In Outpatient Pharmacy, while preparing medications you can set the Quantity to Supply according to the patient's prescription but this might not always comply with the packaging presentations, which is the real amount that will be delivered and charged.
To improve this process and applying the insurance approval threshold onto this window, we have developed a new tool to round up the charges amount of supplied quantities according to the medication's presentation shown in UOM (does not apply for volume UOM); example 20 pills, 10 tablets, etc.
Here below you can see this new improvement in two different scenarios:
a) When total quantity is below volume quantity (units included in presentation):
In this example the patient will need a total amount of 4 suppositories but the presentation chosen comes with 10 suppositories so pharmacists will be preparing the whole blister with 10 suppositories:
In this same example the blister with 10 suppositories costs 8.10 SAR, automatically added to the Total Requested amount:
Note: To see more detailed information about the Limit Threshold, Total Requested and Total Charged fields, check this article.
The applied formula for this case is:
Round up (Total Quantity / Volume Quantity)
Where:
Total Quantity is the amount of units to be delivered
Volume Quantity is the UOM standard measure that must be delivered for that quantity.
Example: If a box comes with 10 pills and the patient requires 10 pills then that amount will be rounded to one box.
b) When total quantity is above or equal to volume quantity :
In this example the patient needs 55 suppositories, and the parmacist selected the suppository presentation instead of blisters:
The insurance company will be charged for six blisters, which is the amount of blisters that cover that amount of medication and it was automatically added to Total Requested line below Limit Threshold:
Note: To see more detailed information about the Limit Threshold, Total Requested and Total Charged fields, check this article.
The formula applied for this case is:
Round up ( Volume / Total Quantity )
Where:
Total Quantity is the amount of units to be delivered
Volume Quantity is the UOM standard measure that must be delivered for that quantity.
Example: If a box comes with 10 pills and the patient requires 9 pills then that amount will be rounded to one box. If the same patient requires 15 pills then it will be rounded to two boxes.
We hope this improves your Cirrus experience. Remember to share this information and ask for help if you need it.
Date: March 14, 2022.