NMS Questions and Answers

1. Does using the NMS change where I should record the identification of an individual picking up a narcotic or controlled prescription?
   • No. There are no changes to the processes and regulations that became effective in November 2011 for acquiring and recording the identification of a patient/agent picking up a narcotic or controlled prescription. The purpose of the NMS is to identify the patient to whom the medication has been prescribed and perform DUR checking against that patient’s history of narcotic and controlled medications.

2. The prescriber uses our pharmacy for both personal and office use prescriptions. How should these prescriptions be differentiated?
   • In such as case, two profiles will need to be created in PharmaClik Rx. One profile for the prescriber’s office use prescriptions following the instructions provided in Q4 above. The second profile must be created for the prescriber’s personal use prescriptions in the same way as any other retail patient, using any of the approved identity cards.

3. Can I submit claims to NMS using the prescriber ID 99 (‘Other’) and the prescriber license number 99999?
   • No. NMS will reject the transaction. A valid license number must be used, as well as its corresponding Prescriber Type.
   • The following Prescriber Types are valid:
     • 01 – College of Physicians and Surgeons of Ontario
     • 02 – Royal College of Dental Surgeons of Ontario
     • 03 – Board of Regents, Chiropody
     • 05 – Carrier Designated out of Province
     • 08 – Ontario College of Midwives
     • 09 – Ontario College of Pharmacists
     • 43 – College of Optometrists of Ontario
     • 44 – College of Nurses of Ontario
4. How do I submit a claim for a patient that is from outside of the country, but has a prescription written by a Canadian doctor?
   • An out of country patient has a standard identity code and identity #. The steps below provide the quickest method of entering the NMS information for the patient. You may wish to record the patient’s identification in the Patient Folder > Notes tab for reference purposes.
     1. Open the Patient’s Folder.
     2. Select the 3rd Party tab.
     3. Select ONG – Out of Country Residents with Approved Identification from the Identity Code dropdown list. The PHN/Identity # is automatically set based on your selection.
     4. Select the OK or Save button.

5. What happens if a claim is submitted to NMS for a drug that is no on the monitored drugs list?
   • NMS will reject the transaction with the response code ‘56 – DIN/GP#/PIN Error’. The NMS flag must be removed from the prescription by following these steps:
     1. Take the necessary to steps to have the NMS flag removed from Drug or Mixture.
     2. Choose to amend the prescription.
     3. Rx Detail opens. Select the Extended tab.
     4. Deselect the NMS checkbox. This removes the NMS claim from the Third Party tab.
     5. Select the Save button.

6. Should Methadone prescriptions be submitted to NMS?
   • Yes. Methadone and all carries must be submitted to NMS using the standard ODB pseudoDIN for Methadone: 9850619.

7. Are there any situations where a narcotic or controlled prescription would not be sent to NMS?
   • Yes. There are four exceptions:
     • The DIN is not included on the Monitored Drugs List
     • The patient’s status is ‘Hospitalized’
     • The patient is in a correctional facility (the patient must be a group, where the group type is ‘Correctional Facility’)
     • The prescriber is a Veterinarian.

8. Will NMS reject a transaction if the birth date is wrong, and I’m not using the Ontario Health Card as the identification?
   • No. NMS will not reject the transaction due to an invalid birth date when other forms of identification are used.

9. Will NMS reject a transaction if the health card version code is missing?

   • No. The NMS transaction will not be rejected, however it is best practice to include the version code, if one exists, in the PHN/Identity # field as part of the Health Card number. If you are also entering the Health Card number in the PHN field in the main tab of the Patient Folder, the version code is mandatory if one exists.

10. What should I do if NMS is offline?

    • The NMS does not adjudicate financially, nor does it prevent you from dispensing the prescription. You may fill and bill the prescription today, and send it to NMS at a later date. You do not need to rebill or refuse the prescription in the event that the NMS is offline. The prescription can be submitted to the NMS anytime within 365 days of the fill date.

    • Refer to the Failed & Rejected NMS Transactions topic to learn how to submit a prescription to NMS after the original fill date.

11. What is the process to bypass the NMS missing information prompting in Rx Detail if you don’t have the mandatory pieces of information, but still want to fill the prescription?
    • In order to bypass the prompting for the birth date, NMS identity code and PHN/identity #, select the OK button in the Narcotics Monitoring System prompt without filling in the missing information. This will submit the prescription for financial adjudication and the NMS transaction will be rejected. Select Skip TP in the NM claim to defer the NMS transaction to a later time.
    • The prescription will be stored on the Workbench Completed tab with an N indicator, as described in the Failed & Rejected NMS Transactions section of the this document. Once you have the mandatory pieces of information, update the Patient’s Folder and resubmit the rejected prescription.

