Supply Guide - e-MASS

Publication 1 / 2016
Supply Guide
2016
Table of Contents
Table of Contents
1.0
INTRODUCTION
1
2.0
SCREENING AND DISPENSING OF MEDICATIONS
1
1. VALIDITY OF BORANG PERUBATAN 1/09
2. DISPENSING OF MEDICATIONS
2
3
GUIDELINES TO SUPPLY RESTRICTIONS
4
1. RESTRICTION ON PRESCRIBER
2. RESTRICTION ON DRUG FORMULARIES
3. RESTRICTION ON SUPPLIES – MEDICATIONS, SUPPLEMENTS
& MEDICAL EQUIPMENTS
4. RESTRICTION ON DOCUMENTATION
4
5
6
ADDITIONAL RESTRICTION
8
3.0
4.0
7
Introduction, Screening & Dispensing | 1
1.0 Introduction
This OratisRx Supply Guide covers important guidelines to assist OratisRx
Providers to provide pharmacy services to patients of OratisRx Agencies under the
e-MASS System, and subsequently prepare and submit claims for reimbursement.
This document is an Addendum to the OratisRx Provider Manual, which is an extension
and forms part of the OratisRx Provider Agreement.
Our OratisRx Provider Liaison Department at 03 – 5522 8600 can be contacted for more
information or if further assistance is required.
2.0 Screening & Dispensing of Medications
1.
Eligible patients under the e-MASS System are entitled for supplies (medications
& medical devices) which are not available at the prescribing KKM / University /
Army hospitals. These supplies are however, strictly subjected to rules and
regulations as outlined in Surat Pekeliling Perkhidmatan JPA Bilangan 21 Tahun
2009.
2.
Providers must confirm eligibility status of the patient via the e-MASS Portal by
either patient’s IC Number, Pension Account Number, Nombor Tentera or other
relevant identification presented. If the patient is;
i.
Eligible: proceed with supply.
ii.
Not eligible: no supply under e-MASS System. Kindly advice patient
on non-eligibility.
Please contact OratisRx for assistance in cases of eligibility
disputes, or other related matter.
The Requirements | 2
These are mandatory requirements to be fulfilled before any supplies can be dispensed out:
REQUIREMENT
DESCRIPTION
Eligibility Status
Must be eligible in the e-MASS Portal
Documentation
Prescriber
All documentations must be issued by government facilities of
KKM hospitals, University hospitals and/or Army hospitals:
1. Borang Perubatan 1/09
2. Prescription
3. Quotation (for medical device)
Pegawai / PakarPerubatanKerajaan
Hospital
Hospital / Klinik Kerajaan of (KKM, University&Army hospitals) only
Restrictions
Medications :
Must be listed in Drug Formularies of prescription-issuing
hospitals of:
1. KKM hospitals
2. University Hospitals (PPUM, PPUKM, HUSM, PPUITM)
3. Hospital AngkatanTentera (HAT)
Duration of supply
Medical Device :
Restricted to listed medical device * Refer to Appendix 3b
As prescribed or for a maximum of three (3) months’ supply
1. Validity of Borang Perubatan 1/09
1.
Validity of Borang Perubatan 1/09 refers to and follows the duration of
accompanying prescription e.g. when a prescription’s duration is 6 months,
hence, Borang Perubatan 1/09 is valid for the same duration of six months;
2.
If there is no duration stated in the prescription, the default validity for both
prescription and Borang Perubatan 1/09 is three (3) months;
3.
Maximum duration is one (1) year or twelve (12) months
Screening & Dispensing of Medications | 3
2. Dispensing of Medications
1.
Duration of supply refers to the prescribed duration andMUST NOT exceed
maximum duration of three (3) months at any one time.
2.
For cases of prescriptions with duration of three (3) months or more, partial
supplies of maximum three (3) months duration, are to be undertaken for
each transaction.
3.
Partial supplies :
4.
•
When a patient presented to the Providers a valid prescription
for the duration of one (1) year, partial supplies of maximum
duration of 3-months to be executed (Supply #1) and repeated
every 3 months until completion of the prescription
•
Original copies of e-MASS documents for Supply #1 must be
retained by Provider and submitted to OratisRx for
reimbursement
•
A set of duplicate copy to be returned to the patient for
reference on the balance supplies until prescription is completed
•
Subsequent partial supplies after the first partial-supply are to be
executed with duplicate copies of Borang Perubatan 1/09 and
prescription.
Overlapping of prescriptions : If a patient is issued with a new prescription
within the duration of the earlier prescription for the same item(s);
a.
The first (earlier) prescription becomes void. Further supplies
must be in reference to the new prescription.
b.
Supply for this latter prescription must follow duration and
quantity as per the latter prescription.
c.
Claims for reimbursement for overlapping supplies will not be
processed and rejected.
5.
Quantity of supply must refer to the date prescription is presented at the
Community Pharmacy until the prescription expiry date i.e. Dispensing Date
until Prescription End Date, regardless of the quantum not yet supplied prior
to date of presentation at the Community Pharmacy.
