8.9 Medication Review Services
Last updated on November 10, 2023General Policy Description
B.C. pharmacies can submit a claim to PharmaCare for medication review services provided by pharmacists to eligible patients.
A medication review is a patient-care service that seeks to enhance a patient’s understanding of their medication regimen, identify and resolve drug therapy problems, and improve health outcomes.
The service is provided by a pharmacist through a one-on-one, in-person appointment during which the patient and pharmacist identify all medications that the patient is taking, discuss how the medications are best taken and, where appropriate, create a medication management plan to address any drug therapy problems. At the end of the appointment, the pharmacist provides the patient with one or more documents listing their medications.
The maximum amount PharmaCare reimburses a pharmacy for any combination of medication reviews, clinical services (e.g., prescription adaptation), and drug and vaccine administrations for the same patient, on the same day is $78.00.
This policy standardizes how medication review services are delivered across B.C.
There are four types of medication review services:
| 1. Medication Review—Standard (MR-S) | Provided at community pharmacies and eligible for PharmaCare payment. |
|---|---|
| 2. Medication Review—Pharmacist Consultation (MR-PC) | |
| 3. Medication Review—Follow-up (MR-F) | |
| 4. Medication Review—Primary Care Network (MR-PCN) | Provided by pharmacists in a primary care network. No PharmaCare payment is provided. |
Policy Details
Policies applicable to medication review services in community pharmacies
Pharmacists should ensure they are familiar with the entire contents of this section of the PharmaCare Policy Manual before delivering and submitting claims for a medication review service.
This section contains policies applicable to medication review services in community pharmacies. (For policies and activities applicable to medication reviews provided by clinical pharmacists in primary care networks, see Medication Review—Primary Care Network [MR-PCN]):
Before performing a medication review service for a consenting patient, for which a claim will be submitted, pharmacists must ensure the patient is eligible for PharmaCare coverage of that service.
To be eligible to receive any of the three PharmaCare-paid medication review services (including follow-up appointments), the patient must meet all the criteria in the table below.
| The patient must | Notes |
|---|---|
|
Be a resident of B.C. |
Must have a permanent address in B.C., verified by a B.C. driver’s licence, BC Services Card or other ID card. |
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Have a B.C. Personal Health Number (PHN) |
Any B.C resident with a PHN is eligible, even if they are not covered by or registered with PharmaCare, such as Non-Insured Health Benefits and Canadian Armed Forces beneficiaries. |
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Not be covered under PharmaCare Plan B |
Medication review services for individuals in long-term care facilities are already funded as part of the monthly capitation fee for PharmaCare Plan B facilities. |
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Have at least five different qualifying medications that have been entered into PharmaNet
|
>> See Qualifying medications below for details. |
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Have a clinical need for service |
>> See Clinical need below for details. |
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Have not exceeded the allowable number of medication review services |
>> See Allowable number of medication review services below for details. Pharmacists are responsible for checking the patient’s PharmaNet record for the number of reviews received. |
|
Sign the acknowledgement on the Best Possible Medication History (BPMH) form. |
>> See 3. Obtaining patient signature in acknowledgement section for details. |
Qualifying medications
Individual DINs and PINs may be counted only once.
A qualifying medication is one of the following that has been entered into PharmaNet:
- A prescription medication; that is, a Schedule 1 (prescription required) drug
- A compounded prescription medication (with a discrete PIN)
- Insulin (if the patient takes multiple types of insulin, it counts as only one qualifying medication)
Non-qualifying items
Items that do not qualify include:
- All non-prescription products, with the exception of insulin, whether or not they are covered by PharmaCare, including but not limited to: over-the-counter medications; vitamins and nutritional supplements; vaccines (regardless of whether they are privately or publicly funded); non-prescription compounds; and natural/homeopathic products.
