Patent Application
20060224405
The present patent relates generally to techniques for facilitating the completion of Treatment Authorization Request (TAR) forms, and more particularly to automatically populating the form's fields upon the rejection of a prescription request and associating the prescription data with that form.
Many pharmacies rely in large part on the business generated by customers enrolled in managed health care organizations. Often, these organizations place restrictions on the number of prescriptions their members may fill without specific approval. When customers present prescriptions requiring a secondary approval, the administrative authorization process can often cause delay. Specifically, once the user enters the customer and prescription data, a request needing further approval will generate a rejection. Upon rejection, the user will have to manually re-enter all customer and prescription data onto a paper treatment authorization request form and transmit this form to the approving agency. Manually filling out each form, especially after the user previously entered the same data, is time-consuming and prone to error. As a result, a system is needed to reduce or eliminate manually completing treatment authorization request forms which saves time and reduces the likelihood of error.
The network 32 may be provided using a wide variety of techniques well known to those skilled in the art for the transfer of electronic data. For example, the network 32 may comprise dedicated access lines, plain, ordinary telephone lines, satellite links, combinations of these, etc. Additionally, the network 32 may include a plurality of network computers or server computers (not shown), each of which may be operatively interconnected in a known manner. Where the network 32 comprises the Internet, data communication may take place over the network 32 via an Internet communication protocol.
The network server 30 may be a server computer of the type commonly employed in networking solutions, and it may also have a data structure into which customer account data and prescription fill data is retained. The network server 30 may be used to accumulate, analyze, and download data relating to the operation of the pharmacies 20 and more particularly to information pertaining to Treatment Authorization Request Forms, insurance companies, federal and state authorization agencies, and rejected prescriptions that have been submitted on Treatment Authorization Request Forms at the pharmacies 20 or another central or regional location.
For example, the network server 30 may periodically receive data from each of the pharmacies 20 indicative of prescriptions that have been attempted to be filled but require submission on Treatment Authorization Request Forms as well as rejected Treatment Authorization Request Forms. This information may be accumulated and periodically transferred to an off-site facility for purposes of data storage, report generation, etc. The information may alternatively be purged from storage on a periodic basis.
The pharmacies 20 may include one or more pharmacy servers 36 that may be utilized to store information on drugs, the weights of those drugs, and other information pertaining to those drugs. For example, the pharmacy servers 36 may store information pertaining to Treatment Authorization Request Forms, insurance companies, federal and state authorization agencies, and rejected prescriptions that have been submitted on Treatment Authorization Request Forms at the pharmacies 20 or another central or regional location. The pharmacy servers 36 may also store information related to prescriptions filled at the pharmacy 36 that may be used to generate a wide variety of reports, such as, for example, error reports, approval reports, override reports, etc.
The data network 10 may also include a Form Web Server 40 operatively coupled to the network server 30. The data network 10 may also include an image server 42 operatively coupled to the form web server 40 and a fax server 44 operatively coupled to the image server 42. Those of ordinary skill in the art will readily appreciate that many alternative couplings could also be contemplated.
The pharmacy servers 36 may store and run an application that automatically populates a Treatment Authorization Request Form's fields upon the rejection of a prescription request. The application may also associate a set of prescription data and a control number with the particular Treatment Authorization Request Form. Alternatively, the application could be stored and run on the form web server 40 or a combination of the form web server 40 and the pharmacy server 36. The application could be configured to allow a proactive submission of a prescription request on a Treatment Authorization Request Form. The fax server 44 could be utilized for a fax retry cycle to place a failed fax into a fax retry pool for a later fax attempt during a subsequent cycle, as well as sending notification, such as an email, back to one or more of the pharmacies 36. These actions are described in greater detail below with reference to the flowcharts.
