If it is decided that the desired problems are fulfilled, next, check the managing standing / stock status of prescription drugs versus many coverage pharmacies near the deal with in the medical establishment / insurance provider, and acquire the outcome. Also supply to clinical institutions. On the flip side, if it is determined that the required ailments usually are not satisfied, the prescription advice matter derived based upon the insured particular person's information presented from the health care institution inside of a range that matches the desired conditions from the evaluation payer and also the insurance company Distribute a summary of medicines to clinical institutions and motivate them to reselect.
During the pharmaceutical prescription information inquiry / distribution process In accordance with claim 1, if the results of perseverance is that the inquiry written content does not conform towards the input information and designated situations of your examination and payment institution along with the insurer, lookup and detect the pharmaceutical group that satisfies these Pharmaceutical prescription information inquiry / distribution program characterized by distribution to health-related institutions.
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最後に、一連の照会履歴を審査支払機関及び保険者に配信し、情報照会・判定の手順を終了する。
【解決手段】保険医療機関が処方する医薬品について、代替品情報、保険者の処方希望優先順位情報を入力・保持する手段、審査支払機関によるレセプト審査承認のための条件・基準を入力・保持する手段、医療機関から診療行為毎に、処方医薬品の保険適用可否に関する照会を受付け、被保険者の症状等の個人情報に基づき、照会内容が保険者・審査支払機関の指定条件に合致しているか否かを判定する手段、上記照会内容が指定条件に合致していない場合は、保険者が指定する医薬品の中から、症状等の被保険者の情報に基づき指定条件を満たす他の医薬品を検索し代替品として医療機関に通知、医療機関にて処方内容の再選択を促す手段を有するシステム。
システムの運用段階では、以下の処理をリアルタイムで実施する。すなわち、個々の診療行為に際して保健医療機関からの処方医薬品の保険適用の可否の問い合わせが通信回線を介して行われ、この問い合わせを前述の審査支払機関及び保険者の入力情報や指定条件に照らし合わせて、審査支払機関及び保険者が保険適用を却下しないか否かを判定し結果を医療機関に配信し、図６に示されるような入出力画面によって医療機関の端末に表示される。尚、判定の結果、問い合わせ内容が審査支払機関及び保険者の入力情報や指定条件に適合しない場合には、これらを満たす医薬品群を検索・同定し、医療機関に配信する。併せて、指定条件を満たした医薬品については、医療機関や被保険者の住所の近くに存在する保険薬局数軒での当該医薬品の取扱情報・在庫情報を保険薬局のデータベースにアクセスし確認を行う。また、保険薬局が、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照会を行う場合には、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。
Hereinafter, a flowchart of the example of an information inquiry / willpower course of action will probably be described with reference to FIG. Initially, the required information is received with the evaluation payer / insurance company / insurance plan medical establishment / insurance pharmacy. The information and designated ailments for being attained within the assessment payer plus the insurance company are as described over.
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And when you receive an inquiry about clinical prescriptions from the professional medical establishment for each individual healthcare apply, insured individual information (health-related insurance policies linked information, information on sickness / indications, etc.
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In essential phrases, the prescription is a little bit of paper which is composed in the registered health treatment practitioner (RMP) dependant on the client's ailment challenge.
The prescription information inquiry / distribution technique In accordance with assert 1, accepting inquiries from insurance coverage pharmacies for coverage coverage of prescribed drugs described in prescriptions issued by medical institutions, and presence of inquiry historical past with prescription issuing clinical establishments Pharmaceutical prescription information inquiry and distribution technique characterised by distributing final results.
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