JAT 2 PHARMACIST CKS Training
CONTENTS 1. RESPONSIBILITIES... 3 2. THEORY, TERMS AND DEFINITIONS... 3 3. PROCESSES... 4 3.1 Maintain... 4 3.1.1 Pay Office Information... 4 3.1.2 Medical Aid Information... 5 3.1.3 Supplier Prices... 9 3.1.4 Translation Files...12 3.2 Process... 15 3.2.1 View Script Details...15 3.3 Batch Claiming... 19 3.3.1 Introduction to Batch Claims...19 3.3.2 Clearing Claimed Resubmissions...20 3.3.3 Run claim and create electronic file...20 3.3.5 Receiving the reply...26 3.3.6 Delete a selected resubmission...27 3.4 Reporting... 28 3.4.1 Script Statistics...28 3.4.2 Schedule Register...29 3.4.3 Outstanding Repeats Report...29 3.4.4 Healthnet & DHS / IPH / ZIETO Scripts Authorized...30 3.4.5 Script Discrepancies...31 3.4.6 Script Checklist...32 3.4.7 Drug Usage Report...32 3.4.8 Drugs to follow...33 3.4.9 Schedule Register...33 3.4.10 Script Book...34 3.4.11 Script Tracking File...34 3.4.12 Script Levies Reconciliation...35 3.4.13 Pharmacy Audit Trail...36 3.4.14 Medical Aid Control Account Reconciliation...37 3.4.15 Pharmacist Statistics...37 3.4.16 Doctor Statistics...38 3.4.17 Doctor Average Statistics...38 3.4.18 Script Statistics per hour...39 3.5 UTILITIES... 39 3.5.1 Merge Profiles...39 3.5.2 Change Dependant number...39 CKS Training 2
1. RESPONSIBILITIES Reconciliation of Scripts submitted via Realtime. Explaining rejections received via Realtime to your client. Understanding of reports. 2. THEORY, TERMS AND DEFINITIONS a. Under Construction When a script has not been finished and you lose connection to the system through a power failure or accidental closure of the terminal or screen. The script will be stored in the system but will not be viewable unless you correct the script by holding the <Shift> key & while holding it press the <~> tilda key. b. Pay Office Information Each Medical aid code is linked to a Pay Office code. The Pay Office could either be the Administrator (e.g. Medikredit, Mediscor, Medpharm) or the Medical Aid itself (e.g. Sizwe, Telemed) In this option the detail for a specific Pay Office is stipulated as per the rules from the Medical Aid. Contact the Price Bureau for assistance. c. Medical Aid Information In this option all the different Medical Aid codes and options for a specific Medical Aid will be stipulated. A pharmacist needs to claim a script on the correct Medical aid code, which in return will send the script number through to the medical aid to process the script successful. Contact the Price Bureau for assistance. d. Mixture File In this option you can create or edit a dispensing mixture onto the system. e. Suppliers Prices Medical Aid prices for items and Nappi codes are maintained from this option. Contact the Price Bureau for assistance. CKS Training 3
f. Audit Trail Will give you a list of all transactions processed within the pharmacy program g. Resubmission Resending a claim to the Medical aid. You can resubmit a claim by using batch claiming or by using the Realtime process (reverse & resubmit) h. System Parameters This is where all the rules and regulations per site are setup. How the user want to use the system installed in his/her business. i. Initialise Files Clearing of files/data already stored on the system. You are not allowed to initialise any files. This option is only used by CKS Support, and may only be used upon authorization. 3. PROCESSES 3.1 Maintain 3.1.1 Pay Office Information From the Pharmacy Main Menu, select: < 1 > Maintain < B > Pay Office Information CKS Training 4
These menus are setup by the Price Bureau. If you require any assistance, please contact them directly. 3.1.2 Medical Aid Information CKS Training 5
If you Press <ENTER> on the Medical Aid code, it will give you access to the Medical Aid Name. Here you can start to type the name of the specific Medical Aid you are searching for. You will notice the name of the Pay Office is also displayed on the menu. CKS Training 6
The Pay Office Code also has to be specified for every Medical Aid code. LEVY: Levy Indicator: <H> Medikredit <I> Interpharm <M> Mediswitch <N> Nowhere / Cash Script LEVY: Levy Maximum (Rands) Always has to be set as 9999999.00 CKS Training 7
On the page above you can specify the fee structure charged by this medical aid. On the page above you can specify a tiered fee structure for the medical aid. CKS Training 8
3.1.3 Supplier Prices When accessing Suppliers Prices, the system will first display your last drug pricing update that has been run on the system. By entering past this point you can search either by using the Drug Name or the 6 digit Nappi code if you have it. CKS Training 9
SCHEDULE NR. NAPPI CODE At this point you can see the drug name, nappi code and the schedule. By pressing the <ENTER> key you are able to view all the different Pack sizes and price setups. CKS Training 10
PACK SIZE EXTENDED CODE The six digit Nappi code for all the different pack sizes stay the same. The three digit Extended Nappi code is for the pack sizes. The price shown to the right is the selling price and not the cost price. When choosing the line number specified per date of the last update. You will be able to view the pricing structure. CKS Training 11
