It used to be said if you wanted to compare to something good, you would say it was the “standard” by which something was measured…A solid foundational concept. I mean, EVERYTHING has standards.  We have standards in the workplace:  My company has a standard for DRESS: we all are to look alike.  We have a standard for the pharmacy layout so when a float comes in, that he/she should be able to find the drugs in basically the same areas from store to store ( given similar construction).  We also have a standard for procedure so that every auditor should be able to locate who filled a script by the placement of the initials, etc.   Its just simple business practice.  We also have standards at home, tho they are probably a lot more flexible than in the workplace.   When I put my dishes away, I always put them in the same place so I can find them again.  Mr Chick is another story..he is a bit of a fruitcake, but that’s another post..

So, (getting back on topic) if STANDARDS are a good thing, why is it such a dirty word in 1) insurance cards and 2) RX hardcopies.  Any pharmacy that has been open this Jan knows that a lot of changes occurred and we have had to change BIN numbers, Group numbers, etc on a lot of Medicare D patients.  It hasn’t been LIMITED to Med-D patients by any means.  After all these years, we still lack a simple standard for prescription insurance cards.  Some cards are ” all inclusive”: which means they are essentially an encyclopedia of info.  One card, one family.  Some insurances send out a medical card, a vision card, a dental card and a rx card, something that the average patient will never keep track of ( I guarantee it).

But the worst are the incomplete/inaccurate cards…ones that simply miss the mark by either placing information that is NOT needed or leaving out information that IS!.  I cite Crapola Insurance Co.  They have a card that has something like 15 characters in the ID field,  but as pharmacists soon find out, we need to LEAVE off the first 3 letters…just so you know…I have no idea what Crapola’s purpose is in eliminating the need for those first 3 letter, but if you put them in the ID field, you will get a rejt ” non match ID”.    We also have a fair number of cards that leave off the ever-essential BIN number.  Since we are long past the days of the ” big 2- PAID and PCS holding 99% of the market, we have literally thousands of PBM’s which have dozens of different BIN’s and PCN’s themselves.  I may very well be billing a Caremark card ( cuz it says so) but if I have the wrong BIN or PCN, it rejects out.

We pharmacies need only 5 ( here it comes) STANDARD bits of information:  1) BIN  2) PCN 3) GROUP 4) ID and 5) person code.  All the rest will usually fall into place. Is it that hard really????

Unless of course you are ANTHEM ( and Yes I am using their real name). I am mad at Anthem today.  I spent a lot of time on the phone trying to get a claim thru. I even called his previous pharmacy and verified I had exactly the right numbers in the right fields. I finally got LaTwitt on the phone from God-knows-where-istan who (after much hand-wringing) said ” you are submitting Robert as his name”.  Here’s a real eye opener LaTwitt…that IS his name She said “Change it to ROB”.

( Can you hear the head hitting the counter?) Robert was not pleased, but at least his anger was directed at the right place…ANTHEM.

I am now used to having to move numbers around to find the right placement: some want person codes at the end of the ID, some want them in the person code field. Some now want 3 digits on the person code field, and some now are using letters instead of numbers ( wtf).

So why is “standard” so dirty?   Lets STANDARDIZE!  One format…One layout.

Next up?   hardcopies…

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