6.
Patients should be adequately counselled on their medications and ensure
maximum patient compliance.
7.
Dispensing of medications must be executed according to the rules and
regulation governing the pharmacy profession with clear labelling
requirements.
Guidelines to Supply Restrictions | 4
3.0 Guidelines to Supply Restrictions
Although supplies under the e-MASS System generally allows medications to be
dispensed and reimbursed based on Surat Pekeliling Perkhidmatan Bilangan 21 Tahun
2009, these restrictions apply:
1.
2.
3.
4.
RESTRICTION ON PRESCRIBER
RESTRICTION ON DRUG FORMULARY
RESTRICTION ON SUPPLIES
RESTRICTION ON DOCUMENTATION
Successful claim processing and reimbursement depends heavily on compliance of the
above. Transactions and claims for reimbursement received with any possible breach of
the above restrictions will risk rejection and non-payment.
In the event of doubts on the above restrictions, Providers are strongly advised to
communicate with us preferably, before executing supplies:
OratisRx Operation Div, Community Pharmacy OperationUnit (CPO):
•
•
•
•
Nuredayu Hana
Nur Azidah
Zarifah Husna
Shahidah
[email protected]
[email protected]
[email protected]
[email protected]
1. Restriction on Prescriber
Prescription and Borang Perubatan 1/09 must be signed by Pegawai /Pakar
Perubatan of government hospitals (KKM/University/Army) only.
It is important that the prescriber’s practicing department is related to patient’s
diagnosis and prescribed medications.
Guidelines to Supply Restrictions | 5
2. Restriction on Drug Formularies
Due to the different drug formularies and internal prescribing restrictions among
hospitals, Providers must refer and adhere to formulary restriction table below
PRIOR APPROVAL
BEFORE SUPPLY FROM
ITEMS LISTED IN FORMULARY OF
PRESCRIPTION
ISSUED BY
KKM
PPUM
PPUKM
HUSM
PPUITM
HAT
IJN
KKM
OK
-
-
-
-
-
-
PPUM
OK
OK
-
-
-
-
-
PPUKM
OK
-
OK
-
-
-
-
USM
OK
-
-
OK
-
-
-
Bhgn Perkembangan
Perubatan, BKP, KKM
PPUITM
OK
-
-
-
OK
-
-
Bhgn Perkembangan
Perubatan, BKP, KKM
HAT
OK
-
-
-
-
OK
-
IJN
OK
-
-
-
-
-
OK
REMARKS
Bhgn Perkembangan
Perubatan, BKP, KKM
Pengarah, PPUM
(assigned to Ketua Jab
Farmasi, PPUM)
Pengarah, PPUKM
(assigned to Ketua
Jabatan Farmasi PPUKM)
Bhgn Perkembangan
Perubatan, BKP, KKM
Jabatan Hal Ehwal
Veteran (JHEV)
Bhgn Perkembangan
Perubatan, BKP, KKM
Special Restrictions : Pusat Perubatan Universiti Malaya (PPUM)
1.
When prescribed medication(s) is not listed in the Drug Formularies of both
PPUM and KKM, supply can be only executed with the condition that the
Pengarah of PPUM (assigned to Ketua Jabatan Farmasi) has endorsed the
Bahagian V of Borang Perubatan 1/09.
2.
The Pharm UMMC routinely ensures that all e-MASS documents have been
thoroughly screened and completed before issuing out to patients.
3.
If Providers are presented with incomplete Bahagian V of Borang
Perubatan 1/0
•
Please direct patients back to Pharm UMMC to completion of screening
and fulfillment approval requirements by PPUM.
•
Supplies must be put on hold until documentation is completed.
•
Providers can seek assistance and communicate with Pharm UMMC or
OratisRx via OratisRx OperationDiv, CPO Unit:
(Nuredayu Hana&Zarifah Husna)
•
Claims for reimbursement may risk rejection and not processed for
supplies made with incomplete documentation.
Guidelines to Supply Restrictions | 6
Special Restrictions : Pusat Perubatan Universiti Kebangsaan Malaysia
(PPUKM)
1.
When prescribed medication(s) is not listed in the Drug Formularies of both
PPUKM and KKM, supply can be only executed with the condition that
Pengarah PPUKM (assigned to Ketua Jabatan Farmasi) has endorsedthe
Bahagian V of Borang Perubatan 1/09.
2.
All prescriptions issued out to patients under e-MASS System
undergo mandatory central screening by Kedai Farmasi NF to ensure that all
documentations are completed before handing over to patients.
3.
PPUKM, strictly do not entertain any request to complete documentation
(verification by Pengarah PPUKM). Therefore, please check thoroughly before
dispensing to minimize delays or rejections at the point of reimbursement.
Special Restrictions : Hospital Angkatan Tentera
1.
2.
Prior Authorization required for all supplies (medications and medical device)
to Veteran ATM Tidak Berpencen.