12. I filled a new NMS prescription for the wrong patient and sued the Wrong Patient function to remove it from the patient’s profile, but it wasn’t removed. Why?
    • When the Wrong Patient function is used on an NMS prescription and the prescription was successfully submitted to the NMS, the prescription will be placed on Hold and discontinued for the patient, but it cannot be removed from the profile due to audit purposes.
    • Since the prescription was submitted to the NMS, the government has a record of the narcotic or controlled medication being filled for the patient and then reversed. You may wish to add a note to the prescription, documenting that it was filled for the wrong patient.

13. I filled a new NMS prescription that I wanted to cancel and remove from the patient’s profile, but I don’t have the option to remove from the Profile. Why?
    • Since the prescription was successfully submitted to NMS, it cannot be removed from the profile due to audit purposes; the government has a record of the narcotic or controlled medication being filled for the patient and then reversed. In this case, refusing the prescription places it on Hold in the Profile, but it remains active. If you do not want the prescription to be dispensed for the patient, it will have to be discontinued.

14. Why isn’t NM in the prescription’s bill code?
    • NMS does adjudicate financially. Therefore, when a prescription is flagged as NMS, ‘NM’ will not be included in the prescription’s bill code. The NMS flag in the Rx Detail Extended tab identifies if a prescription will be submitted to the NMS. When this flag is ON, the NM claim will be added as the claim in the Rx Detail Third Party tab, after Cash.

15. My store fills prescriptions when we do store-to-store transfers of drugs. Do these prescriptions need to be transmitted to the NMS?
    • No, store-to-store transfers do not need to be submitted to the NMS. In order to bypass the NMS, the Patient Folder that you have set up for the other store should have the patient status set to ‘Hospitalized’.
      1. Search for and the Patient Folder that has been created for the other store.
      2. In the main tab of the Patient Folder, select Hospitalized from the Status dropdown list.
      3. Select the OK or Save button.

16. Should OTC narcotics and controlled substances be submitted to the NMS?
    • When an OTC drug is on the Monitored Drug List (e.g. Tylenol #1), a submission to NMS is only required if the drug is prescribed and dispensed. It is not necessary to submit to the NMS if the patient is purchasing the medication over-the-counter without a prescription; in this case your store should add the drug as a DUR on the patient's profile, as per best practices.

17. How can I tell if the NMS claim was successful?
    • The NM claim in the Rx Detail Third Party tab indicates whether or not the claim has been adjudicated successfully. As with all third party adjudication, the claim status indicates if the submission is Complete, Rejected, Failed, Reversal Rejected, Reversal Failed or Cancelled.
    • To access the NMS claim information:
      1. Open the prescription in Rx Detail.
      2. Select the Third Party tab.
      3. Select the Next button until you come to the last claim, which will be the NM claim.

      Note: If the prescription is an outstanding NMS transaction that you opened from the Workbench Completed tab, the NM claim appears automatically when Rx Detail opens. Prescriptions with outstanding NMS transactions are identified by a red N on the Completed tab.

18. What is the difference between a rejected NMS claim and one that has been completed?
    • Check the status of the NM claim in the Rx Detail Third Party tab (refer to Q4 above for instructions on how to access the NMS claim information). This is an example of a Complete claim that does not require any further action. Since the claim status is Complete, the transaction was successfully submitted to NMS. It is possible for NMS to return response messages on Complete transactions; these responses are for informational purposes only.
    • This is an example of Rejected claim. Corrective action is required on Rejected transactions, based on the response messages returned. Unsuccessful NMS transactions are also identified by a red N in the Workbench Completed tab.

19. Is it possible for NMS to accept a transaction even if the birth date is incorrect?

    • Yes. It is possible for NMS to accept a transaction, even though a Date of Birth Error or other type of response message is returned. Refer to Q4 and Q5 above to determine if the transaction has been successful.

20. Should I rebill successful NMS claims that have been returned with a Date of Birth Error, or a similar response message?
    • No. As long as the NMS claim status is Complete, the transaction SHOULD NOT be rebilled; the transaction has been successfully submitted to NMS. You may wish to obtain accurate information from the patient, so the Patient folder can be updated for future submissions.