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 phased approach to maximising the use of the electronic messages in supporting the payment processes whilst still maintaining the accuracy of the payments.
There will be three phases of electronic message utilisation towards full automation of the payment process. PSD will move from Phase 1 to 2 to 3 as and when appropriate, based on the successful validation of ePay. This will ensure confidence in the ‘new versus old’ method achieving the same payment result and to also enable us to identify any system improvements to aid the process in the future.
ePay; a quick reminder
ePay is the application of the existing PSD pricing rules to the electronic claim messages.
Phase 1
Currently PSD is operating Phase 1 and passing all electronic claims through ePay (eMAS and eAMS). During this Phase, we are evaluating the quality of claims from each of the pharmacy systems. When we are certain that ePay is providing accurate execution of PSD business rules and we have validated that there are no issues with the electronic messages arriving at PSD, then we will enable Phase 2.
Phase 2
With Phase 2, the electronic messages will be used to fully support the payment process. While electronic claims are being processed in Phase 2, each claim will be viewed by a PSD operator who will compare the ePay output with the prescription form and check that the correct priceable item has been identified. Where the ePay output is assessed as correct the electronic claim will be used as the basis for payment. If incorrect, then the PSD operator will identify the correct priceable item and record the change. Changes by PSD operators will be analysed to further enhance ePay.
Phase 3
In Phase 3, the viewing of the claim by PSD Operator is by-passed and pricing is based entirely on the electronic message. Phase 3 will not be enabled for an individual community pharmacy until they have completed a period of successful processing using Phase 2. Phase 3 can be enabled/disabled by contractor code and/or service as and where appropriate.
In any instance where ePay cannot determine a priceable item the claim will be processed by a PSD operator from the paper prescription.
Progress to date
Phase 1 has already commenced and Phases 2 and 3 will be implemented during 2009. When eCMS starts in 2009, it will use the Phase 3, fully automated model, since all electronic claims will be required to be made electronically at that time.
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.
- All endorsements have to be both in the electronic message and the paper in case an operator needs to check an electronic claim message against the paper form.
- 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: