MoH ditches diskettes for online pharmacy claims system

An online pilot is currently operating at 90 pharmacies

Pharmacies could soon have an easier time making their payment claims with the aid of a secure virtual private network.

The Ministry of Health’s HealthPAC division, one of whose jobs is to administer government subsidies on medicine, wants to replace the present cumbersome diskette-based payment system used by pharmacies with an online system. Pharmacies would then be able to claim their money directly, through a secure VPN.

Most pharmacies currently submit their HealthPAC claims on diskette, says the ministry. “These diskettes are couriered to HealthPAC (Wanganui), where they are manually loaded into the claims processing system. During processing, a number of documents are created which are sent back to the pharmacies, including buyer-created tax invoices and error and variance reports.

“This process is slow, error prone, labour-intensive and difficult to support,” says the MoH. “As a consequence, the ministry wishes to implement an electronic-messaging solution, to support electronic submission of claims and reports.”

An online pilot is currently operating at 90 pharmacies, but the software being used is “limited in terms of technology and functionality”, says a ministry spokeswoman.

“The ministry requires a new electronic claiming system which will also feature validation of claims and efficient reporting. This solution will enable online claiming by all pharmacies in New Zealand.”

The ministry has prepared what it calls “a high-level design” and has also signalled that its preferred architecture is one that “utilises existing ministry assets, such as [IBM’s] Websphere Application Server and Tivoli Access Manager platform.

“The ministry’s preferred technology choices are driven by the assumption that in leveraging existing investment and services the project will reduce technical risk, time to market and cost,” says the RFP (Request for Proposal) document.

However, the ministry says it is also willing to consider “alternate technology approaches”, especially if the vendor believes this is the only way the system can be delivered in the requested time-frame.

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Tags pharmaciesclaims systemMinistry of Health

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