3.1.4 Translation Files From the Pharmacy Main Menu, select: < 1 > Maintain < G > Translation Files Addresses You can set up in the address field Suburb Names or Regions. This will quicken your dispensing. CKS Training 12
Code <010> has been allocated to Westville. The name will appear as soon as you have entered on the code. Under <3> Reporting, you will find the option <Translation Files>. Here you can print the address details you created above for reference. Doctors Here you can create or edit a Doctor s Profile on the system. CKS Training 13
Directions At this option, a pharmacist can create or edit a dispensing direction. Allergies All different allergies or Ailments can be noted in this option. When dispensing a pharmacist can then pick an allergy from the list created to flag onto a profile. CKS Training 14
3.2 Process 3.2.1 View Script Details From the Pharmacy Main Menu, select: < 2 > Process < N > View Script Details If this option is not available on your menu, you can type in a <?> at the bottom of any of the dispensing menu s. Follow the same procedure as mentioned below. Type in this field the <? > (question mark). CKS Training 15
A menu will be displayed with all the dependants built in on that specific pharmacy profile. You now have to choose the dependant number you wish to the enquiry on. This screen will display the profile detail for the dependant you are about to view. CKS Training 16
Detail 1 <ENTER> Realtime Authorization 1 <TAB> Above are all the scripts that have been dispensed on that specific dependant. Choose a line number for the specific script you wish to view. This screen will show you the status of the script as to how it is currently on the system. When you press [TAB] you will be able to view all the transactions on a script when changed or accessed. CKS Training 17
Choose the line # you wish to view: < 1 > Receipt number and amount paid In order to view all the other lines from here you can just press the down arrow key on the keyboard. You will then be able to view line number 2, 3 and 4. CKS Training 18
3.3 Batch Claiming 3.3.1 Introduction to Batch Claims The batch claims process consists of four easy steps: Clear resubmissions (This prevents the same script being submitted more than once) Running of the physical claim Sending the electronic file Receiving the reply Keep record of all your batch claims. Keep on file which script range you claimed weekly, as well as the claim numbers you used to submit a specific claim e.g. To gain access to the batch claim system from the Main menu: <7> Claims Procedures CKS Training 19
3.3.2 Clearing Claimed Resubmissions To clear previously resubmitted scripts, which are still flagged for resubmission: Select option 1 and press <ENTER> <Clear claimed resubmitted scripts Y/N? > Y <Pay Office Code> - <ENTER> for All If you do not clear the resubmissions, the same script numbers will print again if you run a Resubmission Claim. To view how many scripts are still flagged for resubmissions Print the Script Checklist Report. It is recommended running batch claims over all Pay Offices to prevent the likelihood of one or more scripts not being claimed. 3.3.3 Run claim and create electronic file Choose option <1> All Pay Office Claims: N - New Claims R - Resubmissions (usually both is run separately on a month-end each with an individual claim number) * Print labels - N CKS Training 20
* Print summaries - Y * Start script no. - look from previous claim where ended * End script no. - last script done for the day you wish to claim to. * Specify Bromed claim nr - follow sequence in blue book (This field will always be blank) * Specify MKR claim nr - use date as claim number (Type in the date of the day as a reference to your Medikredit claim number.) * Enter to continue SYSTEM WILL BE RUNNING THROUGH THE SEQUENCE OF THE SCRIPTS If at any point you get a message <Script out of sequence> appear on the screen. This happens when the dispensing menu is not logged out of, and the server moved to a new date after midnight. Upon dispensing you will get the message <Dispensing date is different than system date - Y/N continue> If the pharmacist opst for Y. It will write a new script number in between the previous day s statistics. Script numbers are created in sequence, thus the reason displayed. * Select your Printer number and <ENTER> * New Page per M/aid - N CKS Training 21
SYSTEM WILL START PRINTING AFTER A FEW MOMENTS Detailed claim report per Medical Aid will now print * Again select your Printer number and <ENTER> Summary claim report per Pay Office will now print CKS Training 22
* Wait until print is completed before saying: < SUCCESSFULLY COMPLETED -Y> If you have to re-run a claim because of a paper jam. Use exactly the same Script numbers and claim numbers to rerun a claim. If you chose <Print Successfully Completed> N When pressing <ENTER> only the Claim Summary report will print again. CKS Training 23