- Prescriptions with a Discontinued status in PharmaNet
- Prescriptions that have been reversed in PharmaNet
- Prescriptions with a Not Filled status in PharmaNet
- Non-drug supplies including but not limited to:
- blood glucose testing supplies (e.g., continuous glucose monitors, strips, lancets, needles)
- insulin pumps and insulin pump supplies (e.g., infusion kits)
- medical equipment and supplies (e.g., orthoses, prostheses, gloves)
Clinical need
When determining a patient's eligibility to receive medication review services, clinical need must be identified and clearly documented as one or more of the following:
- Prescriber has requested a medication review
- Patient has multiple diseases
- Patient has one or more chronic diseases
- Patient's medication regimen includes one or more non-prescription medications
- Patient's medication regimen includes one or more natural health products (NHPs)
- Patient has a drug therapy problem (DTP) (see below)
- Patient was recently discharged from hospital
- Patient has multiple prescribers
- Patient is receiving medication(s) that require laboratory monitoring
The seven types of drug therapy problems (DTPs) are:
- Unnecessary drug
- Needs additional drug
- Ineffective drug
- Dosage too low
- Dosage too high
- Adverse drug reaction
- Patient self-management (non-adherence)—that is, the patient is not taking the drug appropriately
Allowable number of medication review services
Eligible patients may receive coverage for
- Either one Medication Review—Standard (MR-S) or one Medication Review—Pharmacist Consultation (MR-PC) service (but not both) every 6 months*
AND
- Up to four Medication Review—Follow-Up (MR-F) services every 12 months
*A patient is not eligible for coverage of an MR-S or MR-PC if they have received an MR-PCN within the past 6 months. Patients are still eligible for up to 4 MR-F in the community following MR-PCNs, within 12 months.
>> For specific eligibility requirements for each medication review service, refer to the Required Activities for MR-S, Required Activities for an MR-PC, and Required Activities for an MR-F.
Patients who receive medication review services from different pharmacies (including PCNs) are still subject to the coverage limits described above (i.e., coverage limits are per patient not per pharmacy).
To ensure coverage is available, pharmacists should review a patient's PharmaNet profile to determine whether the patient has reached their maximum number of allowable medication review services (MR-S, MR-PC, MR-F) before they conduct the medication review.
Medication review service claims in excess of the maximum allowable will not be reimbursed even if the claims are submitted by different pharmacies.
PharmaNet cannot reject medication review service claims in excess of the maximum allowable at the time of submission. These claims are adjudicated in monthly batches. Any claims in excess of the maximum allowable found at that time will be disallowed.
2. Documenting medication review services
PharmaCare requires pharmacies that submit a claim for medication review services to retain specific documentation to support their claim.
Documenting medication review services:
- Provides auditable proof that an eligible medication review service occurred
- Provides patients, caregivers, and other healthcare professionals with accurate, complete, and current information about a patient's medications
The two forms PharmaCare requires for use in documenting medication review services are:
|
Best Possible Medication History (BPMH) (Word), including:
|
Required for medication review services in community pharmacies |
|---|---|
| Drug Therapy Problem (DTP) (Word) form | Required whenever a pharmacist identifies and/or takes action to resolve a patient's DTP |
| Best Possible Medication History Worksheet (Word) | Optional |
The content of these forms constitutes the minimum acceptable documentation required for PharmaCare coverage of a medication review service claim. The associated claim is subject to recovery if these documentation requirements are not met.
>> For details, see the Required Documentation section for each medication review service: MR-S Required Documentation, MR-PC Required Documentation, and MR-F Required Documentation.
PharmaCare provides templates for all medication review services forms provided in community pharmacies. Pharmacies may use the templates to record required information (see Form templates under Tools and Resources below) or create their own forms.
Pharmacies that create their own forms must ensure those forms contain all the text and field titles as well as all the fields shown in the PharmaCare version. For details, see If you are creating your own forms.
Document retention and storage
Documents must be retained in the same manner as other patient records.
>> For more information, see the PharmaCare Policy Manual, Section 10—Audit.
