Pharmacy Point of Sale Replacement Project

The Health Care Authority (HCA) is beginning its journey of modularizing its Medicaid Management Information System (MMIS) with the replacement of the first module - the Pharmacy Point of Sale (POS) system. The Pharmacy POS Replacement Project will replace our current system with a new POS solution that offers the latest functionality, features, and technologies to better meet the needs of Washington’s 2.2 million Apple Health (Medicaid) recipients.

Project overview

The current Pharmacy Point of Sale (POS) system encompasses the automated functions necessary to receive and adjudicate all pharmacy Fee-for-Service (FFS) claims, managed care organization encounters and process drug rebate invoicing. The future solution will build on these features and include a cloud- hosted architecture that is flexible and scalable to meet future Washington State business needs and federal requirements.

Additional features include a secure web portal for drug labelers to retrieve quarterly invoices and claim level detail, more robust prior authorization workflow processes for state staff and rules-engine driven functionality to assist with easy Washington program updates. 

Project status

We are testing of the new system to offer improved functionality, features, and technologies to better meet the needs of Apple Health (Medicaid) clients.

The current projected go-live date is no sooner than February 2024.

More specific details will be shared as we continue to test and validate these new projections.

For managed care organizations

Changes are coming to the companion guide for encounter submissions. Review the draft encounter companion guide and frequently asked questions to prepare for the changes.

We will be involving managed care organizations (MCO) with user acceptance testing later in 2023. Details on how to participate will be shared from our managed care distribution list.

As a result of integrating the preferred drug list (PDL) into the new system, some necessary drug status and class changes were identified. HCA will ensure all changes to the PDL will be provided to the MCOs in the updated file layout 90 days before required implementation by the MCOs.

Submit questions to HCA managed care programs.

For providers and pharmacies

There will be minor changes for pharmacies, including the BIN/PCN and Group they bill for Apple Health FFS pharmacy claims. Those new numbers will be provided as we get closer to go-live. We will be encouraging pharmacies to get all their reversals submitted before the go-live to streamline these changes.

Updates and detailed information will be shared through the pharmacy email list.

For drug manufacturers

Drug rebate invoices will be changing from mailed-in paper to an online application called RebateWeb where you will be able to access your invoice with claim-level detail.

Stay informed

Pharmacy Point of Sale Replacement Project: frequently asked questions

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