[Revised Jan 2012]
There is no need to understand the method and background of Claims to use it, but since large amounts of money are involved the following details are for those interested.
Since 1989 HealthSoft software has been providing Claims for Australian pharmacies. This experience has shown that a simple data extraction is not sufficient 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. The RxOne 'Claims' 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 exception 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 disk.
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 floppy disk the file is read back to verify correct copying.
- A safety copy of the claim is kept on hard disk in case the electronic transmission is lost, 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 Script Owings 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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