In this third installment of our series on the GPI Counter feature, we’re excited to introduce a way to automatically add GPI counters to patient profiles. Automatic tracking is made possible via the Automatically Add GPI Counter Processor Control Code (AUTOGPIC p-code). The AUTOGPIC p-code can be easily set on an authorization to track the number of fills for patients in a group, for an individual patient, and/or for specific drugs.

This article covers:

• Authorization contexts where the AUTOGPIC p-code can be applied.
• Which selectors are compatible with the AUTOGPIC p-code.
• Setting up automatic tracking for all fills (Group level).
• Setting up automatic tracking for a specific drug (Patient level).
• Where to view fill count totals.
• A use-case example.

  🛈 Learn more about p-codes on the Primary Concepts page.

Article Contents

About the AUTOGPIC P-Code

Contexts

The AUTOGPIC p-code can be set on authorizations at the Group or Patient level. The system automatically tracks the number of in-network fills for each group member with the AUTOGPIC p-code set on a Group authorization. If the AUTOGPIC p-code is set on a Patient authorization, the number of in-network fills will be automatically tracked for a specific patient.

No matter the context, there’s no need to manually add a GPI counter for each patient if automatic tracking is set up! Once the AUTOGPIC p-code is assigned and a claim is processed, a GPI counter will be automatically assigned to patient profiles.  

🛈 Even though automatic tracking can be set in a Group or Patient authorization, fill count totals are tracked according to patient at this time.

Compatible Selectors

The AUTOGPIC p-code can be used with the GPI Code field in the Drug Selection of the authorization form. At this time, the system can track by the 10-digit GPI code corresponding to the drug name.

⚠ AUTOGPIC can only be used with the GPI selector at this time. The system does not support the use of other selectors yet.

Step-by-Step

This section describes how to set up automatic tracking for all fills and a specific GPI, and how to view fill count totals for a patient.

Set Up Automatic Tracking for All Fills

Follow the steps below to create a Group or Patient authorization to automatically track fill counts for all medications.

From the authorization form:

1. Enter a seven-digit authorization number (A/N) in the 01000-000 to 09999-999 range. Do not include dashes when entering A/Ns in the Authorization System interface.
2. Under the Processing Time section, click the radio button next to the p-code dropdown menu.
3. Click the down arrow to display the p-code dropdown menu options. Select AUTOGPIC-Automatically Add GPI Count.
4. Scroll to the bottom of the page, and click the Add Authorization button.

You have added an authorization to track counts for all fills. A table containing authorization details will display on the screen.

Set Up Automatic Tracking for a Specific GPI

Follow the steps below to create a Group or Patient authorization to automatically track the number of fills for a specific GPI.

From the authorization form:

1. Enter a seven-digit authorization number (A/N) in the 01000-000 to 09999-999 range. Do not include dashes when entering A/Ns in the Authorization System interface.
2. Under the Processing Time section, click the radio button next to the p-code dropdown menu.
3. Click the down arrow to display the p-code dropdown menu options. Select AUTOGPIC-Automatically Add GPI Count.
4. Go to the Selection section and enter the 10-digit GPI code for the drug you want to track in the Drug GPI Code field.
5. Scroll to the bottom of the page and click the Add Authorization button.

An authorization to track all fills for a specific GPI has been added. A table with authorization details will display on the screen.

View Fill Count Totals

After an authorization with the AUTOGPIC p-code is added at the Group or Patient level, a GPI counter will be assigned to each patient’s profile automatically. The system will start tracking fill counts once the first claim is processed.  

To view fill count totals for a patient:

1. Go to the patient’s profile.
2. Click on GPI Counts in the left side menu. 
3. A table will appear on the screen under the Add GPI Counter interface. 
4. The fill totals will be listed under the Fill Counts heading in the table.

The In Network fill counts will populate in a GPI Count table on patient profiles automatically. Out-of-Network totals are not tracked automatically, but you can enter these values whenever needed. All changes are tracked in the history record.

🛈 Fill limits can be managed using Fill Total ‘Up To’ and ‘Over’ selector fields.  Learn more in the article Setting Fill Limits with Authorizations.

Use Case Example

If you want to keep track of how many times a particular drug has been filled for all patients in a group, setting up a GPI counter for each patient would be an enormous task. Instead, you could:

• Add a Group-level authorization.
• Assign a 7-digit A/N.
• Set the AUTOGPIC p-code on the authorization.
• Enter the 10-digit GPI code for the drug you want to track.

This table shows an example of authorization details:

Key: A/N = Authorization Number, P-code = Processor Control Code

There’s no need for any other selections or a rejection code. The authorization simply enables tracking for the GPI specified. With the Group authorization above in place, a GPI counter will automatically be added to patient profiles. The system will begin tracking once the first claim for the specified GPI is processed. 

Here you can see fill counts for a fictional patient: 

The In Network fill counts will populate on the patient’s profile automatically. Out-of-Network totals are not tracked automatically, but you can Edit these values when needed. The start date is the date of the first fill for the GPI specified.

Summary

With the GPI Count feature, you have the flexibility to track fills automatically or manually. Choosing between manual and automatic tracking methods depends on your need. For smaller patient groups or less frequent fills, manual tracking may be a suitable option. For larger patient groups with high fill volumes, automatic tracking using the AUTOGPIC p-code can save time and effort. Evaluate your specific needs and consider the advantages and limitations of each approach before deciding which solution is right for you.

Contact Support

Our team is here to help!

For plan-specific or urgent needs, contact your account manager directly.

For general Authorization System questions, contact EHO360 Operations at ops@ehorx.com