Enye yezingxenye ezinzima kunazo zonke zokuba ikhemisi ukugcina izintambo
Njengomuthi wezokwelapha , ungase ucabange ukuthi imisebenzi yakho enzima kakhulu izobandakanya ukusiza iziguli nokugcina ithrekhi yezingqinamba ezingekho emkhatsini wemithi . Kodwa omakhemikhali abaningi bathi lezo zinsuku zilula uma kuqhathaniswa ne-accounting ehlukile kanye nokugcinwa kwempahla okudingekayo ekhemisi.
Ukukhokhisa i-Pharmacy akuyona into elula, nakuba ubuchwepheshe buyasusa iningi lamakhanda.
Nakhu okukhokhwa yi-pharmacy kuhlanganisa:
- Bhalisa ne-NCPDP
Ngaphambi kokuba noma yini ikwazi ukufezwa, ikhemisi kudingeka ibhalane noMkhandlu kaZwelonke wezinhlelo zokudakwa kwezidakamizwa (NCPDP), insizakalo yedatha evumela ukuthi ikhokhwe. I-NCPDP inikeza ikhemisi ngayinye ngenombolo ehlukile edijithi eyisithupha, eyaziwa njenge-BIN, eyikhomba ngezinjongo zokukhokha.
- Qondana Ubudlelwane Bamathathu-Party
Qaphela ukuthi izinkampani zomshuwalense azenzi ngokwabo imali yokukhokha. Ngamunye unomuntu wesithathu-i-Pharmacy Benefit Manager (i-PBM) njenge-Express Scripts noma i-Medco. Laba bahambeli bayakhokhiswa uma kugcwaliswa umuthi, futhi bahlola amafayela ukuqinisekisa ukuthi konke kulungile futhi baqinisekise inkampani yomshuwalense abayenzile ngokuzikhandla.
- Faka isicelo sezinkontileka
Isinyathelo esilandelayo ukufaka isicelo sezinkontileka zomshuwalense. Okokuqala, ngibhalise namanye amaqembu ekhemisi wendawo (la maqembu angase abe namandla okubhalisa izinhlelo eziningana zomshuwalense ngesikhathi) bese ubhalisa izinkontileka kulelo qembu.
Kubalulekile ukusayina izinkontileka, kodwa khumbula ukwazi ukuthi usayini. Amacala avunyelwe futhi akhokhwayo yizinombolo ezibalulekile zokuqonda.
Ikhemisi ayikwazi ukukhokhela i-PBM ngaphandle kokuthi isayine inkontileka. Le nkontileka iveza ukuthi i-PBM ikhokhela kangakanani ekhemisini, ikhokha imali, njll. PBM ngayinye inezinkontileka ezahlukene.
- Qala ukukhokha
Uma inkontileka isayinwe, ikhemisi lingakwazi ukukhokhela. Ngokusebenzisa uhlelo lwekhompiyutha lwekhompiyutha, lapho kugcwaliswa umuthi, futhi lonke ulwazi lomdabu lomthengi lugcwele, luya ePBM. Okwesibili kamuva kubuya ukuthi ukhokhelwe noma wenqatshelwe, kungakanani okukhokhelwe kanye nenani le-co-pay.
- Ukusebenzisana
Ezamakhemikhali, kungenzeka kube nomuntu oyedwa noma ingxenye enkulu yabasebenzi-kuye ngokuthi ubukhulu bekhemisi noma ukuthi luyingxenye yeketheni-ehambisana nenqubo yokukhokha. Imenenja ibuye iqondise inqubo futhi umuntu oyedwa unesibopho sokugwetshwa kokugcina nokuhlolwa kwezimangalo.
- Ubuchwepheshe
Zonke izinkokhelo zenziwa nge-software yokukhokha ekhemisi njenge-QS1. Iningi lezinqubo lizenzekelayo kusukela ngesikhathi umuthi odokotela ugcwalisiwe, kodwa amanye amacala adinga ukukhokha okukhethekile nokuvuma kwangaphambili. Kulezi zimo, kuvame ukudingeka ukuba ufonele inkampani yomshuwalense ukuqinisekisa ukuthi umuthi uyabuyiselwa.
Ubuchwepheshe bubalulekile kule nqubo. Ngaphandle kokusesikhathini izinhlelo, akunakwenzeka ukuxhumana ngokunembile nezinkampani zomshuwalense, abaphathi beqembu lesithathu, nodokotela.
- Izinselelo ku-Billing Billing
Kubalulekile ukuqinisekisa ukuthi amanani akhokhelwayo alungile ekulungisweni kokugcina kwezicelo. Ngakho imali ekhokhelwa yinkampani yomshuwalense kanye ne-copay kumele ilinganise inani elikhokhisiwe. Lezi zibalo kufanele zivumelaniswe ngobuqotho bezezimali.
Okunye okubalulekile ukuqonda izinkontileka zenkampani yangaphandle futhi unqume ukuthi kufanelekile yini ukubhalisa. Abanye kungenzeka ukuthi akufanelekile ukubhalisa. Kodwa-ke, ikhemisi ayikwazi ukukhokhela izimangalo kunoma yimuphi umuntu wesithathu ongenayo isivumelwano.