ePay Programme
Background
A key success criterion for ePharmacy and the Electronic Transfer of Prescriptions (ETP) is that all community pharmacists submit as many prescription claims as possible electronically. Practitioner Services (PSD) is pursuing a gradual approach to maximising the use of the electronic messages in supporting the payment processes whilst still maintaining the accuracy of the payments.
In order to price each prescription we need to identify “a priceable item”. Payment will only be automated where:
- The ePay priceable Item = the PSD pricing staff’s priceable item
- The priceable item has been identified for automation
The actual reimbursement for the item will be calculated in exactly the same way as currently happens.
ePay, the PSD process which checks the electronic claim, identifies the priceable item from the contents of the electronic claim message, uses the same business rules as PSD pricing staff and then decides whether the claimed dispensed item is a valid claim against the prescribed item.
For the items identified for automation, there is sufficient existing data in PSD’s payment system to demonstrate a direct match between pricing staff and ePay output for the same prescribed/dispensed combination. This ensures that there is no human inconsistency in interpreting the application of the pricing rules.
When this direct match does not happen the prescription will be presented to our pricing staff for manual intervention using information from the claim and the output from ePay processing to advise the pricing staff.
Prescriptions that meet the following conditions will be passed to pricing staff for processing regardless of the ePay output:
- Any prescription form where the PSD scanners are unable to correctly read the form information or barcode
- Any form other than a GP10
- Any GP10 prescription form where an electronic claim message cannot be found for the barcode
- Any GP10 prescription form or electronic claim which indicates that the patient has paid a patient charge
- Any claims that contain an electronic endorsement that ePay cannot currently process
- Any items in short supply
Note on Cancelling Electronic Claims
It is important that community pharmacists follow the same process with electronic claims as they would with the paper form. Claims should only be submitted when the dispensing episode is complete and they have checked that the patient details are correct e.g. exemption category should be checked prior to sending the claim to ensure that the electronic claim is accurate.
A community pharmacist has 14 days from submitting the electronic claim to modify or cancel the claim. However, outwith this 14 day period, if a pharmacist realises an incorrect electronic claim has been submitted, the following process can be followed.
Prescription form is still held in the pharmacy
- Call the PSD Helpdesk with the Unique Prescription Number (UPN) and they will cancel the electronic claim
- Ensure the claim is correctly endorsed on the paper form
Prescription form has been sent to PSD
- Use the existing process for correction of incorrect paper prescription submissions
Additional information on ePay
ePay does not:
- change or add in any new rules to current business processes
- reject items for payment; it only directs items to a PSD operator when it cannot determine a priceable item
- contain any prices or price prescriptions; pricing is carried out by the current payment process
PSD require community pharmacists to support AMS by submitting electronic claims.
Pricing of items is always calculated by the Verification and Pricing element of DCVP, regardless of whether the claim data is entered by operator or by an electronic message, meaning that an item will only be priced once.
ePay determines whether sufficient information is in the eMessage to enable the prescription to be priced. It also translates the electronic claim message into a form DCVP can understand.
Prescriptions that are supported by an electronic claim message should all contain the drug dictionary code (the dm+d code), the unit of measure code and the total quantity dispensed meaning that an operator would not need to provide any additional data. If ePay detects any data is missing from the claim then the form is passed to an operator for completion, just as with existing scanned prescriptions.
ePay will apply the same PSD Business Rules currently used by an operator.
For a scanned prescription form with no supporting eMessage, an operator is required to correct any fields that have failed to scan correctly, e.g. eVadis drug code, and enter any fields that are not captured by scanning. e.g. dispensed quantity and endorsements.
Any claim with an endorsement that can not be processed by ePay, will be directed to an operator.
The ePharmacy helpdesk at PSD will provide support and advice on queries regarding eAMS, for example reassurance of the backup processes for AMS using the paper form if there is an irrecoverable problem with an electronic claim.
The ePharmacy Helpdesk at PSD will assist with cancellation requests outwith the 14 day cancellation period as described above.
The ePharmacy Helpdesk number is: 0131 275 6600
Alternatively you can email: nss.psdhelp@nhs.net