Descriptive & Procedural Manual for Pharmacies

Transcription

1 Descriptive & Procedural Manual for Pharmacies Access and use of i*care For any assistance please contact us on:

2 Contents 1) Initial access to the system a) Typing into explorer: b) Entering Username and password to access the system c) Using magnetic card reader to swipe card or manually pressing enter and accessing the info of the insured from the card ) Processing the claim a) Enter barcode sequence on claim form (either by barcode reader or manually)... 7 b) Enter Prescribing doctor c) Enter date d) Enter diagnosis (ICD10) e) Medicine selection: ) Claim entry and recording a) Submission for approved drug b) Submission for rejected drug c) Submission for drug pending decision ) Rules and alerts ) Claim Submission as per contract (Important, this is not to be done except after approval from the pharmacy management) a) Undelivered bills screen b) Selection of billing month and sorting criteria c) Submission

3 1) Initial access to the system. a) Typing into explorer: b) Entering Username and password to access the system. 3

4 c) Using magnetic card reader to swipe card or manually pressing enter and accessing the info of the insured from the card. 4

5 2) Processing the claim. The claim form will be presented by the insured and from this form the following will be chosen: Bar code sequence or serial number. Diagnosis chosen (ICD10 code or description). Date of prescription. Name of prescribing doctor. Medicines prescribed. It is very important that the correct data is extracted from this form as this will allow all the system rules and medical expert systems to work properly and allow you to confidently submit the claim. On the next page is an example of a claim form 5

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7 a) Enter barcode sequence on claim form (either by barcode reader or manually). If the doctor visit claim is already on the system the data of the doctor visit claim will be automatically saved including diagnosis and doctor name and date, if not we will do the following: 7

8 b) Enter Prescribing doctor. Chose from the doctors list according to the prescription c) Enter date. Chose date from calendar 8

9 d) Enter diagnosis (ICD10). Add the diagnosis code from the claim form or add the diagnosis by typing the beginning and choosing from the drop down menu. e) Medicine selection: Scan each medicine by the barcode scanner and after each medicine we will add the posology: 9

10 If the medicine is not found by the bar code scanner we need to search for the medicine name manually and choose from the drop down menu: f) Posology: (dosage). We will add the number of units per intake and then number of times per day and number of days as indicated by the doctor in the prescription, this is to be done after every medicine entry and press add drug. 10

11 3) Claim entry and recording. a) Submission for approved drug. Once the required medicine is dispensed we will submit the transaction by clicking the request authorization button and if the drug is approved the following screen will appear. b) Submission for rejected drug. If any of the drugs is rejected we will receive the following message. 11

12 c) Submission for drug pending decision. If any drug is waiting for a decision the following screen will appear and we will wait for feedback. While waiting for feedback, if another client requests service we can go back to the PBM screen by clicking PBM button on the left of the screen. 12

13 After each client we will need to go back to the home screen to check for updates on our submitted approval for the medicine, this is done by clicking on the Home button at the top left corner of the screen to get the following screen which will show one new approval if the decision has been submitted (on the right side of the screen we will find You have 1 new approval ). Once the feedback is received we will click on the new approval and find the below screen. 13

14 4) Rules and alerts. The following rules may appear due to rules and expert systems and the following table shows the different rules and their meanings: Age Incompatibility, medicine not suitable for the age of the patient. Lactation, please make sure that the patient is not lactating and if she is please make sure that the drug is safe. Dialysis alert, please make sure that the patient is not under treatment for renal failure (dialysis) and if he/she is, please make sure that the drug is safe. Duplication of active ingredient of medicine. Renal insufficiency, please check the renal status of the patient. Pregnancy alert, please make sure that the patient is not pregnant and if she is please make sure the drug is safe. Tobacco alert, please make sure that the patient does not smoke and if he/she does, please make sure that the drug is safe. 14

15 5) Claim Submission as per contract (Important, this is not to be done except after approval from the pharmacy management). Please note that this section is to be done after confirmation with pharmacy management and is done according to set rules and at specific times mentioned in the contract. Do not access the below screens unless you are authorized form the pharmacy management. a) Undelivered bills screen. The user is to access the below screen for bills submission (delivery) as per the specified time mentioned in the contract. 15

16 b) Selection of billing month and sorting criteria. The user selects dates (from to) that are to be submitted to GlobeMed and processed for payments accordingly 16

17 c) Submission Once bills count and amount have been verified, deliver all button is clicked to create a lot number and bills are sent to GlobeMed for processing. 17