The e-commerce division of listed IT group, USKO, has successfully implemented its MediSwitch electronic transaction system at Mediscor PBM, a pharmacy benefit management company, to facilitate on-line processing of claims for 1860 pharmacists nationwide.
Pharmacists currently lose an estimated R250-Million every year as a result of rejection of medical claims by medical schemes. "MediSwitch acts as a `carrier` for all on-line communication between Mediscor and pharmacists," says Jack Perel, operations director at Mediscor. "MediSwitch enables us to provide a quality service for our clients with an up-time of 100%. It also shortens the on-line claims and validation process to 18 seconds."
MediSwitch is a leader in electronic connectivity within the health care industry and is the only on-line claims switching facility that is linked to pharmacies, medical schemes and doctors.
"Using MediSwitch eliminates the menial, time-consuming tasks of traditional batch claiming," says Perel. It provides the pharmacist with a number of exclusive benefits such as a simplified claiming procedure that affords the pharmacist the luxury of absolutely no risk and guaranteed payment. This in turn improves cash flow and simplifies administration by creating a paper-free environment," says Perel.
Perel goes on to say that after the customer`s details have been submitted to the PBM in real-time, the system will verify medical scheme membership, validate the claim and process the prescription within 18 seconds. A payment or rejection response is then sent immediately. According to Perel, the rejection rate can sometimes be as high as 12%, and this system eliminates all financial risks previously posed to the pharmacist.
Another advantage of MediSwitch is that Mediscor is able to monitor drug treatments on-line thereby eliminating `drug misadventures`. Mediscor carries information supplied by the patient`s medical aid scheme in regard to direct or pre-existing diagnosed conditions. Perel says that the traditional methods of prescribing and dispensing medication do not ensure the safety of drug therapy.
In addition to drug monitoring, Mediscor enables pharmacists to do a range of other checks such as drug to drug interaction, dosage range checking and drug to allergy checking. This entitles members of contracted medical schemes to a variety of benefits such as improved pharmaceutical care with the continual monitoring of the clinical effects of drug therapy.
Wendy Strauss, marketing director of USKO`s e-commerce division, says MediSwitch has partnered major medical practice management software vendors to integrate the MediSwitch communication interface into their software packages. "As a consequence, vendors have been able to update their clients with the latest MediSwitch enabled version of their practice management and dispensing software systems. Once the service provider accesses his or her accounting or dispensing programme, there is an automatic live dial-up through MediSwitch into the Mediscor system for contracted schemes using PBM."
Strauss goes on to say that the Mediscor`s system adjudicates the processed transaction on-line and the confirmed amount is transferred electronically directly into the service provider`s bank account within fourteen to thirty days.
"No additional devices are needed and pharmacists can retain their existing systems," she adds. "Another advantage is that the service providers or medical schemes simply pay when using the MediSwitch system, as it is offered on a pay-for-use basis and there are no registration or monthly maintenance costs."
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