Orders & Billing

Subscription Management

Article 11: Subscription Management Overview Subscription management is central to Phox's automated refill system. This article covers viewing subscriptions, understanding next fill dates, managing active and canceled subscriptions, and the subscription lifecycle. What is a Subscription? A subscription in Phox represents: - A recurring prescription for a patient - Automated tracking of refill dates - Scheduled delivery cycles - Continuous medication management Accessing Subscription Management Navigation: 1. Go to Subscription Management 2. View all subscriptions (active and canceled) 3. Filter and search as needed Subscription List View Information Displayed ColumnDescriptionPatient NameClick to view patient fileMedicationPrescription drug nameLast DeliveryDate of most recent deliveryNext FillScheduled date for next refillDays Until DueCountdown to next fillStatusActive or Canceled Example Display PatientMedicationLast DeliveryNext FillDue InJohn SmithHumiraJan 27, 2026Feb 26, 202630 daysJane DoeEnbrelJan 15, 2026Feb 6, 202610 days Understanding Next Fill Dates How Next Fill is Calculated The next fill date is automatically calculated based on: 1. Last Delivery Date - When the order was completed 2. Day Supply - How long the medication lasts 3. Buffer Days - Lead time for processing (configurable) Formula: Next Fill = Last Delivery + Day Supply - Buffer Days Example: - Last Delivery: January 27, 2026 - Day Supply: 30 days - Buffer: 6 days - Next Fill: February 20, 2026 Buffer Days Setting Buffer days ensure orders are processed before the patient runs out: To Adjust Buffer: 1. Go to Settings 2. Find buffer/lead time configuration 3. Adjust the number of days 4. Save changes Recommendation: A 6-day buffer provides adequate time for billing, verification, and delivery. Viewing Subscription Details Click on a Subscription When you click on a subscription, you see: - Complete subscription history - All past orders - Current status - Patient preferences - Notes and comments Subscription Detail Fields FieldInformationMedicationDrug name, strength, formFrequencyDelivery cycle (monthly, etc.)Day SupplyDays per fillStart DateWhen subscription beganLast FillMost recent order dateNext FillUpcoming scheduled dateDelivery MethodHow orders are deliveredStatusActive / Canceled Active Subscriptions Managing Active Subscriptions Active subscriptions appear in: - Subscription Management list - To-Do Reports (when due) - Patient 360 view Actions Available: - View details - Edit preferences - Cancel subscription - Create immediate order Subscriptions Due Soon Filter to see subscriptions approaching their next fill: 1. Use the filter options 2. Sort by "Days Until Due" 3. Focus on upcoming refills 4. Proactively manage the queue Canceled Subscriptions Viewing Canceled Subscriptions Steps: 1. In Subscription Management, find the Canceled filter/tab 2. View all canceled subscriptions 3. See cancellation date and reason Cancellation Information FieldDescriptionCancellation DateWhen subscription was canceledCancellation ReasonWhy it was canceledCanceled ByStaff member who processedFinal DeliveryLast delivery before cancellation Canceling a Subscription When to Cancel Cancel subscriptions when: - Patient no longer needs medication - Patient switched pharmacies - Prescriber discontinued therapy - Patient request - Insurance coverage ended Cancellation Process Steps: 1. Find the subscription in Subscription Management 2. Click on the subscription 3. Select Cancel Subscription 4. Choose a cancellation reason: - Patient Request - Prescriber Discontinued - Insurance Change - Pharmacy Transfer (PPN) - Deceased - Other 5. Add notes if needed 6. Confirm cancellation Cancellation Reasons (PPN) PPN (Pharmacy Patient Number) reasons track why patients leave: Reason CodeMeaningPatient RequestPatient asked to cancelPPN - TransferMoving to another pharmacyTherapy CompleteTreatment finishedInsuranceCoverage issuesPrescriberDoctor discontinued To-Do Report Integration Subscriptions in To-Do Subscriptions automatically appear in the To-Do Report when: - Next fill date is approaching - Order needs to be created - Follow-up is required From To-Do: 1. Click Create Subscription (creates billing item) 2. Process through normal workflow 3. Delivery updates next fill date Assigning Subscriptions User Assignment Subscriptions can be assigned to team members: 1. Select the subscription 2. Click Assign 3. Choose the staff member 4. They see it in their assigned queue Adding Notes Add notes to subscriptions for: - Special handling instructions - Patient preferences - Clinical considerations - Follow-up reminders Steps: 1. Open subscription 2. Enter notes in the notes field 3. Save All Orders View Viewing All Orders The All Orders view shows: - Every order in the system - Search and filter capabilities - Order status tracking - Quick access to order details Search Options: - Patient name - Order number - Date range - Status - Medication Best Practices Subscription Management - Review upcoming subscriptions regularly - Process orders before patients run out - Keep subscription information current - Document cancellation reasons accurately Communication - Contact patients about upcoming refills - Verify continued need before processing - Address issues proactively Data Quality - Keep addresses current - Update delivery preferences - Maintain accurate day supplies - Note any special requirements Quick Reference TaskStepsView all subscriptionsSubscription Management → View listSee next fill dateCheck "Next Fill" columnCancel subscriptionSelect → Cancel → Choose reasonView canceledFilter by Canceled statusAssign to userSelect → Assign → Choose userAdd notesOpen subscription → Enter notes Next Steps To learn about comprehensive patient information, proceed to Article 12: Patient 360 - Patient File Management for details on viewing and managing complete patient records.