Although the data network 10 is shown to include one network server 30 and three pharmacies 20, it should be understood that different numbers of computers and pharmacies may be utilized. For example, the network 32 may include a plurality of network servers 30 and hundreds or thousands of pharmacies 20, all of which may be interconnected via the network 32. According to the disclosed example, this configuration may provide several advantages, such as, for example, enabling near real time uploads and downloads of information as well as periodic uploads and downloads of information. This provides for a primary backup of all the information generated in transactions where prescriptions are filled and rejected and where Treatment Authorization Request Forms are completed and submitted, as well as the status of the prescriptions associated with the submitted forms.
The Treatment Authorization Request Form manager 34 may be used as a repository to store information pertaining to Treatment Authorization Request Forms for various states, or other third party payers or prescribers, prescriptions submitted on Treatment Authorization Request Forms and their current status, and other data corresponding to prescriptions filled and attempted to be filled at the pharmacies 20. As with the network server 30 in
Referring to
The client device 80 may allow a customer to submit a Treatment Authorization Request Form for a prescription that was previously rejected, without having to physically visit one of the pharmacies 20. The pharmacy organization may provide the customer the option of having the prescription drug(s) shipped to the customer or having the prescription drug(s) made available at a local (or any other) retail pharmacy 20 for pickup by the customer.
While the network 10 is shown to include one network server 30, one Treatment Authorization Request Form manager 34, three pharmacies 20, and one client device 80, it should be understood that different-numbers of computers, pharmacies, and client devices may be utilized. For example, the network 32 may include a plurality of network servers 30, a plurality of Treatment Authorization Request Form managers 34 and or databases, hundreds or thousands of pharmacies 20, and a plurality of client devices 80, all of which may be interconnected via the network 32.
The controller 100 may include a program memory 120, a microcontroller or a microprocessor (MP) 122, a random-access memory (RAM) 124, and an input/output (I/O) circuit 126, all of which may be interconnected via an address/data bus 130. It should be appreciated that although only one microprocessor 122 is shown, the controller 100 may include multiple microprocessors 122. Similarly, the memory of the controller 100 may include multiple RAMs 124 and multiple program memories 120. Although the I/O circuit 126 is shown as a single block, it should be appreciated that the I/O circuit 126 may include a number of different types of I/O circuits. The RAM(s) 124 and programs memories 120 may be implemented as semiconductor memories, magnetically readable memories, and/or optically readable memories, for example. All of these memories or data repositories may be referred to as machine accessible mediums. The controller 100 may also be operatively connected to the network 32 via a link 130.
For the purpose of this description and as briefly discussed above, a machine-accessible medium includes any mechanism that provides (i.e., stores and/or transmits) information in a form accessible by a machine (e.g., a computer, network device, personal digital assistant, manufacturing tool, any device with a set of one or more processors). For example, a machine-accessible medium includes recordable/non-recordable media (e.g., read only memory (ROM); random access memory (RAM); magnetic disk storage media; optical storage media; flash memory devices), as well as electrical, optical, acoustical or other form of propagated signals (e.g., carrier waves, infrared signals, digital signals); etc.
The pharmacy 20 may have a pharmacy server 36, which includes a controller 140, wherein the pharmacy server 36 is operatively connected to a plurality of workstations 150 via a network 152. The network 152 may be a wide area network (WAN), a local area network (LAN), or any other type of network readily known to those persons of ordinary skill in the art. The workstations 150 may also be operatively connected to the network server 30 as illustrated in
Similar to the controller 100 from
The workstations 150 may include a display 154, a controller 156, a keyboard 160, a barcode reader 164 (either stationary or portable and either wired or wireless), as well as a variety of other input/output devices such as an RFID tag reader, a mouse, touch screen, track pad, track ball, isopoint, printer, card reader, voice recognition system, a keypad, a biometrics device (such as an iris reader or fingerprint scanner), etc. With regard to the barcode scanner 170, as discussed below, this device may be eliminated in some of the disclosed embodiments. Each workstation 150 may be signed onto and occupied by a pharmacy employee to assist them in performing their duties. Pharmacy employees may sign onto a workstation 150 using any generically available technique, such as entering a user name and password, using an ID card, or inputting biometric data. If a pharmacy employee is required to sign onto a workstation 150, this information may be passed via the link 152 to the pharmacy server 36 so that the controller 140 will be able to identify the signed on pharmacy employees and the corresponding workstation 150. This may be useful in monitoring the pharmacy employees' Treatment Authorization Request Form completion performance.
