MaxCare eRx Provider Training

Venturing into the world of paperless claims

e-Prescription initiative is the computer-based electronic generation, transmission and filling of a medication prescription, taking the place of paper prescriptions (Mandatory from 01.01.2014). In Dubai, e-prescribing would allow a Provider\Clinician to electronically transmit a prescription to the DHPO\eRx Hub (via OP Max; a software by MaxCare ME), getting coverage feedback from MaxCare ME real-time before the patient leaves their office. Later when the patient will visit the Provider\Pharmacy, the pharmacist will download the prescription electronically and obtains coverage authorization from us, at time of dispensing the medication, real time.

We are one of the few TPAs to have valid license, well-compliant with all the norms. Our software- OP Max is integrated with eRx and eClaim as per the DHA’s requisite. We held training for our providers in several batches during the 1-month testing environment, provided by DHA. In our training, we have elaborated about functioning of eRx module integrated with OP Max.

Venturing into the world of paperless claims

We have worked out a simplified user interface. The flow is as follows:

  • As soon as the patient visits the physician, physician will post e-prescription on eRx module of OP Max, with all the relevant details made mandatory by DHA.
  • Then a token number generated by the system, will be given to the patient.
  • Then the patient will go to a pharmacy (with-in MaxCare’s network) and will give e-prescription token number to pharmacist.
  • Pharmacist will enter this token number in OP Max module to see prescription by physician. He will further enter rates and submit to MaxCare ME for approval.
  • Approval will be given with-in a 30- 60 seconds on real time basis.

Pictorial representation as below

Advantages: Decreased
  • Prescribing mistakes: It will ensure error-free, accurate, comprehensible prescriptions
  • Dispensing mistakes
  • Frauds
  • Waste
  • Abuse
  • Waste-time at provider: As there will be no calls, faxes from provider to MaxCare ME and vice-a-versa
  • Pharmacy physician calls
  • Claims submission time
  • Payer-provider calls
  • Patient’s safety
  • Health outcome
  • Information accuracy
  • Effective communication
  • System efficiency
  • Control on resources
  • Transparency
Goals of incorporating eRx with OP Max:
  • Minimize medical mistakes in prescribing and dispensing.
  • Reduce fraud, abuse and waste.
  • Monitor drugs utilization more efficiently in Dubai.
  • Reduce patients’ wait time at Provider\Pharmacy significantly.
  • Inform patients about insurance coverage at Provider\Clinician office and Provider\Pharmacy real time.
  • It will enable sharing of prescriptions among different medical entities across the emirate in a swift manner
  • At one click only, the xml file of a particular provider, of a given month will be uploaded at DHPO from OP Max
  • This will enable us to pay our providers in a very short time

All Providers should claim only through eClaimLink to all payers.