Troubleshooting & Rescheduling Orders

Article 10: Troubleshooting & Rescheduling Orders Overview When issues arise during the order fulfillment process, Phox provides robust troubleshooting workflows. This article covers how to send orders to troubleshooting, cancel deliveries, reschedule orders, and resolve common problems. Troubleshooting Queues Types of Troubleshooting Phox has dedicated troubleshooting queues for different issue types: QueuePurposeBilling TroubleshootingInsurance/payment issuesScheduling TroubleshootingDelivery timing problemsClinical TroubleshootingMedication/clinical concerns Accessing Troubleshooting Navigation: 1. Go to the relevant section (Billing, Scheduling, or Clinical) 2. Click on Troubleshooting 3. View all orders requiring attention Sending Orders to Troubleshooting From Any Stage You can send an order to troubleshooting from most stages: Steps: 1. Open the order 2. Click the Troubleshooting or Send to Troubleshooting option 3. Select the appropriate troubleshooting queue 4. Add notes explaining the issue 5. Confirm the action Example: Sending from Clinical to Scheduling Troubleshooting If a delivery needs to be rescheduled: 1. From Clinical Verification, click troubleshooting option 2. Select Scheduling Troubleshooting 3. System shows: "Delivery will be canceled" 4. Choose whether to notify the patient 5. Enter the reason (e.g., "Patient missed delivery") 6. Add notes (e.g., "Reschedule for February 1st") 7. Click Send to Troubleshooting Canceling Deliveries When to Cancel Cancel a delivery when: - Patient requests cancellation - Delivery cannot be made - Order needs significant changes - Rescheduling is required Cancellation Process Steps: 1. Send order to troubleshooting (triggers cancellation) 2. System prompts: "Delivery will be canceled" 3. Choose notification preference: - Send cancellation notification to patient - Do not send notification 4. Acknowledge the Descartes order will be canceled 5. Enter cancellation reason 6. Confirm cancellation Cancellation Reasons ReasonWhen to UsePatient RequestPatient asked to cancelMissed DeliveryUnable to complete deliveryAddress IssueDelivery address problemPayment IssuePayment not resolvedClinical HoldMedication issue identifiedOut of StockMedication unavailableInsurance IssueCoverage problem Rescheduling Orders From Troubleshooting Queue Steps: 1. Go to Scheduling Troubleshooting 2. Find the order to reschedule 3. Review the troubleshooting notes 4. Click Edit or access order options Rescheduling Options From the troubleshooting edit screen, you can: ActionDescriptionChange AddressUpdate delivery addressChange Order TypeSwitch between delivery/pickupChange Delivery TypeCourier, third party, in-houseReschedule DateSelect new delivery date Reschedule Process Steps: 1. Click Reschedule or date change option 2. Select the new delivery date 3. Choose a reason for rescheduling 4. Click Save or Confirm What Happens: - Order is removed from troubleshooting - New Descartes shipment is created - Order appears in the appropriate queue - Patient may receive new notification Rescheduling Reasons ReasonDescriptionPatient RequestedPatient asked for different dateMissed DeliveryPrevious attempt failedWeatherDelivery delayed due to weatherMedication AvailabilityProduct wasn't readyOperationalInternal scheduling conflict Viewing Troubleshooting Notes Note History When an order is in troubleshooting: 1. Open the order 2. View the note that was added when sent to troubleshooting 3. See any additional notes from the order or patient file 4. Review the full context before taking action Example Note: "Missed delivery, please reschedule to February 1st" Changing Delivery Details Change Address Steps: 1. From troubleshooting, click Change Address 2. Enter the new delivery address 3. Verify address is complete 4. Save changes Change Order Type Switch between: - Delivery - Courier brings to patient - Pickup - Patient comes to pharmacy Steps: 1. Click Change Order Type 2. Select new type 3. Confirm change Change Delivery Type Options include: - Courier - In-house drivers - Third Party - External delivery service - In-House - Internal handling Resolution Workflow Completing Troubleshooting Once an issue is resolved: 1. Make necessary changes (reschedule, update address, etc.) 2. Order automatically moves out of troubleshooting 3. Returns to appropriate workflow stage 4. Continues through normal process Troubleshooting Flow Issue Identified → Send to Troubleshooting → Review Notes → Take Action (Reschedule/Cancel/Update) → Order Returns to Workflow Team Coordination Why Different Queues? Different teams handle different issues: - Billing Team - Insurance and payment experts - Scheduling Team - Delivery coordination - Clinical Team - Pharmacists for medication issues Routing to the correct queue ensures the right people address each problem. Best Practices Sending to Troubleshooting - Always include detailed notes - Specify what action is needed - Provide relevant dates/information - Select the correct queue Resolving Issues - Review all notes before acting - Contact patient if clarification needed - Document resolution actions - Verify order returns to workflow Communication - Keep patients informed of changes - Use notification options appropriately - Follow up on complex issues Quick Reference ScenarioActionNeed to rescheduleSend to Scheduling TroubleshootingInsurance problemSend to Billing TroubleshootingMedication concernSend to Clinical TroubleshootingPatient requests cancelCancel with reasonAddress is wrongChange address from troubleshootingPatient wants pickupChange order type Next Steps For managing ongoing patient subscriptions, proceed to Article 11: Subscription Management to learn about viewing and managing recurring orders.