PharmaCare covers medication review services only if the patient or their legal representative signs the acknowledgement on the Best Possible Medication History (BPMH) (Word 282KB) form at the conclusion of the medication review service.
Whenever someone else is acting on a patient’s behalf, the pharmacy must retain documentation of that person’s right to act as the patient’s legal representative.
For each medication review service provided, the patient or their legal representative must sign acknowledgement on the BPMH form.
In B.C., an acceptable legal representative for a patient is a representative acting under a representation agreement under the Representation Agreement Act or a committee appointed under the Patients Property Act.
Note: The Health Professions Act (HPA) and Pharmacy Operations and Drug Scheduling Act (PODSA) bylaws state that, for purposes of continuity of care, pharmacists can share information about a patient with other healthcare professionals within the circle of care without having to obtain specific consent from the patient to do so.
>> See HPA Bylaws (PDF, 611KB), section 71 (Use of Personal Information) and section 72 (Disclosure of Personal Information) and PODSA Bylaws (PDF, 354KB), section 35 (Data Collection, Transmission of and Access to PharmaNet Data) and section 36 (Confidentiality).
Pharmacies must not request or accept additional fees or payments from any patient or third-party payer in relation to a medication review service for which a fee will be, or has been, claimed from PharmaCare.
Only one fee (i.e., MR-S, MR-PC or MR-F fee) can be claimed for each service appointment.
The maximum PharmaCare reimburses for a combination of medication review services, clinical services, or administration of vaccines for the same patient, on the same day, from the same pharmacy is $78.00.
Example: If a pharmacy claims an MR-PC, that pharmacy cannot be reimbursed for any other service on that day or if a pharmacy submits a claim for an MR-S, a therapeutic substitution and administration of a vaccine on a single day, only the MR-S and vaccine administration will be eligible for reimbursement.
To ensure maximum reimbursement, and to preserve the accuracy of the patient’s medication history, please submit all claims whether or not you expect the claim to be reimbursed.
If a pharmacy provides multiple services to a patient on the same day but submits claims on separate days in an attempt to circumvent this policy, any claim reimbursed in excess of the $78.00 daily limit is subject to recovery by PharmaCare.
>> See MR-S–Claims for Payment, MR-PC–Claims for Payment, and MR-F–Claims for Payment.
Required activities for medication review services in community pharmacy
When community pharmacists choose to deliver medication review services, all three types of medication review services must be:
- Provided by an authorized pharmacist or pharmacy student under the supervision of an authorized pharmacist
- Provided as a one-on-one, in-person appointment (and not by telephone or any other electronic means)
- Provided in a suitable area that the patient accepts as respectful of their right to privacy, and
- Provided and documented in accordance with the specific requirements of this policy
>> For details on required activities for each service type, see MR-S Required Activities, MR-PC Required Activities, and MR-F Required Activities.
Documenting medication review services that are not eligible for reimbursement
Pharmacists who conduct a medication review service for a patient who does not meet the PharmaCare eligibility requirements are encouraged to create a record of service in PharmaNet.
Use the Medication Review - Non-Benefit PIN 99000504 and, in the SIG field, enter the 10-digit phone number of the pharmacy where the service took place to record the service.
The claim will not be paid, but the patient’s PharmaNet record will indicate to other healthcare professionals that a medication review is available.
