) offered from the medical institution at time of inquiry and information obtained beforehand And in genuine-time if the required disorders with the insurance company to whom the insured is affiliated and also the assessment and payment organization in cost are happy.
While in the pharmaceutical prescription information inquiry / distribution system As outlined by assert one, if the result of determination is that the inquiry articles would not conform towards the input information and selected circumstances in the evaluation and payment institution along with the insurance company, lookup and discover the pharmaceutical group that satisfies these Pharmaceutical prescription information inquiry / distribution technique characterized by distribution to healthcare institutions.
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plus the information in (one) and (two) over, whether the inquiry articles meets the desired problems of the insurance company / evaluation / payment in real time (4) If the above mentioned inquiries usually do not match the specified disorders, seek out other drugs that meet up with the required conditions depending on the insured's information for instance indications from the drugs specified because of the insurance provider. Notify medical establishments as a substitute, Prompting reselection prescription at engine operating such process, rapidly and efficiently, the selection of formulation medicament, for the opportunity of coverage coverage, achieve consensus between the get-togethers.
During the program Procedure phase, the subsequent processing is performed in serious time. Quite simply, inquiries regarding the availability of insurance coverage for prescription drugs from health treatment establishments are created by way of conversation traces through each health-related exercise, and these inquiries are when compared with the enter information and specified conditions from the evaluation and payment institutions and insurers described earlier mentioned. Then, the evaluation paying out institution as well as insurance provider ascertain whether to reject the insurance policy application, distribute The end result towards the healthcare establishment, and Show it on the terminal of your clinical institution by an enter / output screen as demonstrated in FIG. As a result of the perseverance, In the event the written content with the inquiry isn't going to conform for the enter information and designated ailments on the assessment and payment institution and also the insurance provider, a pharmaceutical group gratifying these is searched and recognized and dispersed to your health-related institution.
Although the execution in the usually means from the present invention is executed by way of an information process, this execution is about divided into two levels: a procedure preparing phase and an operation stage.
従って、本発明の課題は、わが国の医療保険制度の中で、医療サービス受給の公平性を維持しつつ、被保険者・保険者もしくは審査支払機関が、代替品の中から最も強く処方を希望する医薬品を、医療機関・保険薬局が、他の代替品の中から優先的に採用する機会を提供することを可能にさせる、医療用医薬品処方情報照会・配信システムを提供することにある。
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【選択図】図３[Complications] To deliver a procedure for giving a chance for just a clinical institution / coverage pharmacy to preferentially adopt a medication that an insured / insurance company or examination / payment establishment hopes to prescribe from the health-related insurance policies procedure. Presented. [MEANS FOR Fixing Troubles] Moving into / Keeping information on alternatives, prescription priority order information of the insurance company, and problems / requirements for approval of the receipt assessment by an assessment / payment establishment for just a medicine prescribed by an insurance policies professional medical establishment Inquiries about regardless of whether insurance plan for prescription drugs is accessible for Each individual professional medical practice with the suggests and clinical institution, and whether or not the inquiries match the specified circumstances from the insurer / assessment and payment Firm according to private information including signs from the insured Indicates to ascertain if the above inquiry information does not match the required ailments, hunt for other drugs that fulfill the desired disorders from your drugs specified by the insurance company dependant on the insured's information which include signs and symptoms A method having signifies for notifying a medical institution in its place and prompting the health care institution to reselect prescription contents. [Range] Figure 3 Description
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In addition, the evaluation and payment institution and the insurance provider will specify the medicines that they would like to preferentially prescribe. The designation technique is as follows: (one) Specify the name of a particular team of drugs for each injuries and symptom classified Based on various disorders like the insured's age, gender, Structure and healthcare record. Or use (2) the upper Restrict from the professional medical remuneration score / made use of drug insurance policies rating and permit the prescription from the drug given that the upper limit will not be exceeded. These enter information and specified conditions are stored as information while in the information system.
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、判定の結果、照会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ことを特徴とする医薬品処方情報照会・配信システム。
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・ It's not necessarily intended to expand the choices for pharmaceuticals of insurers and minimize the cost of prescribed drugs. Moreover, PBM in The us gives drug Charge management services for firms which include firms as the most crucial customers and won't address all citizens. is not really.