) introduced from the healthcare establishment at time of inquiry and information obtained in advance And in serious-time whether or not the specified disorders of your insurance company to whom the insured is affiliated as well as examination and payment Firm in cost are content.
Initial, in FIG. one, the events connected to the information process of the current invention will likely be clarified. This information process features a medical institution that prescribes pharmaceuticals to your insured, an insurance pharmacy that dispenses prescription drugs determined by a prescription issued via the health-related institution and delivers them into the insured, an insurance provider that bears health care insurance prices, and An evaluation / payment institution that examines clinical cost details from healthcare establishments / insurance policies pharmacies is connected. Every bash gives the information program with a number of important information to get explained afterwards.Inside the information system, (one) information on alternatives and prescriptions with the insurer for drugs prescribed via the insurance health care institution with the insured Enter / maintain ideal precedence information, (2) Enter / hold ailments / requirements for approval of receipt critique by critique / payment organization, (three) Inquire about availability of insurance policy for prescription drugs from health care institutions for every professional medical practice Based on personal information like acceptance, insured's symptom, healthcare history, age, etcetera.
次に、図２を用いて本発明の手段が実行されるフローを時系列で説明する。本発明の手段の実行は情報システムを通じて行われるが、この実行は大別して、システムの準備段階及び運用段階の二段階に分けられる。
Hereinafter, a flowchart of the illustration of an information inquiry / determination process are going to be described with reference to FIG. First, the required information is obtained through the evaluation payer / insurance provider / insurance plan health care establishment / insurance policies pharmacy. The information and designated conditions to get acquired in the evaluation payer plus the insurance company are as described above.
以下に、図４を用いて情報照会・判定の手順の一例のフローチャートを説明する。まず審査支払機関・保険者・保険医療機関・保険薬局から必要な情報を取得する。審査支払機関及び保険者から取得する情報・指定条件は前述の通りであり、医療機関・保険薬局からは所在地等の基本情報に加え、使用希望薬剤情報・医薬品取扱情報・同在庫情報等を取得し、取得したデータを格納する。
請求項１に記載の医薬品処方情報照会・配信システムにおいて、医療機関が発行した処方箋に記されている医薬品の保険適用につき、保険薬局からの照会を受付け、処方箋発行医療機関との照会履歴の有無、結果について配信することを特徴とする医薬品処方情報照会・配信システム。
医療機関からの照会後、処方医薬品を確定した段階で医療機関から最終の処方内容が情報システムに送信される。保険薬局から処方箋記載の医薬品の保険適用の可否について照会があった場合には、医療機関との照会履歴の有無、結果を配信する。
The prescription information inquiry / distribution technique As outlined by declare one, accepting inquiries from insurance policy pharmacies for insurance protection of pharmaceuticals explained in prescriptions issued by health-related establishments, and existence of inquiry historical past with prescription issuing healthcare establishments Pharmaceutical prescription information inquiry and distribution method characterized by distributing success.
【選択図】図３[Challenges] To supply read more a technique for furnishing a possibility for just a healthcare institution / insurance policies pharmacy to preferentially adopt a medicine that an insured / insurer or examination / payment institution wishes to prescribe inside the health-related insurance policy method. Offered. [Implies FOR SOLVING Difficulties] Entering / holding information on alternate options, prescription precedence order information of an insurance provider, and ailments / benchmarks for approval of the receipt examination by an assessment / payment institution for your medicine prescribed by an insurance policy clinical establishment Inquiries with regards to regardless of whether coverage for prescription drugs is readily available for Just about every health care observe in the means and health care institution, and if the inquiries match the required situations from the insurance company / assessment and payment Firm based on personalized information such as indicators on the insured Means to determine whether or not the above inquiry information doesn't match the desired ailments, search for other drugs that satisfy the desired problems with the drugs specified via the insurance provider based on the insured's information such as signs A technique getting implies for notifying a health care institution as an alternative and prompting the healthcare establishment to reselect prescription contents. [Selection] Figure 3 Description
At this time, an information method that replaces the creation and software of the above-pointed out receipt with an electronic method from a standard written approach has already been place into realistic use. Then again, in America, Pharmacy Advantage Administration (“PBM”) is a company that manages dispensing costs for policyholders.
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