Supplies to Army Veterans are subjected to notifications issued out from time
to time.
*Please refer to the Appendix 3a for detailed restriction
Guidelines to Supply Restrictions | 7
3. Restriction on Supplies - Medications, Supplements
& Medical Equipments
Dispensing of medication under e-MASS system refers to the
“Panduan Pelaksanaan Peraturan Permohonan Perbelanjaan
Kemudahan Perubatan”
of
“Pekeliling Perkhidmatan Bilangan 21 Tahun 2009:”
BAHAGIAN B: PERMOHONAN PERBELANJAAN BAGI PEMBEKALAN UBAT
1.
Syarat-syarat dan peraturan-peraturan bagi permohonan perbelanjaan
bagi pembekalan ubat adalah ditetapkan seperti berikut:
(i)
Perbelanjan bagi pembekalan ubat yang diperaku (prescribe) oleh
Pegawai Perubatan Kerajaan (PPK) dan disahkan tidak dapat
dibekal / disediakan oleh hospital / klinik Kerajaan boleh
dipertimbangkan dengan syarat ubat tersebut disenaraikan di
dalam senarai ubat-ubatan KKM / hospital university;
(ii)
perbelanjaan bagi pembekalan ubat yang tidak disenaraikan di
dalam senarai ubat-ubatan KKM/ hospital universiti boleh
dipertimbangkan dengan syarat penggunaan ubat tersebut
hendaklah terlebih dahulu mendapat kelulusan daripada BPP.
KKM (bagi rawatan yang diperolehi di hospital/ klinik dibawah
KKM) atau Pengarah hospital universiti (bagi rawatan yang
diperolehi di hospital universiti)
(iii)
permohonan perbelanjaan untuk pembekalan ubat yang
melibatkan keperluan penggunaan bagi suatu tempoh yang
berpanjangan adalah dibenarkan. Walau bagaimanapun,
kelulusan oleh Ketua Jabatan hendaklah tertakluk kepada had
perbelanjaan bagi pembekalan ubat yang melibatkan keperluan
penggunaan untuk tempoh tiga bulan sahaja bagi setiap
permohonan
*Please refer to Appendix 3b for detailed restriction of medication supplies
Guidelines to Supply Restrictions | 8
4. Restriction on Documentation
1.
Providers must ensure that all documentations are completed before
dispensing.
2.
Incomplete or wrongly filled documentations will result in delays
reimbursement and possible total rejections.
Borang Perubatan 1/09
NO
1
2
DETAILS
Butiran Diri Pegawai/Pesara:
• Borang 1/09(T)
• Bahagian I (No. 1-8)
4
All columns filled completely
Pengesahan Pesara :
•
3
REMARKS
Signature of Pesara
Bahagian III, No. 14
PerakuandanPengesahanolehPegawai
/ PakarPerubatan :
•
Bahagian IV, No. 15-18
•
Bahagian V
No. 15-17 : Mandatory to be filled
No. 18 : Doctor’s signature with
clear and legible official stamp
Mandatory if relevant
Prescription
NO
1
2
DETAILS
Overall document
Mandatory details
REMARKS
Providers must ensure that the prescription is
valid from the issuing hospital
•
•
•
•
•
Date
Prescription Serial No.
Medications Name, dosage form, dose,
frequency and duration prescribed.
Prescriber’s signature
Clear and legible official stamp for prescriber’s
and issuing hospital details
Additional Restrictions | 9
4.0 Additional Restriction
Requesting for Prior Authorization
Prior Authorization is mandatory for these;
1.
2.
3.
4.
Prescribed medication(s) not listed in the Drug Formularies of KKM,
ATM and/or University hospitals.
Prescribed medical equipment/device(s) other than as stated in the
Pekeliling Perkhidmatan Bil. 21 Tahun 2009
All enteral and nutritional products.
Items as listed in APPENDIX 3a – JHEV Supply Policy
Steps to request for Prior Authorization;
1.
Ensure that patient is eligible under the e-MASS System.
2.
Submit to OratisRx via email:
i.
ii.
iii.
iv.
Borang Perubatan 1/09,
Prescription,
Quotation of items to supply,
Justification letter (if relevant).
3.
OratisRx process and forward to Bhgn Pasca Perkhidmatan (BP, JPA),
Unit Perubatan JHEV and Bhgn Perkembangan Perubatan (BPP, KKM)
(whichever is relevant). Please allow 4-8 weeks for completion of
process.
4.
BPP, KKM notifies BP, JPA and later would inform OratisRx on the
outcome.
5.
Providers would be notified by OratisRx on the outcome and to
proceed with supplies
Limitation on Quantity & Brand
Limitations on the maximum quantity limit dispensed and brands limitation is
applicable for selected items
Please refer to the Appendix 4a for detailed listing
Limitation on Stoma Care Preparation
Please refer to provided Stoma Care Supply Guideline attached i.e. Appendix 4b