How to work an underwater fill and acknowledge it

Executive summary. Open a margin flag, read the economics that produced it and the rule that raised it, and record that somebody has seen it.

Definition

A margin flag is a dispensed fill whose reimbursement did not cover what the pharmacy paid, raised by a rule you can read.

What to do

Open Margin, then Flags. Each row is one fill that a rule has raised for attention.

Open a flag. The detail names its economics: what was reimbursed, what the medication cost, and the difference between them.

Read the rule named on the flag. It tells you why this fill was raised rather than leaving you to guess from the numbers.

Acknowledge the flag when you have seen it. Acknowledging records that a person looked, and it is not the same as fixing the underlying contract question.

Where this legitimately goes different ways

A flag may be correct and still not worth pursuing: a single fill a few cents underwater is a real result and a poor use of an afternoon. Acknowledging it is the honest close.

A flag that repeats across many fills of the same medication or the same payer is a contract question rather than a dispensing question, and belongs with whoever owns that payer relationship.

The whole list can be filtered to underwater fills alone, which is the view most teams work from daily.

Frequently asked questions

Does acknowledging a flag change what was paid?

No. It records that somebody reviewed it. Recovering money is a separate piece of work, and the flag stays readable afterwards so the review and the recovery do not get confused with each other.