How we do, what we do.

1. PROCESS FLOW
CHART &
DESCRIPTION
“Order Entry” 1

2. 2
Order Entry Floor

3. 3
Order Entry Process Flow Chart
Clinic Pharmacy Manager
Special Order Entry STAT Order Entry
IV
Orders
Regular
Orders
Damar
& RSI
Orders
Uneek
Dose
Order
Pharmacist Verification
STAT Order Entry
Check Entered Orders
and Fill Prescriptions
Delivery

4. 4
GENERAL ORDER ENTRY
Order Entry
Regular
Order Entry
• Order Entry Process Involves: Pharmacy Technicians or In Training Pharmacy Technicians,
Pharmacists or In Training Pharmacist.
• Perform General Order Entry Duties.
__________________________________________________________________
•Receive documents (Fax Machines or e-scripts)
•Inform Order Entry if there is new admit in the queue, prescriptions need to be entered, or
inform Pharmacists If transfers needed.
•Process doc-u-flow (Documents Received Thru Paperless Document management system
will be assigned to proper category and processed in a timely manner)
•Preview: System will recognize the bar code then determine the Category
•Order Entry Techs will assign each category to the department for completion of the
document.
•Follow-up: This queue contains any document where further information is needed.
Complete Documents: If a document in completed documents is re-opened, it must be closed
again when finished or it will remain in the completed documents.
•Archived Documents:
•Audit Follow up Documents
•Verify Anything Needed
•Complete Batch.
•Damar & RSI Orders: Due to Special Care for any received by Clients and the Medical
Records, they are only handled by Ahsley, Matt & Laura.
• Ronnie : Intake
•Bree : Order Entry
•Chelsea : Order Entry
•Ashley : Backup OE
•Heather : Backup OE
•Anna : Backup OE
Damar & RSI
Orders
•Ashley
•Matt
•Laura

5. Uneek Dose Order Entry
5
Order Entry
Uneek Dose
Order Entry
Heather : Order Entry
Ashley : Order Entry
Chelsea : Backup
Bree : Backup
Uneek Dose
• Check Uneek Dose Calendar in order to determine which cycle needs to be
processed
• Prepare cycles to be sent to pacmed machine.
• Review all profile sheets of each individual to ensure no orders have changed
or added. Also check if all prescriptions have refills.
• If prescription need refill call or fax Doctor’s Office.
• Bill all scripts to verify no billing issues.
• Place Labels with Profile Sheet and send cycle to pacmed machine.
• Give the Labels and Profile Sheet to the pacmed operator.
• When working on facility batch several residents together and send to the
Machine and give profile sheets to the pacmed operator.

6. STAT ORDER
6
Order Entry
STAT ORDER
STAT ORDER
• Start a STAT Sheet
• Fill out all information needed on the sheet , resident, date, time, fax or call
on any clarification.
• Page floor to make sure they are aware of the STAT.
• Order Entry Specialist enter the order in a batch.
• Pharmacist verify the batch
• Print to zone printer.
• Walk the STAT sheet and labels to the floor.
• Verify with the Pharmacist the Stat is on the Floor.
• Verify with the Pharmacist if the STAT has been given to the Delivery.
• Verify the STAT has left the building.
• if any of the STAT claims are not paid send a 3 day emergency supply to get
the proper information to the insurance carrier.

7. 7

8. FILLING PRESCRIPTION
8
Filling
Prescriptions
Prescriptions
Holly : Fill Tech
Bree : Backup
Anna : Backup
Ashley : Backup
Heather : Backup
Filling Prescriptions
• Check Daily Orders Bin.
• Scan inventory in Pharmacy Software from Wholesaler
• Place Label on Each product and stack it on shelves.
• Any C2 Narcotics need to be scanned into inventory by Pharmacist in Software system &
update Inventory Book.
• Process all back orders that are due for particular day.
• Fill all daily orders placed in the daily basket.
• Determine if orders are to be filled in Vials, Punch cards or in Original Containers.
• Fill all Orders from the refill report for the next day.
• Pharmacist will check and verify the orders
• Pack and put Delivery Ticket on Order and hand it over to delivery team.
• Any medication that needs to be ordered, place the order and send
the order at end of the day.