Policies and required activities for each medication review service
Medication Review—Standard (MR-S)
Required activities
| Required Activity | Where to document the activity results | |
|---|---|---|
| 1 |
Confirm the patient meets all the criteria in 1. Determining patient eligibility, under Policies applicable to medication review services in community pharmacy. |
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| 2 |
If the patient meets all eligibility requirements, document the patient information gathered in Step 1 above. |
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| 3 | Document the clinical need(s)–as listed under 1. Clinical need |
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| 4 |
Collect and document information about patient medical issues such as known allergies and reactions. Information is collected from multiple sources including but not limited to:
|
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| 5 |
Collect and document all pertinent information about the patient's current and recently discontinued medications (including prescription medications, non-prescription medications, and natural health products). Collect information from:
Determine whether the patient is currently taking each medication and how they are taking it. Document any clinically relevant medications the patient is no longer taking. |
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| 6 |
Discuss, review, and document the details of each medication the patient is currently taking with the patient or their legal representative, including
|
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| 7 |
Document all information relevant to continuity of care (e.g., details about decisions, evaluations, plans of action, and other directions or observations). Note: If a drug therapy problem is identified during an MR-S, the pharmacist is professionally responsible for taking action by working to resolve the issue or by referring the patient to an appropriate healthcare professional. If the pharmacist takes action to resolve the issue and completes one or more DTP forms, a claim for an MR-PC may be submitted instead of a claim for an MR-S. For MR‑PC required activity details, see MR-PC–Required Activities. |
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| 8 |
Ensure all forms are fully completed, including the name and Registration ID of the pharmacist, and the contact information for the pharmacy providing the service (to enable healthcare professionals to request the patient’s information). |
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| 9 |
Obtain signature of patient or their legal representative in the Patient Acknowledgement section of the BPMH. If someone else is acting on the patient’s behalf, obtain documentation of that person’s right to act as the patient’s legal representative. Retain the signed original for your records. |
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| 10 |
Provide a copy of the completed and signed Patient section of the BPMH to the patient or their legal representative. It is not necessary to provide the BPMH Health Care Professionals section to the patient. It is designed for use by clinicians only. |
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| 11 |
Store all documents together for future reference. (For details, see PharmaCare Policy Manual, Section 10—Audit). |
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| 12 |
Submit the medication review service claim on the date of service delivery, using the appropriate PIN. This ensures other pharmacies know that you have delivered the service to the patient and makes the clinical information available to other health care providers in a timely fashion. >> See Submitting Claims for the appropriate PIN and data entry instructions. |
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| 13 |
When you receive a request for medication review information from a healthcare provider within the patient’s circle of care,
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Required documentation
To support your claim for an MR-S service, retain the following documentation in a manner accessible for audit:
- Completed BPMH original, signed and dated by patient or their legal representative
- If applicable, documentation of another person’s right to act as the patient’s legal representative
- A written record of any requests for a copy of a patient’s BPMH (Word)
Claims for payment
For an eligible patient, the pharmacy can submit a claim to PharmaCare for a $60 MR-S fee.
The claim must be submitted on PharmaNet on the date the medication review service is provided to the patient.
Submit the claim using the appropriate PIN and the College Registration Identification (Reg ID) of the pharmacist who provided the service to the patient.
The pharmacy must enter the 10-digit pharmacy phone number in the first 20 spaces and in front of any other information that appears in the SIG field on the patient’s PharmaNet profile to facilitate continuity of care and sharing of the BPMH (Word) within the circle of care.
>> For details, see Submitting claims for payment.
>> For information on claim limits, see Policies applicable to medication review services in community pharmacy, 4. Claiming medication review services fees.
