Healthcare Insurance for D365 Finance & Supply Chain
by The Solution Consulting FZCO
End to End solution for Healthcare Insurance
Pharma 365
Pharma 365 is a digitalized pharmaceutical solution that leverages advanced technologies to enhance the efficiency, accuracy, and overall functionality of pharmacy operations. By implementing Pharma 365, businesses can improve operational efficiency, reduce errors, enhance customer service, and ultimately contribute to better health outcomes for patients. Pharma 365 contains various tools and systems designed to streamline and enhance the operations of a retail pharmacy.
The application is built on Dynamics 365 ERP as an add-on, utilizing the robust integration capabilities of Dynamics 365 in Finance-Operation and Commerce.
Pharma Modules:
- Point of Sale: Dynamics 365 Store Commerce is customized to provide all the necessary functionality to run pharmacy operations. Combined with the inbuilt capabilities of Dynamics Commerce, our solution helps businesses streamline and enhance various aspects of pharmacy operations.
- Patient 360: Maintains detailed patient profiles, including personal information, contact details, medication history, allergies, and preferences.
- Patient Timeline: Records personalized conversations and activities in one place, empowering pharmacists to provide personalized experiences to customers.
- Prescription Tracking: Records all prescribed medications, dosages, refill dates, and instructions.
- Medication History: Maintains a complete history of all medications dispensed to a patient, including any changes or discontinuations.
- Refill Reminders: Sends automated reminders for patients to refill their prescriptions.
- Insurance Billing: Captures accurate data from manual prescriptions or eRX and creates transactions for the approval process
- Manages prior requests and prior authorizations: System integrates with health authorities to perform these tasks
- Medicine Dispense: Process compliance with respective health Authority.
- Billing: Conclude the billing by collecting the required Co-pay amount from the Patient.
Insurance Revenue Cycle Management: Effective revenue cycle management (RCM) is crucial for a pharmacy's operations, encompassing the entire process of handling claims from patient intake to final payment. It ensures timely reimbursement, reduces errors, and enhances financial performance.
- Claims Generation: Automates the generation of insurance claims based on captured prior authorizations.
- Claims Scrubbing: Identifies and corrects errors before submission through pre-submit claims scrubbing.
- Claims Submission: Electronically submits claims to insurance payers.
- Automated Posting: Automatically posts payments received from insurance payers to the corresponding patient accounts.
- Remittance Advice Processing: Reconciles payments with remittance advice to ensure accuracy.
- Claims Resubmission: Resubmits claims to insurance payers if necessary.
Financial Reporting: Generates comprehensive financial reports to monitor revenue cycle performance.
- Key Performance Indicators (KPIs): Tracks KPIs such as claim denial rates, days in accounts receivable (A/R), and collection rates.
- Trend Analysis: Analyses trends in denials, payment delays, and reimbursement rates to identify areas for improvement.
Pharma365 Integration Capabilities:
- HIS Integration: The system is capable of integrating with HIS systems. Provide APIs to integrate patients, prescriptions, and basic masters. Businesses can integrate with any clinics and hospitals, and based on the mapping, orders will be available in the Commerce POS for processing and delivery to customers.
- E-Commerce and Telehealth Integration: Offer a close integration solution with e-commerce and telehealth solutions. The system architecture allows for the extension of any marketplace channel integration, specifically for prescription upload and eRX processing.
- Credit Card Payment Gateway Integration: Integrated with many regional payment gateways in the Middle East.