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。
The present invention pertains to transactions connected to prescription and purchase of ethical drugs concerning suppliers and prescribers like healthcare institutions and insurance policies pharmacies and people which include evaluation payers, insurers and insured individuals inside the pharmaceutical distribution marketplace. It gets to be possible to make clear whether or not there is settlement amongst the events in true time. Due to this fact, the evaluation / payment establishment / insurer should have a chance to effectively Categorical their intentions regarding the array of drugs, which allows them to develop their options for drug prescriptions they drive and increase their satisfaction and value usefulness.
After the inquiry from the medical establishment, the final prescription written content is transmitted in the medical institution for the information technique in the event the prescription drug is set. When an insurance policies pharmacy inquires about the availability of coverage for prescription drugs described in prescriptions, the presence / absence of your inquiry record With all the professional medical establishment and the results are distributed. Ultimately, a number of inquiry histories is dispersed into the evaluation and payment institution along with the insurance provider, as well as information inquiry / judgment course of action is concluded.
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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The healthcare prescription information inquiry / distribution method according to declare one, whereby the professional medical prescription is been given from the health care institution for each healthcare apply, and insured information (medical insurance policies relevant information, harm and sickness) offered from the health care establishment at time of inquiry.
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Concurrently, for prescription drugs that fulfill the specified circumstances, obtain the insurance pharmacy database and check the managing and inventory information of the prescribed drugs at numerous insurance policies pharmacies near the deal with with the healthcare institution or perhaps the insured. . Additionally, when an insurance policy pharmacy tends to make an inquiry in regards to the insurance policy application of the drugs explained in a prescription issued by a medical institution, the presence or absence of the inquiry historical past Along with the prescription issuing health-related institution and the result are distributed.
It is composed of assumed medical charge factors calculated for every personal injury and symptom categorized Based on scenario, drug rate standard of used drugs, insurance policy details, other data necessary for evaluation of professional medical fee information, and many click here others. Pharmaceutical prescription information inquiry and distribution program.
1st, in FIG. one, the functions linked to the information process of your existing creation will be clarified. This information method includes a health-related institution that prescribes prescription drugs into the insured, an insurance coverage pharmacy that dispenses pharmaceuticals based on a prescription issued by the professional medical establishment and delivers them to your insured, an insurance provider that bears health care insurance policy expenses, and An assessment / payment establishment that examines health-related payment facts from health-related institutions / insurance plan pharmacies is related. Every single social gathering provides the information procedure that has a series of important information for being described later on.From the information method, (one) information on solutions and prescriptions from the insurer for drugs prescribed via the insurance plan clinical establishment to the insured Enter / hold ideal priority information, (2) Enter / keep disorders / requirements for acceptance of receipt assessment by assessment / payment organization, (three) Inquire about availability of insurance policy for prescription drugs from healthcare establishments for every health-related exercise According to personal information including acceptance, insured's symptom, professional medical background, age, and many others.
Observe: It is usually advised that to aid Slice down the level of medication difficulties, prescription generating really should be 100% English, without having Latin abbreviations. I am going to teach you The 2 and assist you to arrive at a decision.
Ought to your health care medical doctor demands the pharmacist to give you a particular brand of medication, they have got to exactly Notice this or register the Area delivered.