Payment Collection & Day Supply Verification

Article 3: Payment Collection & Day Supply Verification Overview After insurance adjudication, the next step is to collect payment from the patient and verify that the day supply matches the subscription frequency. This article covers the payment collection process and day supply verification. Payment Collection Accessing Payment Options After clicking Next from the billing queue, you'll see the payment collection screen with two options: 1. Payment Collected 2. Not Collected Option 1: Payment Collected Select this when the patient has already paid their portion. Steps: 1. Select Collected 2. Choose the payment method: - Credit Card - Debit Card - Cash - Other 3. Enter payment details if required 4. Proceed to the next step Option 2: Not Collected Select this when payment will be collected later (e.g., at delivery). Steps: 1. Select Not Collected 2. Add any relevant notes about payment arrangements 3. Proceed to the next step Example: A prescription costing $3,696 would show this amount on the payment screen. The staff can mark it as collected or not collected based on the patient's payment status. Day Supply Verification What is Day Supply? Day supply refers to the number of days a prescription will last based on the dosage instructions. Why Verify Day Supply? The system compares: - Kroll Day Supply: The day supply entered during billing - Subscription Frequency: The delivery frequency set up for the patient Day Supply Match (Green) When the day supply matches the subscription frequency: - The indicator shows green - No action required - Proceed to the next step Day Supply Mismatch (Red) When there's a discrepancy between day supply and subscription frequency: - The indicator shows red - A reason must be provided Common Reasons for Mismatch: ReasonDescriptionDrug/MedicationThe medication requires a different supply cyclePatient PreferencePatient requested a different delivery scheduleInsurance RequirementInsurance only covers specific day suppliesClinical ReasonMedical necessity for different supply Handling Day Supply Discrepancies Steps: 1. Review the mismatch notification 2. Select the appropriate reason from the dropdown 3. Add additional notes if needed 4. Proceed with the order Example: Kroll shows 1-day supply, but the patient is set up for monthly delivery. Select "Drug/Medication" or "Patient Preference" as the reason. Payment and Day Supply Screen Summary The screen displays: FieldDescriptionPatient NameThe patient receiving the prescriptionPrescriptionMedication name and detailsAmount DueTotal patient responsibility after insurancePayment StatusCollected / Not CollectedPayment MethodHow payment was received (if collected)Day SupplyNumber of days the prescription coversFrequency MatchGreen (match) or Red (mismatch) indicator Best Practices Payment Collection - Always verify the amount with the patient before marking as collected - Document payment method accurately for record-keeping - Note any payment arrangements for "Not Collected" orders Day Supply Verification - Always investigate red indicators before proceeding - Document the reason clearly for audit purposes - Consult with pharmacist if unsure about the discrepancy Quick Reference ScenarioActionPatient paidSelect "Collected" + payment methodPayment at deliverySelect "Not Collected"Day supply matchesProceed (green indicator)Day supply mismatchSelect reason + proceed (red indicator) Next Steps Once payment status is recorded and day supply is verified, proceed to Article 4: Delivery Scheduling & Text Notifications to set up the delivery details and patient communication.