9. PHARMACIST VERIFICATION
9
Pharmacist Verification
Pharmacist Verification
• Pharmacist will check all orders filled and
placed in filling area.
• Scan the bar code.
• Approve the filled order.
• Place in designated area for delivery ticket.
• Filled Prescription is sealed properly by Pharm
Tech.
•Put it on Delivery Rack and inform the delivery
team.

10. 10

11. 11
Delivery Process

12. Delivery
12
Pharmacist Verification
Delivery
•Dashona
• Ketra
• Markeeta
• Adrian
• Dave
•Catrina
Dispatch / Delivery
• After Pharmacist Verification Order is ready for
delivery
• Pharm Tech will print delivery ticket and place the
order on Delivery rack
• Delivery team will be informed about the order
placed.
• Delivery team will call the Patient about the delivery
to scheduled for the date and time.
• Check with patient if will be available to accept the
delivery.
• Give any special instructions to drivers about the
delivery.
• Driver will inform Pharmacy once the delivery is
made.

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Driver arrives
at
Pharmaneek
Route is assigned
to driver
Completed
Manifest is given
to driver
Driver verifies he/she
has the correct number
of items for each stop
loaded into vehicle.
All Totes must be sealed by
a Pharmacy tech prior to
being handled by a driver.
Details # of items for
each stop.
Leave Pharmaneek with
all items on Manifest.
Stop at patients home in
the order listed on
Manifest.
Upon arrival at patient’s home. Park
in designated parking spot. Do not
park in fire lane, handicap, visitor, or
other specially marked parking.
Ask for the patient if
someone else opens the
door. Disclose the
purpose of visit.
Only hand over prescription
after verifying the patient
name. In case of patient not
able to walk. Hand over the
prescription to family member
or nurse.
Have nurse / family member or
patient sign the white copy of
delivery ticket.
Ask if any items needs to be
returned to Pharmaneek. Or
any discrepancies. Note on
the delivery ticket.
Go to next delivery
location – Return all
signed delivery tickets to
Pharmaneek.
If any are returned.
Return all delivery
ticket paperwork and
all return items to
Pharmaneek.
Hand all items to
Pharmacy Technician
upon arrival at
Pharmaneek
Technician Will File delivery ticket/
paperwork in the appropriate
folder.

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Med Select, Control
Letter and EDK Billing
Pod

15. 15
EDK Emergency Drug Kits

16. 16
• Re-Writes
• Doc - u – flow
• Capture
• Flow Sheets
• Add Writes
• Fax / Clarification
• Add / Writes
• Service Emails.
Customer
New Re-
Admit
• Place in Totes
• Shipped Product
• Driver Scans
Delivery
Pharmaneek
Medical Records
Specialist
Re- Routing
Orders for IV /
Wound / Care
Nutritionals
• Month End
Reports
• Print Assembly
Quality
Assurance
Telephone
Orders
Medical Records

17. 17
Billing Department

18. 18
835 Process
• One vital element of receivables management and cash flow is the processing of
insurance payments. Timely posting of accurate payment and adjustment
information can accelerate cash flow by advancing the patient account to the next
stage of billing or collections. Although HIPAA implemented a standard format for
electronic remittance of data, the ANSI 835, a majority of the remittance
documentation received by the healthcare industries today is still on paper.
• The healthcare industry spends 15% of each dollar on payment processing compared
to only 2% in retail industries1. Of the remittances processed by healthcare
facilities, 80% - 90% are still provided on paper.
• Paper insurance remittances are generally translated manually into payment and
adjustment transactions for each documented account. This process is very time
consuming and prone to error. In addition, vital details about these payments are
often excluded in the interest of time. For example, charge level denials and other
detailed adjustments that are often available in the electronic remittances or on the
paper equivalent are often summarized or excluded.
• It is our Junior Accountants responsibility to update all remittance information,
captures, and communicate with each insurance payee type regarding updated
processes and procedures.

