Additional Requirements

The AlphaScript Pharmacy Management System (“AS PMS”) is directly accredited to all switching house and currently switches to your medical scheme’s Administrator;

The maintenance of the master product/price file in the AS PMS occurs from the centrally maintained Department of Health Product File, by means of a service which monitors the file to ensure that an update will run to automatically update the appropriate product record(s) on the AS PMS master product/price file;

AlphaScript has a proven track record of supplying mission critical medicine provision solutions that thrive on seamless integration and collaboration between other healthcare intermediaries and technological topologies as per the needs analysis of our medical scheme clients. Once we receive the interfacing requirements from the medical scheme will we develop this capability accordingly;

The AS PMS can entertain an unlimited amount of product formularies in any one of the following formats:

  • By Medical Scheme
  • By Plan Option
  • By Benefit Option (Acute; Chronic: PAT)
  • By NAPPI (Brand Name)
  • By Generic Reference Price
  • By Therapeutic Reference Price
  • By Chronic Drug Amount (“CDA”)

AlphaScript uses Qlikview as a dynamic Reporting and Analytical Tool.

Qlikview forms the backbone of the AlphaScript MIS Department and enables AlphaScript to design standardized reports, to be made available at predetermined intervals, as well as ad-hoc reports as and when requested by a medical scheme client.

The AlphaScript Reporting Tool further allows the end-user of the reports to drill down to the smallest measurable entity ie:

  • Patient;
  • Claim Number;
  • Medical Aid Number (inclusive of Option code);
  • Member or Dependent Code;
  • Product by 9 digit Name Description;
  • Metric Quantity dispensed (Tablets, Capsules, Milliliters etc)
  • Original Packs
  • Number of scripts
  • Number of line Items
  • Value measures
  • Script value
  • Cost of Goods (SEP)
  • Professional Fee
  • Scheme endorsed co-pays
  • Disease Entity Classification:
    • PMB Classification
    • ICD10 Classification
    • ATC5 Classification
    • MIMS Classification

AlphaScript will be able to comply to the standard and ad-hock reporting requirements of a medical scheme client. The AlphaScript MIS reporting tool is a very powerful and dynamic analytical tool that can provide the Medical Scheme with Business Intelligent Reports in the exact scoped format on a as frequent as required basis ie daily, weekly, monthly, quarterly, bi-annually or any other customized period of measurement within the current year of measurement or compared to a congruent period of measurement in the preceding year(s). The Reports can be supplied in the form of Data Tables (straight or pivot) or any form of Charts (line; bar; combo bar-line; pie; gauge; radar, scattered, grid, funnel, block charts);

AlphaScript has developed various standard Exception Reports which are used to identify any deviations from the prerequisites of a medical scheme client. These Exception Reports are designed to prompt management of any irregularities in advance ie prior to the realization of the milestone activities and hence allows management the pro-active ability to mitigate any errors or irregularities before actualization thereof. AlphaScript will be able to design specific reports based on the process checks that the medical scheme would want to impose from a SLA point of view.

AlphaScript will set up an username and password protected File Transfer Protocol (FTP Site) for the authorized user(s) of the medical scheme to allow such users access within 24 hours of such data being requested;

Alpha Script will co-operate with any member and beneficiary data file requirements that the medical scheme may have from time-to-time by either including such data files as standard reports in the AlphaScript MIS Reporting Tool or making such data files available on the FTP Site on agreed intervals or by extracting custom-made reports for the medical scheme as and when required in a predetermined format;

AlphaScript applies international data management technologies that can jump start the medical scheme’s’ business and save months of development time. These best practices will help to protect, control and enhance the value of the medical scheme’s data and information asset and is focused on the foundation data management practices of Data Governance, Data Quality and Data Integration;

AlphaScript will produce measurable results quickly at a tactical level and deploy the program at an enterprise level if so required. AlphaScript will deliver “peak condition” information fit-for-your-business however, wherever and whenever needed. Our Data Quality will ensure correct and consistent data at every touch point;

AlphaScript will integrate our co-existing information systems to dynamically meet your needs. This will allow us to create a single, unified interface and data set that creates the illusion of a single system that will enable us to provide a more accurate and comprehensive response to questions asked by the medical scheme executives and other the medical scheme intermediaries;

We must develop the ability to have a single accurate and consistent view of the critical business data to ensure that the legal (refer: The Protection of the Personal Information Act) and operational imperatives with respect to the non-transactional master data are being met;

AlphaScript is prepared to arrange for a demonstration of our operational systems and to refine aspects thereof to comply with the medical scheme’s audit requirements;

AlphaScript entered into a SLA with LHIT (Pty) Ltd to procure their contemporary off-site data storage, back-up and disaster recovery processes to ensure that AlphaScript is in compliance with best practice protocol and standards from a data protection point of view;

 Supply Chain:

AlphaScript through its auto-scheduling of the chronic claims on a 28 day cycle will under normal circumstances procure and supply a patients chronic medication to the ASNP at least 2-3 days before the due date thereof which allows the ASNP adequate time to perform the final dispensing function on the AS PMS on the 3rd, but not later than the 2nd day prior to the due date.

The aforesaid may not be possible in the event of a particular Innovator Product being out of stock in which instance the AlphaScript DUR Department will have to cross liaise with the patient’s medical practitioner in order to obtain a replacement prescription for a therapeutic equivalent. The reversal of the original prescription and re-submission of the re-written script may have an adverse effect on the timelines which may result in the parcel being delayed;

An uncontrollable situation, such as an “Act of God” eventuality, may also contribute to the delayed supply of medicine which will also trigger AlphaScript’s pro-activeness in reporting the same at least four days before the scheduled date of delivery to the patient;

AlphaScript will in any instance of delayed supply be in a position to notify the patient 3 days before the scheduled due date of the alternate arrangement and will maintain an audit trail to this effect;

AlphaScript will re-supply and deliver any medicine which is lost or damaged, inclusive of cases where the cold chain has been broken, while in transit to the patient at its own cost;

Confidentiality of member information:

AlphaScript will manage the scheme’s data with integrity and protect confidentiality, security and integrity of the beneficiary records data and information by allowing secured log-on and password protected access to the AS PMS by AlphaScript authorized personal only;

All AlphaScript authorized personnel to sign a the Medical Scheme Confidentiality Agreement to be provided by the medical scheme in order to achieve the same;

AlphaScript will develop customer database management and maintenance protocols to ensure the maintenance and operation of an effective medical scheme membership management system by importing the beneficiary information from the medical scheme’s Health Care Administrator and running cross-checks against the two comparative files to identify and rectify any anomalies every time membership details are being updated and exchanged;

The above database management and maintenance protocols read together with the authorized access to the master customer/beneficiary file will also ensure the integrity and accuracy of the beneficiary records;

An existing version of the the medical scheme customer database will be archived as the specific version before superseded by a new version as and when a database update is performed and audit trails will be created by colour coding the edited records from one version to the next in red on the latest version;

AlphaScript will not change the standard format in which the medical scheme have provided the customer database in and will create the necessary data table linkages with the AS PMS and the AlphaScript MIS Reporting Tool. AlphaScript will also assist the medical schemes’ Health Care Administrator and Managed Healthcare Provider(s) with data extracts within the specifications and required format that they may request it in from time-to-time.

Single point of negotiations for all agreements:

AlphaScript as the Network Management Company of the ASNP is duly mandated to centrally negotiate and conclude any agreements or addendums to existing agreements for as long as the AlphaScript core business and the interest of the ASNP’s is not prejudiced in doing so.