Medication History for Populations

this guide is about medication history for populations panel the medication history for populations panel management solution is designed to help health systems, hospitals, and accountable care organizations (aco) manage cost effective care for patient populations outside of the patient visit by providing a comprehensive medication history of both pharmacy benefit manager (pbm) claim data and pharmacy dispensed fill data that can be used to calculate medication adherence scores, stratify risk, and identify gaps in care for more careful monitoring of higher risk groups note throughout the remainder of the guide the “medication history for populations panel” product will be referred to as “panel” about medication history for populations prescription notifications prescription notifications provides near real‑time alerts when key medication‑related events occur, helping care teams quickly identify adherence concerns, treatment gaps, or new activity that may affect a patient’s care plan this service uses timely pharmacy‑dispensed data and continuous monitoring every four hours to surface actionable insights directly within customer workflows by evaluating refreshed daily fill data such as when a medication is picked up, refilled, or not filled as expected, prescription notifications determines whether an event meets the customer‑selected criteria and delivers the appropriate notification note the first fill not picked up docid\ ue5o7docmp02nebfo29le notification is based on newrx data and refreshed daily prescription notification types the following prescription notification types are described as follows new medication a new medication (newrx) notification occurs when the fill number field is 00, indicating the pharmacy has defined it as the original fill, and the date picked up/dispensed field is populated note the prescription number is not considered when determining a new medication, as prescription numbers can be reused refill a refill (refill) notification occurs when the fill number field in the medication record is greater than 00, indicating this is not the original fill and the date picked up/dispensed field is populated new prescriber a new prescriber (newprescriber) notification occurs when a new medication record has 00 in the fill number field, indicating the pharmacy has defined it as the original fill, the date picked up/dispensed field is populated and the prescriber’s dea, npi, and/or spi varies from all other prescribers within the last four months of the patient’s medication history controlled substance a controlled substance (controlledsubstance) notification occurs when a new or refill medication record for the patient has a value greater than 0 in the drug class field, indicating the medication is a controlled substance and the date picked up/dispensed field is populated no refills remaining a no refills remaining (norefillsremaining) notification occurs when a medication is picked up where the number of refills originally authorized is greater than zero and the number of refills remaining on the picked up medication is zero refill not picked up a refill not picked up (refillnotpickedup) notification occurs from a daily search for medications picked up by the patient where additional refills were authorized if the date picked up, plus days' supply, and default grace period of three days has passed, and the next due refill is not found, a refill not picked up notification is generated notifications are generated one time per prescription refill that is not picked up note contact your surescripts account manager if you would like to change the three day grace period to a different length of time surescripts recommends using a grace period anywhere from one to five days monitored medication a monitored medication (monitoredmedrx) notification occurs when a specific medication chosen by the customer is picked up from the pharmacy this is customizable by surescripts or the customer via national drug code (ndc) notifications are generated one time per prescription refill that is picked up note customers identify the medications they wish to monitor through the surescripts customer support process as indicated in the support chapter of the network operations guide patient paid cash a cash pay (cashpayrx) notification occurs when payment code field provided is “01” indicating private pay (cash, charge, credit card) first fill not picked up a first fill not picked up (firstfillnotpickedup) notification is triggered when a newrx prescription is authorized but the patient does not pick up the medication within three days of the written date \<font color="#002a3b"> notes \</font> additional contracting may be needed contact your surescripts account manager to confirm whether the first fill not picked up service is available for your organization to adjust the default three day grace period, contact your surescripts account manager surescripts recommends a grace period of one to five days about medication history for populations patient file load the medication history for populations patient file load process is used by customers to enroll patients of interest this process is currently used by the following products medication history for populations (panel) medication history for populations (prescription notifications) refer to the patient file load process flow docid 2mz8jvaya3uafomtema u topic for detailed information about this guide this guide is designed to assist customers in enrolling patients for medication history for populations (panel) and medication history for populations (prescription notifications) develop software to deliver historical claim data from pbms/payers and pharmacy fill data for customer defined populations to acos, healthcare entities, and third party vendors for analysis serve as a high level specification document to engage vendors in implementing the medication history for populations fhir® release 4 api the audience for this document includes any customer or vendor responsible for developing a system interface for these electronic messages document references please refer to the following documents when reading this guide surescripts provided materials connectivity and authentication implementation guide network operations guide for prescription notifications, access the topic pertaining to searching and managing notifications by therapy class in the notifications dashboards workbench help guide external materials to be obtained by the customer hl7® fhir® release 4 https //hl7 org/fhir/r4/ us core implementation guide https //www hl7 org/fhir/us/core/ hl7® fhir® portions of this guide utilize the hl7® fhir® standard messaging release 4 as a baseline in conjunction with this surescripts implementation guide, participants should have a copy of the fhir® standard document readily available for use with the transactions documentation can be obtained through health level seven® the hl7® fhir® standard is 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