Medication Review—Pharmacist Consultation (MR-PC)
Required activities
| Required Activity | Where to document the activity results | |
|---|---|---|
| 1 |
Ensure the patient meets the criteria for an MR-PC. The patient must
|
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| 2 |
If the patient meets the eligibility requirements, document patient information gathered in Step 1 above. |
Patient section of
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| 3 |
Document the clinical need(s)—as listed under 1. Clinical need—that are the reason(s) for providing the service. |
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| 4 |
Collect and document information about patient medical issues such as known allergies and reactions. Information is collected from multiple sources including but not limited to:
|
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| 5 |
Collect and document all pertinent information about the patient’s current and recently discontinued medications (including prescription medications, non-prescription medications and natural health products). Collect information from:
Determine whether the patient is currently taking each medication and how they are taking it. Document any clinically relevant medications the patient is no longer taking. |
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| 6 |
Discuss, review, and document the details of each medication the patient is currently taking with the patient or their legal representative including
|
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| 7 |
Document all information relevant to continuity of care (e.g., details about decisions, evaluations, plans of action, and other directions or observations). |
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| 8 |
Document the identification of and actions taken/to be taken to resolve a minimum of one DTP. Work with the patient to:
Document all DTP-related decisions, plans, and actions decided upon during the appointment. Notify (and, if necessary, collaborate with) the most responsible physician or other prescriber about the DTP, care plan, and results achieved. |
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| 9 |
Ensure all forms are fully completed, including the name and Registration ID of the pharmacist, and the contact information for the pharmacy, providing the service (to enable healthcare professionals to request the patient’s information). |
Page headers of:
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| 10 |
Obtain signature of patient or their legal representative in the Patient Acknowledgement section of the BPMH. If someone else is acting on the patient’s behalf, obtain documentation of that person’s right to act as the patient’s legal representative. Retain the signed original for your records. |
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| 11 |
Provide a copy of the completed and signed Patient section of the BPMH to the patient or their legal representative. |
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| 12 |
Store all documents together for future reference. (For details, see PharmaCare Policy Manual, Section 10—Audit). |
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| 13 |
Submit the medication review service claim on the date of service delivery, using the appropriate PIN. This ensures other pharmacies know that you have delivered the service to the patient and makes the clinical information available to other health care providers in a timely fashion. >> See Submitting Claims for the appropriate PIN and data entry instructions. |
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| 14 |
When you receive a request for medication review information from a healthcare provider within the patient’s circle of care,
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Required documentation
To support your claim for an MR-PC service, retain the following documentation in a manner accessible for audit:
- Completed BPMH original, signed and dated by patient or their legal representative
- A separate DTP form for each DTP
- If applicable, documentation of another person’s right to act as the patient’s legal representative
- If applicable, a written record of any request for a copy of a patient’s BPMH and/or DTP form(s)
Claims for payment
For eligible patients, the pharmacy can submit a claim to PharmaCare for a $70 MR-PC fee.
If, during the MR-PC, a DTP has been resolved by an action that has a separately defined PharmaCare service fee (e.g., administration of injections and/or adaptations of prescriptions), the pharmacy may submit the claims as usual, but will be reimbursed to a maximum of $70.
The claim must be submitted on PharmaNet on the date the medication review service is provided to the patient.
This ensures other pharmacies know that you have delivered the service to the patient and makes the clinical information available to other health care providers in a timely fashion.
Submit the claim using the appropriate PIN and the College Registration Identification (Reg ID) of the pharmacist who provided the service to the patient.
The pharmacy must enter the 10-digit pharmacy phone number in the first 20 spaces and in front of any other information that appears in the SIG field on the patient’s PharmaNet profile to facilitate continuity of care and sharing of the BPMH and, if applicable, DTP Form(s) within the circle of care.
>> For details, see Submitting claims for payment.
>> For information on general claim limits, see Policies applicable to medication review services in community pharmacy, 4. Claiming medication review services fees.