Typically, pharmacy servers 36 store a plurality of files, programs, and other data for use by the workstations 150 and the network server 30. One pharmacy server 36 may handle Treatment Authorization Request Forms from a large number of workstations 150. Accordingly, each pharmacy server 36 may typically comprise a high end computer with a large storage capacity, one or more fast microprocessors, and one or more high speed network connections. Conversely, relative to a typical pharmacy server 36, each workstation 150 may typically include less storage capacity, a single microprocessor, and a single network connection.
One manner in which an exemplary system may operate is described below in connection with a number of flow charts which represent a number of portions or routines of one or more computer programs. As those of ordinary skill in the art will appreciate, the majority of the software utilized to implement the routines is stored in one or more of the memories in the controllers 100 and 140, and may be written at any high level language such as C, C++, C#, Java or the like, or any low-level assembly or machine language. By storing the computer program portions therein, various portions of the memories are physically and/or structurally configured in accordance with the computer program instructions. Parts of the software, however, may be stored and run locally on the terminals 150. As the precise location where the steps are executed can be varied without departing from the scope of the invention, the following figures do not address the machine performing an identified function.
Referring to
In many situations a patient may be limited in the number of prescriptions that they may have filled in a particular time period by requirements established by the patient's healthcare insurance provider or a federal government agency such as Medicare. If the patient needs a prescription that exceeds the normal allotted number of prescriptions or a special prescription that requires special authorization, it may be necessary to fill out a Treatment Authorization Request Form. It should be noted that users may need to fill out an enrollment form for participation in the Treatment Authorization Request program as an initial matter.
As shown in the process flow 200, it may be determined if the prescription presented by the patient is fillable without a Treatment Authorization Request Form (block 204). If it is determined at the block 204 that the prescription is fillable without a Treatment Authorization Request Form, the pharmacy employee may fill the prescription (block 206) and the system may record the transaction data associated with the filled prescription in the program memory 120 or the Treatment Authorization Request Form database 34 or any other suitable memory (block 210).
If the pharmacy employee attempts to fill the prescription and it is determined at the block 204 that the prescription is not fillable without a Treatment Authorization Request Form, the rejection may be generated and a set of data associated with the rejection may be sent to a rejection que (block 212). It should also be noted that the prescription may be associated with a plurality of elements such as, for example, patient data and/or drug data.
The pharmacy may contact a prescriber associated with the prescription to obtain information for the Treatment Authorization Request Form. This information may include diagnosis description and medical justification for the prescription. Medicaid or any other authorizing agency may reject the Treatment Authorization Request if sufficient justification for the additional prescription request cannot be provided. Alternatively, prescribers may fill out a hard copy prescription pad or Treatment Authorization Request Form with the information on it, that includes specific services requested, and send this information with the patient to the pharmacy. A few examples of reasons for generating a rejection include: drug not covered, prior authorization needed, ingredient duplication, therapeutic duplication, invalid prescription denied, and coverage expired.
Once the prescription has been rejected, it may be retrieved from a rejection que (block 214). It may then be determined if the prescription is fillable by completing a Treatment Authorization Request Form (block 216). If the prescription is not fillable by completing the Treatment Authorization Request From, the prescription may be rejected (block 220), and the transaction data associated with the prescription attempted to be filled may be recorded in the program memory 120 or the Treatment Authorization Request Form database 102 or any other suitable memory (block 222).
