This feature uses Fee Schedules to determine the allowable amount for each product and provides that as the Amount Paid in your BIN billing response. This provides a more accurate picture of what you're likely to be reimbursed when the medical claim is fully adjudicated.
Medicare Fee Schedule Integration
This opt-in feature on the RelayHealth integration utilizes the Medicare Fee Schedule to calculate paid amounts on BIN billed claims based on allowable amounts for mapped HCPCS codes.
To enable this feature:
Navigate to Organization Settings → Locations tab
Select your pharmacy location → Data Exchange tab
Access the RelayHealth integration card
Enable Medicare Fee Schedule option
This enhancement provides more accurate reimbursement predictions and helps pharmacies better understand expected Medicare payment amounts before claim submission.
What to expect
When DocStation can match the billed NDC to a HCPCS code on the Medicare Fee Schedule, DocStation will return the allowable amount in the claim response as the ingredient cost paid.
If DocStation is unable to match the NDC or the HCPCS, or find a dollar amount on the Fee Schedule for that HCPCS, DocStation will return the U&C as the total amount paid.
More fee schedule-related features are on the horizon, so stay tuned!