Medication Review—Follow-Up (MR-F)
Required activities
| Required Activity | Where to document the activity results | |
|---|---|---|
| 1 |
Ensure the patient meets the criteria for an MR-F. The patient must
AND
|
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| 2 |
If the patient meets all eligibility requirements, document patient information gathered in Step 1 above. |
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| 3 |
Document the reason(s) for providing the MR-F service: that is, patients must have a clinical need (as listed under 1. Clinical need) that requires the following:
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| 4 |
If appropriate, review and update information about patient medical issues such as known allergies and reactions. Information is collected from multiple sources including but not limited to:
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| 5 |
If the service is a follow-up due to a subsequent medication change (i.e., a change in medication that is entered on PharmaNet):
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| 6 |
If the service is a follow-up to implement and/or evaluate progress towards resolving the patient’s DTP(s):
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| 7 |
Document all information relevant to continuity of care (e.g., details about decisions, evaluations, plans of action, and other directions or observations). |
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| 8 |
Ensure all forms are fully completed, including the name and Registration ID of the pharmacist, and the contact information for the pharmacy, providing the service (to enable healthcare professionals to request the patient’s information). |
Page headers of:
|
| 9 |
Obtain signature of patient or their legal representative in the Patient Acknowledgement section of the BPMH. If someone else is acting on the patient’s behalf, obtain documentation of that person’s right to act as the patient’s legal representative. Retain the signed original for your records. |
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| 10 |
Provide a copy of the new, completed and signed Patient section of the BPMH to the patient or their legal representative. |
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| 11 |
Store all documents together for future reference. (For details, see PharmaCare Policy Manual, Section 10—Audit). |
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| 12 |
Submit the medication review service claim on the date of service delivery, using the appropriate PIN. This ensures other pharmacies know that you have delivered the service to the patient and makes the clinical information available to other health care providers in a timely fashion. >> See Submitting Claims for the appropriate PIN and data entry instructions. |
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| 13 |
When you receive a request for medication review information from a healthcare provider within the patient’s circle of care,
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Required documentation
To support your claim for an MR-F service, retain the following documentation in a manner accessible for audit:
- New BPMH-Patient Information section, original signed by the patient or their legal representative
- New or updated version of the BPMH-Health Care Professionals section,
- If applicable, a new or updated DTP form for each DTP
- If applicable, documentation of another person’s right to act as the patient’s legal representative
- If applicable, a written record of any request for a copy of a patient’s BPMH and/or DTP forms
- If the original MR-S or MR-PC service was provided at another pharmacy, the pharmacy providing the MR-F service must obtain a copy of the PharmaCare-required documentation for the patient’s most recent MR-S or MR-PC.
- If the original medication review was provided at a PCN, the pharmacy providing the MR-F service must obtain a copy of the most recent MR-PCN documentation from the PCN.
- If information is missing from the previous pharmacy’s or PCN's documentation, the current pharmacy should ensure that all information required for the current MR-F is obtained, documented and retained in their records.
Claims for payment
For eligible patients, the pharmacist can submit a claim to PharmaCare for a $15 MR-F fee.
Either an MR-S, MR-PC or an MR-PCN must have been claimed for the patient within the previous year.
A maximum of four MR-F claims can be made in the 12 month period following the MR-S, MR-PC or MR-PCN.
For information on general claim limits, see Policies applicable to medication review services in community pharmacy, 4. Claiming medication review services fees.
The claim must be submitted on PharmaNet on the date of the medication review service.
This ensures other pharmacies know that you have delivered the service to the patient and makes the clinical information available to other health care providers in a timely fashion.
Submit the claim using the appropriate PIN and the College Registration Identification (Reg ID) of the pharmacist who provided the service to the patient.
The pharmacy must enter the 10-digit pharmacy phone number in the first 20 spaces and in front of any other information that appears in the SIG field on the patient’s PharmaNet profile to facilitate continuity of care and sharing of the BPMH and, if applicable, DTP Form(s) within the circle of care.
>> For details, see Submitting claims for payment.
Medication Review—Primary Care Network (MR-PCN)
Patient Eligibility
Health care practitioners in the Primary Care Network (PCN) will refer patients to a pharmacist working within the PCN. Generally, these patients will have complex medical conditions, but they may not meet the requirements for medication reviews in the community, with respect to qualifying medications, non-qualifying medications, and clinical need.
Allowable number of MR-PCNs in a year
There is no maximum number of allowable MR-PCNs in a given year. However, if a patient has received an MR-PCN, they will not be eligible for a PharmaCare-paid community medication review (MR-S or MR-PC) for the next six months. Patients may still receive up to four follow-up medication reviews (MR-F) in community after an MR-PCN, within 12 months.
