Claim Management & Rx Processing

Script Authorization Process

  • AlphaScript has a dedicated Authorization Department staffed with Medical Aid Clerks (“MAC’s”) that cross liaises with medical aids, prescribers and patients to facilitate the authorization process of chronic diseases that falls within the pre-authorization requirements of the Prescribed Minimum Benefits;
  • The AlphaScript Authorization Department can perform this on-line in cases where authorizations are automated or manually in cases where automation does not exist;
  • The AlphaScript Authorization Department will keep all stakeholders well informed with respect to the progress of a specific authorization and will make encrypted patient notes on the patient profile as a status report for viewing on a prescriber or patient’s enquiry.

 Script Processing Process

  • AlphaScript has a dedicated Production Department comprising of Post Basic Qualified Production Pharmacist Assistants (“PPA”) that receive, translate and capture incomplete scripts received form the AlphaScript Network Providers;
  • Each PPA is designated to ± 20 AlphaScript Network Providers and is responsible for the processing of approximately 2000 scripts per month ie 100 scripts per day;
  • The PPA’s will also make the prospective generic interventions in accordance with the medical scheme’s formulary and lawful substitution;
  • The PPA’s are also responsible for the 28 day scheduling of the number of repeats as prescribed by the doctor on the Alpha Script Scheduler thereby ensuring that the maximum number of scripts per annum is not exceeded;
  • No PPA can activate a prescription on the AlphaScript PMS and is solely responsible for the processing of an “Incomplete Script” as explained above thereby giving effect to changing the script status to “New Script”, triggering the next step namely the validation of the New Scripts by a Script Quality Assurance Pharmacist in the Script Quality Assurance (“QA”) Department.

Script Validation Process

AlphaScript has a Script QA Department where all the New Scripts are subjected to strict QA Validation Protocols by a Script QA Pharmacist (“QAP’s”) to:

Verify member/script data by checking patient details on the script versus:

  • patient name on the profile;
  • attached copy of I.D. Document;
  • copy of Medical Aid Card

Verify the integrity of the script in terms of prescriber details by checking the following details on the script:

  • The name, qualification, practise number and address of the prescriber. (This can also be done against a pre-determined list of approved network doctors if required);
  • The date of issue of the prescription
  • The dosage form, the strength of the dosage form and the quantity of the medicine to be supplied;
  • Instructions for the administration of the dosage and the frequency of administration
  • The age and sex of the patient
  • The number of times the script may be repeated
  • The Patient notes made by the PPA or the MAC for any special instructions or requests

In the case of a faxed, e-mailed, telephone or electronic transmission of a prescription for delivery though AlphaDirect, the Script QAP will verify the authenticity of the prescription if it was not faxed, emailed or electronically transferred directly from the Doctor’s rooms or another Pharmacy by telephonically confirming the authenticity of the script with the prescribing Doctor’s rooms

A request will be made for the original prescription or order of the faxed, e-mailed, telephone or other electronic transmitted prescriptions or order to be posted within 7 working days.

The original script or a reproducible copy thereof will be kept on file for a minimum of 5 years and made available for any future reference when requested

Script Assessment Procedure prior to changing status from “New” to “Active”

The QAP will assess each script and the patient’s medicine history by using the built-in intelligence in the back-end of the AlphaScript PMS as well as the treatment journal as contained in the patient notes with respect to:

  • Therapeutic aspects (Pharmaceutical and Pharmacological )
  • The safety of the medicine
  • Incorrect medicine dosage
  • Incorrect duration of medicine treatment
  • Possible contra-indications
  • Drug-drug interactions
  • Drug-disease interactions
  • Treatment duplications
  • Appropriateness for the individual and the indications for which the medication is prescribed
  • Social, legal and economic aspects
  • Clinical abuse or misuse of the medicine

The Script QAP will telephonically communicate any identified problems or uncertainties and work out a plan of action with the prescriber;

A new script will be requested in the case where mistakes have been identified and corrected;

A patient note will be made on the patient file in the case where motivation is given for an unusual dosage etc. and a motivation letter will be requested where necessary;

If a prescriber cannot be contacted telephonically an email will be sent to the prescriber and the Script QAP together with the Responsible Pharmacist (“RP”) will decide on a course of action, based on their professional judgement, which will be in the best interests of the patient;

The Script QA Pharmacist will contact the patient telephonically and inform him/her of any changes.