Following the inquiry with the professional medical institution, the final prescription information is transmitted from the professional medical establishment for the information technique in the event the prescription drug is decided. When an insurance policies pharmacy inquires about The supply of insurance coverage for pharmaceuticals explained in prescriptions, the existence / absence with the inquiry heritage Along with the healthcare institution and the outcomes are distributed. At last, a number of inquiry histories is dispersed for the evaluation and payment establishment plus the insurance provider, as well as information inquiry / judgment technique is finished.
In case the health care Qualified would like the pharmacist to offer you a certain brand of drugs, they must Primarily Notice this or sign-up the Place furnished.
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Observe: It is frequently encouraged that to help Minimize down the amount of medication complications, prescription making must be a hundred% English, without any Latin abbreviations. I will educate you the two and let you come to a decision.
Inside the technique operation phase, the next processing is done in authentic time. To paraphrase, inquiries with regards to The provision of insurance coverage coverage for prescription drugs from health treatment establishments are created by means of conversation lines during Every medical apply, and these inquiries are compared Along with the input information and specified circumstances in the assessment and payment institutions and insurers mentioned higher than. Then, the assessment shelling out institution and the insurance provider establish whether to reject the insurance coverage software, distribute the result into the health-related establishment, and display it to the terminal in the medical institution by an enter / output screen as shown in FIG. On account of the dedication, if the information of the inquiry will not conform into the input information and specified conditions from the assessment and payment establishment and also the insurance company, a pharmaceutical team fulfilling these is searched and discovered and distributed to the health-related establishment.
医療機関による医薬品の処方に際しては、被保険者（患者）が保健医療機関で医師の診察を受け、その診断結果をもとに医師が処方箋を発行、同処方箋に基づき保険薬局にて医薬品が調剤、提供される、という流れになっている。保険が適用される医薬品の費用請求については、被保険者による一部費用負担を除くと、医療機関・保険薬局などが、レセプトと呼ばれる診療報酬明細書に、診療、検査、投薬、手術など医療行為の内容を記入し、月ごとに審査支払機関に提出、医療費を請求する。審査は、社会保険診療報酬支払基金と都道府県支部、国民健康保険中央会と各都道府県の国民健康保険団体連合会にて実施され、かかった医療費をそのまま医療保険から支払う「出来高払い制」を採用されている。
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、本システムを介して為された一連の照会履歴を審査支払機関及び保険者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。
The prescription information inquiry / distribution procedure Based on declare 1, accepting inquiries from coverage pharmacies for insurance coverage coverage of pharmaceuticals explained in prescriptions issued by medical establishments, and existence of inquiry heritage with prescription issuing professional medical establishments Pharmaceutical prescription information inquiry and distribution technique characterized by distributing final results.
【選択図】図３[Troubles] To supply a system for furnishing a chance to get a medical establishment / insurance coverage pharmacy to preferentially undertake a medicine that an insured / insurance company or examination / payment establishment desires to prescribe during the health-related insurance technique. Provided. [Signifies FOR Resolving Difficulties] Moving into / Keeping information on choices, prescription precedence order information of the insurance provider, and circumstances / expectations for acceptance of a receipt evaluation by an evaluation / payment establishment for your drugs prescribed by an insurance health-related institution Inquiries with regards to no matter if coverage for prescription drugs is readily available for Each individual health-related apply from your indicates and professional medical establishment, and if the inquiries match the specified conditions of your insurance provider / evaluation and payment organization based on own information for example signs of the insured Usually means to here find out if the above inquiry content won't match the specified conditions, seek for other drugs that meet the specified problems in the drugs specified because of the insurer determined by the insured's information which include signs A process having implies for notifying a clinical establishment as an alternative and prompting the healthcare institution to reselect prescription contents. [Variety] Figure 3 Description
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指定条件を満たしていると判定した場合には、次に、医療機関・保険者の住所から近くに存在する複数の保険薬局に対して、処方対象医薬品の取扱状況・在庫状況を確認、結果をあわせて医療機関へ配信する。一方、指定条件を満たしていないと判定した場合には、審査支払機関及び保険者の指定条件に合致する範囲内で医療機関が提示した被保険者情報をもとに導出される処方推奨対象となる医薬品のリストを医療機関に配信、医療機関にて再選択を促す。医療機関にて処方推奨医薬品が選択されると、近隣の保険薬局での取扱状況・在庫状況を確認、結果を通知する。
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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、医療機関から診療行為毎に照会される処方医薬品が、保険者・審査支払機関の指定条件を満たす場合、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ことを特徴とする医薬品処方情報照会・配信システム。