Pharmacists in PCNs aren't required to use the same documentation as in community pharmacies, such as the PharmaCare Best Possible Medication History (BPMH) form or the Drug Therapy Problem (DTP) form. A community pharmacist providing a follow-up medication review (MR-F) to a client whose original medication review was provided by a pharmacist in a PCN must obtain the most recent MR-PCN documentation. As per usual MR-F procedure, the pharmacist is required to complete both the BPMH patient and the Health Care Professionals sections.
Submitting PharmaNet Records
The pharmacists in the PCN will use the MR-PCN PIN to submit a $0 claim on PharmaNet after providing a medication review. Primary Care pharmacists should refer to PCN documentation for this process according to their specific PCN. Since PCNs are enabled via a partnership between regional health authorities and divisions of family practice, claims for MR-PCNs will adjudicate to $0 as medication reviews are included in the services provided by pharmacists in the PCN.
Submitting the MR-PCN PIN on PharmaNet allows for documenting the patient's care by the pharmacist in the PCN and prevents duplicate medication reviews from being provided in community pharmacies (e.g., providing an MR-S within six months after a patient has received an MR-PCN).
Procedures
Claims for medication review services must be submitted on PharmaNet on the date of the medication review, using the appropriate PIN, as shown below.
The PIN and the payment amount for each service are as follows:
| PIN | Description | Payment Amount |
|---|---|---|
| 99000501 | Medication Review Standard (MR-S) | $60.00 |
| 99000502 | Medication Review Pharmacist Consultation (MR-PC) | $70.00 |
| 99000503 | Medication Review Follow-Up (MR-F) | $15.00 |
| 99000505 | Medication Review Primary Care Network (MR-PCN) | $0.00 |
To submit a claim for a medication review service:
- In the Days Supply field, enter 1.
- In the Quantity field, enter 1.
- In the Drug Cost field, enter 0.
Entering zero in the Drug Cost field ensures the fee does not inadvertently appear on the patient's receipt. - In the DIN/PIN field, enter the appropriate PIN.
- In the SIG field, in the first 20 spaces in the field and in front of any other information that appears in the field, enter the 10-digit phone number (including area code) of the pharmacy where the service took place. Other healthcare professionals will use this number to contact you to request patient information.
If the pharmacy phone number is not entered in the first 20 characters of the SIG field, the claim will not be reimbursed. - In the Prescriber ID field, enter the College Registration Identification (Reg ID) of the pharmacist who provided the service to the patient.
Consult your software vendor to determine any other requirements for payment reconciliation.
PharmaNet response code for medication review service claims
Claims for medication review services are processed for payment in monthly batches rather than in real-time. When a claim for a medication review service is submitted, PharmaNet returns one of several “rejection” responses (e.g., CD - patient not entitled to drug claimed). These adjudication messages from PharmaNet can be ignored.
Do not reverse or re-submit claims in response to adjudication messages. If the data has been entered correctly in the requested fields, the claims will be processed for payment.
Reconciling payments
Please call the PharmaNet Help Desk about specific claims. The PharmaNet Help Desk has access to payment and claim details and can fax or mail these details (with patient identifiers removed).
Audit
All claims to PharmaCare are subject to audit and any amount associated with a disallowed claim will be recovered.
>> For information on PharmaCare audit policies, see Section 10—Audit of this manual.
Medication Review Services Forms
| Purpose |
The purpose of the Best Possible Medication History (BPMH) (Word) is to
The BPMH includes two sections: the Patient section and the Health Care Professionals section. The Patient section of the BPMH is a comprehensive list of all prescription medications, non-prescription medications, and natural health products the patient is currently taking on a regular or “as needed” basis.
The Health Care Professionals section of the BPMH provides a professional summary of information collected during the review suitable for sharing with other healthcare professionals.