Still referring to
A particular state may also be set as a default if more than one state Treatment Authorization Request Form is available and additional state Treatment Authorization Request Forms could be selected from a drop down menu. The selected Treatment Authorization Request Form may include a plurality of fields that correspond to at least a portion of the plurality of elements that may be associated with the prescription.
A Treatment Authorization Request control number may then be associated with the selected Treatment Authorization Request Form (block 222). The control number may be an alphanumeric code such as a sequence number. The control number may be given to the pharmacy by the authorizing agency in a predetermined fashion, or the control number may be automatically generated by the system and associated with the selected Treatment Authorization Request Form. At least a portion of the plurality of fields on the selected Treatment Authorization Request Form may be associated with at least a portion of the data set and the plurality of elements associated with the pharmaceutical prescription. In other words, the information associated with the data set and elements from the prescription is autopopulated into the plurality of fields on the Treatment Authorization Request Form.
Thus, the patient and prescription data and the Treatment Authorization Request Form are flattened and merged into an integrated file that is capable of being printed and transmitted such as, for example, via facsimile (block 226). The form can also be transmitted electronically as well, such as, for example, via email. It should be noted that before the data and the Treatment Authorization Request Form are merged, an image of the pharmacy manager's signature may be stamped on a signature line on the Treatment Authorization Request Form. Alternatively, a numeric authorization code, a digital signature, or any other electronic authorization could be applied to the completed Treatment Authorization Request Form to indicate an appropriate level of approval. Any form that requires the patient's signature could incorporate an electronic signature that was captured/submitted via the client device 80.
After the completed form has been stamped and flattened (converted to a stand alone file) it may be converted to a different format, such as, for example TIFF or PDF. The merged form may then be printed (block 224) and/or displayed for the pharmacy employee. The pharmacy employee or other such person associated with the pharmacy may then transmit the completed Treatment Authorization Request Form having the data associated with the patient and the prescription autopopulated and merged into the form to the appropriate authorizing party (block 230). The merged form would not necessarily need to be printed. The merged form could be transmitted directly from the electronic copy on the computer by facsimile or e-mail or any other electronic form of transmission. For example, the merged form could be converted to a PDF file for attachment to an e-mail message or transmission via facsimile without ever being printed.
Once the completed Treatment Authorization Request Form has been transmitted to the authorizing party, the completed form may be stored in a memory such as the program memory 120 or the Treatment Authorization Request Form database 34, or any other suitable memory. The pharmacy may then wait for the approval of the prescription from the authorizing party (block 232).
Once notification has been received from the authorizing party regarding the completed Treatment Authorization Request Form, it may be determined if the prescription has been rejected or approved (blocked 234). If it is determined at block 234 that the prescription has been rejected, it may be determined if the rejection is reversible (block 236). If it is determined that the prescription is rejected for a reason that is not reversible, the prescription will be rejected (block 240) and the transaction data associated with the rejection of the submitted prescription will be recorded in an appropriate memory (block 242). If it is determined at the block 236 that the prescription was rejected for a reversible reason, the user may edit the completed Treatment Authorization Request Form to correct the rejection errors (block 244). Thereafter, the process flow returns to stamp and flatten the modified data and the Treatment Authorization Request Form for a subsequent transmission to the authorizing party.
If it was determined at the block 234 that the prescription is approved by the authorizing party, the prescription may be filled (block 246) and the transaction data associated with the correct prescription may be recorded in an appropriate memory (block 250). It should also be noted that the completed TAR forms, whether approved or rejected, may be stored in a memory such as the Treatment Authorization Request Form database 34 for an indefinite period of time or for a predetermined period of time to facilitate refills for the prescription. In addition to the data set elements associated with the prescription that is associated with the plurality of elements from the Treatment Authorization Request Form, the system may also automatically populate an NDC-UPC field on a Treatment Authorization Request Form that is based on the drug name associated with the prescription.
The invention has been described in terms of several preferred embodiments. It will be appreciated that the invention may otherwise be embodied without departing from the fair scope of the invention defined by the following claims.
