[Revised Aug 99]
There is no need to understand the method and background of SmartClaim to use it, but since large amounts of money are involved the following details are for those interested.
- By Mid 1997, HealthSoft software was providing Electronic Claims for 1052 Australian pharmacies, some since 1989. This 5000 user-years of successful electronic claims experience had shown that a simple data extraction was not nearly good enough to provide the required security of payment, when faced with the inevitable operator errors, hardware breakdowns, power problems, and other unexpected events that occur in the real world. 'SmartClaim' was designed to be able to resist or repair a wide range of possible problems, including and extending the checks, balances and verifications that have proved successful during a long period of actual experience.
How it works;
1. While dispensing, RxOne attempts to pick up all operator errors, and questions any unusually large quantities etc, and carries out as much as possible of the Claim preparation. It records every item, whether a likely claim or not.
2. At the end of the batch period, an exclusion report is run.
When ready to claim, it previews every script for the period, checking every piece of data for legibility and reasonableness. A double-check system is used which knows if an item has dropped completely off the file.
3. The user is advised of any potential problems, and given a chance to fix them before the claim is made up.
4. Only then is the claim made up, and after copying to the file, is read back to verify correct copying.
- A safety copy of the claim is kept on hard disk in case the file is destroyed, and the whole claim can be made up again if necessary.
- There are checks against accidentally double claiming, or against claiming scripts that are not yet legal (such as phoned scripts not yet received.)
- The system can normally recover from database corruption without loss of scripts due to the roll forward data recovery.
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