cannot be two EFT records with have overlapping dates .If an attempt to create a second record with the same key value of an overlapping date of an existing record, the |

| |following two messages will be displayed: 1) Date field conflict .2) A begin date on one record cannot prior to the end date of another with the same key values. The begin date|

| |of the record you are saving is before the end date on an existing record. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Pharmacy Functional Group

Notes Tab Page

|Window Name: |

|Pharmacy: Notes |

|Description: |

|The Notes window appears when clicking on the Notes window tab .It contains information recorded from conversations with the pharmacy .The “Recorded” section of the window displays the date |

|and time the note was created and the user ID of the person who created it .The “Note” section of the window displays the text of one note. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking on the Notes tab while in the Provider Pharmacy subsystem. |

|Interface to other sub system(s): |

|N/A |

|Interface to other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. |

|Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

|Presentation Sequence(s): |

|The Notes pane is sorted in descending date sequence under the Recorded date field. |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Pharmacy Functional Group

Notes Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Pharmacy Functional Group |

|Notes 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Pharmacy Functional Group

Review/Audit Tab Page

|Window Name: |

|Pharmacy: Review/Audit |

|Description: |

|The Review/Audit window appears when clicking on this tab .It contains two panes. |

| |

|The Review Information pane is used to display pharmacy review information including sanctions .Rules are applied to incoming claims from providers under review depending on the action code |

|assigned to the pharmacy’s review status. |

| |

|The Audit Information pane is used to display audit information for the pharmacy .This pane is not currently being utilized for any Conduent Customers but could be used to track Pharmacy |

|audits. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking on the Review/Audit tab while in the Provider Pharmacy subsystem. |

|Interface to other sub system(s): |

|N/A |

|Interface to other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. |

|Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

|Presentation Sequence(s): |

|The Review Information pane is sorted by Group ID. |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Pharmacy Functional Group

Review/Audit Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Pharmacy Functional Group |

|Review /Audit 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

New Mexico PDCS OS PLUS Provider Subsystem

Window Specification

Pharmacy Functional Group

Affiliations Tab Page

|Window Name: |

|Pharmacy: Affiliations |

|Description: |

|The Group Affiliations window appears when clicking on this tab .It contains group affiliations with which the pharmacy is associated .Effective and end dates will be listed for provider |

|affiliations. |

|Window Type: |

|Response window. |

|Navigation: |

|The user enters this window by clicking on the Affiliations tab while in the Provider Pharmacy subsystem. |

|Interface to other sub system(s): |

|N/A |

|Interface to other Application(s): |

|N/A |

|Special Security Requirements: |

|Access to data within one or more Group is controlled by the user’s security profile. |

|Note that Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

|Presentation Sequence(s): |

|The search results are sorted by the Provider Group ID . |

|Remarks: |

|N/A |

New Mexico PDCS OS PLUS Provider Subsystem

Window Layout

Pharmacy Functional Group

Affiliations Tab Page

[pic]

|New Mexico PDCS OS PLUS Provider Subsystem |

|Window Exhibit |

|Pharmacy Functional Group |

|Affiliations 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 |Provider subsystem update capabilities in the production system are limited to Conduent Provider Relations. |

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