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Pharmaneek Daily Census Procedure
All facilities are requested and have agreed to provide Pharmaneek with:
• • A complete month to date census in alphabetic order by resident last name every
Monday.
• • Daily update changes for all other days of the week Tuesday thru Friday. (Saturday
and Sunday updates will come on Monday)
• • We should receive these by 10am each day via email or fax.
Daily: Monday thru Friday
• • Check off spreadsheet to confirm receipt of census (check all places; email, doc-
u-flow, fax machine in billing office
• • If census is not received by 10am, send email to BOM/ED for the facility
requesting (politely) the census or census updates depending on what day of the
week it is.
• • If no responses by 1pm, call facility ask to speak with Business Office Manager,
politely request the census or census updates
• • If no response, send another email detailing efforts (who and when emails were
sent, who you spoke with when you called)

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Prior Authorizations
Pharmaneek Long Term Care provides a highly trained Billing Specialists
to handle prior authorizations:
• Call the facility to obtain the information regarding the patient (s) history, diagnosis, past
medications tried etc.
• Call the insurance company to obtain or start the prior authorization process.
• If insurance requires paperwork to be signed by the Doctor our nurse cannot sign but will
get the process started and will follow up with the Doctor until resolved.
• If labs are required, we will start this request process.
• If a PA cannot be resolved the same day the medications are ordered, we will contact your
facility via fax to notify you of the status of the PA.
• Pharmaneek will attempt to get an initial override to get you the medication that day, but
sometimes this is not possible.
• All information will be communicated to your facility.

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Pre-pack
• Re-package bulk medications into standard
packaging for dispensing suitable for long
term care. The top 250 to 500 medications
are packaged to streamline efficiencies in
dispensing of prescriptions.

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Nurse
Transcribes order
to a telephone
order form
Nurse Notifies
Physician to call
Pharmaneek @ 317-
293-1700
Physician Calls a verbal
order to Pharmaneek
Pharmacist. (DEA # will
be verified)
Nurse Faxes Telephone
Order to Pharmaneek
Physician Verifies
that Physicians
verbal order and
nurses telephone
order match
Pharmaneek
Process the Now
Validated RX
Processing A Controlled Substance
Obtaining a VERBAL RX
Pharmaneek Procedures for
Processing an RX for a
controlled Substance in
accordance with DEA
regulations (Obtaining a
verbal prescription – not
allowed for CII meds)

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Processing A Controlled Substance
Obtaining a Written RX
Nurse Transcribes
order to a telephone
order form &
Telephone order is
Faxed to Pharmaneek
Pharmacy Process
information –
generates Rx
Template for Doctors
Signature.
RX Template is Faxed to
Dr- Monitored Daily by
Pharmaneek for
Signature Receipt.
Physician Signs RX and
Faxes back to
Pharmaneek.
Pharmaneek
Process the
now
Validated RX
Finish
Medication is
Delivered to
LTCF
Pharmaneek procedures for
processing an RX for a
controlled substance in
accordance with DEA
regulations (Obtaining a
written prescription)

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Medication
Returned
Full Card/ Full
Sealed Bulk / Unit
Dose
Expiration Date Less
Than 6 Months
Expiration Date Less
Than 6 Months
No Credit Card / Bulk Med
Defaced / unit
Dose (not re-
usable
Card / Bulk
Med / Unit
Dose Re-
usable
No Credit Credit
Note: Refrigerated
Items Must be
returned in a cooler
to be eligible for
credit
Partial Credit /
Full Card or Bulk
defaced
Compound /
Special Order
Refrigerated (Not
Stored or
transported
properly)
Below
minimum re-
stock fee
No Credit

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Compounding
• Prepare medications that are not manufactured in the form or
combination prescribed. Ex: mixture of multiple creams,
compounding medications into an oral solution or suspension
that are only available commercially in an oral solid
form. Compounding must be done in a clean environment
following sound industry standards. Compound templates
must be carefully developed and executed by licensed
pharmacy personnel.