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|---|---|
| When to complete form |
For every MR-S or MR-PC appointment for which a claim will be submitted to PharmaCare, complete a new BPMH-Patient section and a new BPMH- Health Care Professionals section For every MR-F appointment for which a claim will be submitted to PharmaCare, complete a new BPMH-Patient section and a new or updated BPMH- Health Care Professionals section. MR-PCNs use their own documentation. |
| Form contents |
All content (i.e., text, fields, and field labels) included in the Best Possible Medication History template is mandatory and must be included in any pharmacy-created forms. See If you are creating your own form(s). |
| Notes on completing the form |
All fields on all pages must be completed unless otherwise indicated. See the BPMH template for the form fields. IS IT LEGIBLE? The intent of the BPMH Patient Section is to give the patient (or their family or caregiver) a clear, written record of your discussion. To make sure your directions and comments are easy for the patient to read, use the tips below. Tips for clarity:
Ensure that the patient or their legal representative signs and dates the Patient Acknowledgement section of the BPMH. On every page of the form, include the
If the service was delivered by a pharmacy student or intern, provide the name of the pharmacist who supervised the session. If the appointment is a follow-up and the service is delivered by a different pharmacist, add the pharmacist name and Reg ID after the original pharmacist’s ID:
Optional fields include “special instructions.” Complete if applicable. Complete all fields related to clinically relevant medications that have been stopped, if the information is available. If the patient is taking more than eight medications, add additional rows to the Medications I Take and Current Medications sections as necessary, or complete additional forms. |
| Purpose |
The Drug Therapy Problem form is a record of all information associated with the identification, resolution, follow-up care, and communication for a DTP identified during a Medication Review—Pharmacist Consultation service appointment. This form may be shared with healthcare professionals within the patient’s circle of care at the pharmacist’s discretion. |
|---|---|
| When to complete form |
A form must be completed whenever a DTP has been identified and resolved. A separate form must be completed for each DTP. For every MR-PC appointment for which a claim will be submitted to PharmaCare, complete a DTP form in addition to the BPMH-Patient section and BPMH-Health Care Professionals section. If applicable, for every MR-F appointment, when implementing and/or evaluating progress towards resolving the patient’s DTP, for which a claim will be submitted to PharmaCare, update each previous DTP form with new information (or generate a new one for each DTP) in addition to completing a new BPMH-Patient section and a new or updated BPMH-Health Care Professionals section. |
| Form contents |
Pharmacists may design their own version of the form; see If you are creating your own form(s) for requirements. All content (i.e., text, fields and field labels) included in the Drug Therapy Problem (Word) form template is mandatory and must be included in any pharmacy-created forms. See If you are creating your own form(s). |
| Notes on completing the form |
All fields on all pages must be completed unless indicated otherwise; see the DTP form template for the form fields. If a form is illegible, the associated claim will be subject to recovery. On every page of the form, include the
If the service was delivered by a pharmacy student or intern, provide the name of the pharmacist who supervised the session. If the appointment is a follow-up and the service is delivered by a different pharmacist, add the pharmacist’s name, and Reg ID after the initial pharmacist’s ID:
Optional fields include “notification.” Complete if applicable. |
Best Possible Medication History Worksheet (BPMH Worksheet)
| Purpose |
The Best Possible Medication History Worksheet (Word) is an optional form that pharmacists can use to gather, record, and review the patient’s medication information before the medication review appointment. The Worksheet complies with all requirements for pharmacy printing of the PharmaNet Medication Reconciliation Report. |
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| When to complete form |
This form may be used as a starting point for gathering information before a medication review service appointment. Use of this form is optional. |
| Form contents |
The contents of this form are found in the Best Possible Medication History Worksheet (Word) template. Pharmacists may design their own version of the form; see If you are creating your own form(s) for requirements. |
| Notes on completing the form |
N/A |
PharmaCare provides form templates that contain the minimum documentation requirements for claiming a fee for a medication review service from PharmaCare.
Any pharmacy that chooses to create their own versions of the medication review services forms must ensure that these minimum requirements are met; that is, each form must contain all the text and fields in the PharmaCare templates.
The wording of the text and field labels must not be changed.
Claims for medication review services will be reimbursed only when the forms contain all required text, fields, and field labels. If the forms do not meet these minimum requirements, claims will be subject to recovery.