Point-of Sale Pharmacy Claims Processing System Sample Clauses

Point-of Sale Pharmacy Claims Processing System. The Contractor shall implement, operate, and maintain a Point-of Sale Pharmacy Claims Processing System (“POS System”) consisting of a data-driven, user configurable rules engine for the validation and pricing of claims. The POS System must be compliant with all applicable federal, state, and industry standards, such as the most recent release of the NCPDP Telecommunications standards and HIPAA. The Contractor’s is fully responsible for all claims adjudication as well as providing a system that must be capable to accept and adjudicate all drug claims. The State’s Medicaid Management Information System (MMIS) is responsible for making payments to providers for all claims accepted for payment. The Contractor must provide adjudicated claims data to the State’s MMIS on a State-defined schedule so that the MMIS may conduct their operational responsibilities, including generating payments to providers. The POS System must apply a variety of rules and edits to assure proper claims adjudication. The system must be capable of adding, changing or removing adjudication rules, edits and customized transmission messages to accommodate State-required changes for its current and future pharmacy programs. At a minimum, the POS System shall have the following functionalities and capabilities:
Sample 1
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