Billing Queue & Insurance Adjudication

Article 2: Billing Queue & Insurance Adjudication Overview Before any prescription order can be fulfilled, it must be billed and adjudicated through the patient's insurance. This article explains the billing queue and the adjudication process using Kroll. Understanding the Billing Queue The Billing Queue contains all billing items that have been created through Phox Entry and are awaiting insurance adjudication. Accessing the Billing Queue 1. Navigate to the Billing section 2. View all pending billing items 3. Each item displays patient name, prescription details, and status The Adjudication Process What is Adjudication? Adjudication is the process of submitting a prescription claim to the patient's insurance company to determine: - Coverage eligibility - Patient copay amount - Insurance payment amount Steps to Complete Adjudication 1. Select a billing item from the queue 2. Open Kroll (the pharmacy management system) 3. Bill the prescription in Kroll 4. Wait for adjudication to complete 5. Return to Phox and proceed with the order System Message: "Please bill this prescription in Kroll before proceeding. Ensure that the adjudication is complete." Billing Item Status StatusMeaningPendingAwaiting adjudication in KrollAdjudicatedInsurance response received, ready to proceedRejectedInsurance claim denied, requires resolution Important Considerations Duplicate Order Prevention The system automatically checks for existing orders: - If an order already exists for the same prescription, you cannot create a duplicate - View the order history to check the status of previous orders - Completed (delivered) orders allow new orders to be created One Order Per Patient Rule Best practice is to maintain only one active order per patient at a time to: - Prevent confusion - Ensure accurate tracking - Maintain inventory accuracy Working with Kroll Key Integration Points 1. Billing Items created in Phox must be processed in Kroll 2. Adjudication results from Kroll determine the patient's cost 3. Day supply information syncs between systems Common Kroll Tasks - Submit insurance claims - Process prior authorizations - Handle rejected claims - Update patient insurance information Troubleshooting Claim Rejected If an insurance claim is rejected: 1. Review the rejection reason in Kroll 2. Contact insurance if needed 3. Resubmit with corrections 4. Update Phox once resolved Patient Not Found If the patient doesn't appear in the billing queue: 1. Verify the billing item was created 2. Check if the order was already processed 3. Review the patient's order history Quick Reference ActionSystemPurposeCreate Billing ItemPhoxInitiate order processBill PrescriptionKrollSubmit to insuranceAdjudicateInsuranceDetermine coverage/costProceed with OrderPhoxContinue to payment collection Next Steps Once adjudication is complete, proceed to Article 3: Payment Collection & Day Supply Verification to learn about collecting patient payments and verifying prescription details.