If for any reason you lost connection to your system while running a claim the following message will appear on screen when you go into the claim option. Press <TAB> to ignore the message if you have to re-run the whole claim. Press <ENTER> - this will take you to print only the claim summary copies. Claim Summary Report CKS Training 24
Detailed Medical Aid Claim Report 3.3.4 Sending the Electronic File Select number <7 Claims Communication menu> If you have to send Mediswitch batch files to send. CKS Training 25
Select option <7> Dial Mediswitch Super Format Claims> To successfully forward these files displayed, only select the line number. 3.3.5 Receiving the reply Batch Claims will only be acknowledged on the medical aid computer the next morning. Select option <8 Get M/Switch Claim Acknowledgement> You will now dial into the Medical Aids computer to collect any outstanding replies that are available on their system. CKS Training 26
3.3.6 Delete a selected resubmission Type in the script number and press <ENTER> The resubmission flag has now been removed from the script and will no longer print on the Script Checklist. CKS Training 27
3.4 Reporting 3.4.1 Script Statistics The report will be able to give you statistical details of you script by giving you overall details based on specific catagories. CKS Training 28
3.4.2 Schedule Register Daily Script Total This report will show what patients have been using which scheduled drugs. Every item name will print on a separate page, including customer details. 3.4.3 Outstanding Repeats Report CKS Training 29
This report will show what repeats are still outstanding for a specific date range. To get a list of your chronic scripts they must be maintained as repeats. The parameter has to be maintained for chronic/repeat scripts if you want to print this report. 3.4.4 Healthnet & DHS / IPH / ZIETO Scripts Authorized This report can be printed by using the script range for the previous day, in order to obtain if a script was authorized for payment by the Medical Aid. CKS Training 30
Choose [N]on Authorized, as you would want to investigate which scripts have to be resubmitted to the medical aid for payment. 3.4.5 Script Discrepancies The script discrepancy report can be printed for <D>iscounts. Whenever a discount was given on a script at Point of Sale the detail will reflect on this report. Further investigation has to be done to determine reason for discount. CKS Training 31
3.4.6 Script Checklist Resubmission field explained in Claiming procedures. This report can also be used for when you are no longer running batch claims to obtain if all your scripts are handed in and signed daily. This report will show the scripts done over a date or script range and show the medical aid, patient and the script cost. 3.4.7 Drug Usage Report CKS Training 32
3.4.8 Drugs to follow This report will show a list of all the scripts that have had a to-follow set for it. Quantity owing 3.4.9 Schedule Register CKS Training 33
3.4.10 Script Book This report will display all scripts done for a specific day or period - Deleted, Priced and Dispensed. Medication, Nappi codes, quantity and price. 3.4.11 Script Tracking File CKS Training 34
This report has to be followed up daily. It will display all outstanding levies and not authorized scripts. Once a levy is paid in invoicing it will come off the script tracking file. This report works in conjunction with the next report levy reconciliation. 3.4.12 Script Levies Reconciliation Every time a script is changed when a levy is involved, it will write a transaction to this report for reconciliation purposes. CKS Training 35
3.4.13 Pharmacy Audit Trail This report will show all transactions that took place in the pharmacy program. Every new script and rewrite with levy and script changes. CKS Training 36
3.4.14 Medical Aid Control Account Reconciliation * Script not in C/S or Control The purpose of this report is to reconcile Medical aid and Claim Settlement. These two fields must be in sync.! Script in C/S but not in Control Acc. 3.4.15 Pharmacist Statistics This report will give you statistical information over a date range for the pharmacists. CKS Training 37
3.4.16 Doctor Statistics This report will give the income value per doctor for a specific day or period. 3.4.17 Doctor Average Statistics Same amount of scripts as the previous report, different detail. CKS Training 38
3.4.18 Script Statistics per hour Time of day Total of scripts at the end of the day 3.5 UTILITIES 3.5.1 Merge Profiles Will be explained in detail when in training. When merging - <Profile 2> is the profile that will be folded into <Profile 1> the base Profile. Both profiles have to be exactly the same before merging. 3.5.2 Change Dependant number A dependant can be: <D>eleted <M>oved <S>wop <P> Preferably only move the dependant and then make inactive. never delete. Move one dependant to another dependant code. A dependant Code must preferably only be moved to a blank dependant field. between two dependant codes within the same profile. - move some scripts to another dependant. CKS Training 39