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Retention and Retrieving
Prescription
Records

29. 29
Parata Fill

30. Prodigy System Parata System
PharmacyTechnician
Parata Filling OrdersPharmacist Verification
Delivery

31. 31
Parata Fill (PACMED)
• Orders are sent to Pacmed Fill, days in advance from Prodigy
System.
•Pharmacy Tech Checks the inventory of drugs in Pacmed Fill
and make sure the counts are sufficient to run Batches
•Once Pharmacy Tech Approves the inventory in Parata.
Pharmacy Tech starts the Equipment for Filling process.
•Pharmacy Tech Verifies # of Pills in Packets.
•After Prescriptions are filled. Pharmacist Verifies each filled
order.
•Once Pharmacist Verifies the Prescription. Delivery
department is informed about it. All tickets are printed as per
the delivery and prescription is out for Delivery.

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Accreditation
What is Accreditation:
• Are all Long Term Care Pharmacies alike? No
• Quality can differ significantly from one pharmacy to another
• There are 1,000’s of public and private pharmacies nationwide with new ones opening every day.
• Goal: to protect the consumer, states have licensure laws governing these pharmacies. (Usually minimum
requirements).
• Centers for Medicare and Medicaid services (CMS) have established requirements.
• Another form of consumer protection is voluntary accreditation.
• Standards of care are based upon the consensus of professionals of elements that should exist in LTC
Pharmacies, that have gone the “extra mile”
Accreditation is a means of :
• Measuring the organizational management
• Internal processes
• Patient safety
• Service outcomes
• Organizations that have earned accreditation usually are most serious about maintaining the quality of services
and products they provide.
Accreditation is
• A professional peer review administered by a private nonprofit organization
• It is structured to establish higher standards than state and federal requirements
• This is voluntary and the Pharmacies do have to pay a fee to participate.

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PROCESS IN PIPELINE
IV Order / IV Order Entry
Consultant Pharmacist
Med Select

34. IV Order Entry
34
Order Entry
IV Order
Entry
IV Order Entry
• Select the drug • Add Expiration Date
• Add NDC / Quick Code • Check IV ED
• Dosage Form • Check Pump Allocation
• Route of Administration • Send IV Pole and equipment Needed
• Dispensing Unit • Log all pump locations
• Main Ingredient •Log EDK Expiration pickup dates
• Add Sub Ingredients • Provide Pump Training
• Call to verify daily before refilling • Provide IV Support to facilities

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36. 36
Consultant Pharmacist

37. 37
Med-Select
Purpose:
The Med Select unit will replace the EDK and can be used for first dose of
medications until the full supply arrives from the Pharmacy.
Scanning each medication removed from the system verifies it is the correct
medication and reduces med errors.
Procedure:
If not already logged in, log into the DT using your User ID and Biometric/PIN.
Once logged in you will see the patient browser screen.
To select a patient begin typing the LAST name and then select the desired
patient and select Continue.
Select the medications) to be dispensed.
Enter desired quantity.
Select the Dispense button.
When a drawer opens, a window on the screen will display the medication to
be dispensed with the cabinet location.
Remove the requested medications) in the requested amount and close the
drawer.

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If multiple medications are being dispensed - remove the
medication and close the drawer - the next drawer will
open and the screen will display the medication and the
location. This process will continue until all requested
medications are dispensed.
After removing all requested medications, begin scanning
the barcode on each package.
If barcode scanning is unavailable, you must have a witness
to visually verify the medication. Select the desired
medication and press Verify.

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Policy:
•All medication removed from the Med Select unit must be signed out to
a patient.
•All medication removed from the Med Select unit must have a
physician’s order.
•All medication orders must be reviewed and approved by a licensed
pharmacist prior to dispensing except for in emergency situations (SEC.
I).
•When dispensing medication the nurse must scan the medication for
verification. If the nurse is unable to scan the package they must have a
witness visually verify the medication.
•Medications will be available to dispense for a limited time before and
after scheduled administration time. PRN orders will always be available.
•If a controlled (Class 2-5) medication is stored in a drawer it must be the
only item in that drawer. The system will require a user count each time
the item is dispensed. Count discrepancies will be monitored on a daily
basis.
Med-Select