The following answers to "Frequently Asked Questions" are provided to the inquiring prospective user of the family of TeleCLAIM software systems as a quick overview.

• Can a micro-based system be capable of at least 2 million claims per month without time-outs and slow response?
• Can TeleCLAIM expand its transaction capacity to more than 3 million claims per month?
• What platforms are used and supported under TeleCLAIM?
• How does the use of INTEL technology benefit the user?
• How does the software employed in the system contribute to the system efficiency?
• Are backup provisions included for fast Recovery-Restart?
• Are there any extraordinary and special data protection features in the system?
• Can TeleCLAIM be maintained locally and remotely, and how?

• Are all the functional characteristics of Mainframe systems included with TeleCLAIM?
• Do I have the commercial capabilities of the mainframe versions of Managed Care adjudication provided by PBMs like PCS, Express Scripts, Merck-Medco, etc.?
• Does the TeleCLAIM system include DUR (Drug Utilization Review)?
• Will I have the ability to accommodate all users of the systems including inquiry access for pharmacies, physicians and administrators?
• Does TeleCLAIM offer a superior version of Formulary management and controls?
• Does TeleCLAIM provide for Mail Order processing concurrently with regular and customary adjudication and processing claims?
• Is the system provided with comprehensive administrative and analytic tools for management of the Benefit Plans?
• Do the system reports follow any hierarchy of controls for ease of tiered accounting and reconciliation?
• What Managed Care features are provided that will help contain costs?
• Does the "PlanBuilder" module offer commonly used Managed Care controlling techniques popular in Managed Care environments?
• What if PlanBuilder does not do something I need for my Plan?
• What does the TeleCLAIM system do to assist the Help Desk perform efficiently?
• When do the month-end financial and administrative reports get created?
• How much transaction history is kept online for access, if necessary?

Yes. The TeleCLAIM system’s original architecture was created over a decade ago with Intel 386 and 486 microprocessors. It was important then for DP/Rx to optimize the use of processing resources by breaking the important functions into a balanced distribution of processing. That resulted in tying three or four computers together with fast transfer rates, each operating simultaneously for the major functions of transaction-communication management ("FEP"), adjudication ("Adjudicator") and administrative functions on a server that is capable of inquiry, update and fast HD storage of major data files ("Multi-function Services processor"). This simultaneous shared interaction between connected processors is called "parallel processing".

Today with 2 GHz processors and 10,000 rpm HD, the systems can receive and dispatch a transaction in less than 0.10 second (36,000 per hour). With DUR suspended, even faster.

Yes. At the current time (circa 2002), existing micro hardware and HD enable attainment of 3 million transactions per month. Each year there are hardware advancements that will further increase TeleCLAIM transaction capacity and in those cases an upgrade in hardware may significantly increase capacity. When it is not enough for user needs, the FEP is designed to interface with multiple adjudicators to almost double the standard capacity.

All Windows platforms have been implemented and/or tested. The latest Windows platform that has the longest period of reliable operation is Windows NT. This latest version follows five years of production implementation. Windows 2000 has been tested and is prepared for release when the company determines that performance is improved over NT. Servers interfacing the Internet employ Linux.

The engineers of DP/Rx believe that the system software can be implemented under the RISC6000 family of AIX operating systems without a major overhaul of the application software.

The TeleCLAIM hardware approach enables a robust flexibility for DP/Rx and the user by employing the most dominant technology. It gives us all the software technology of developers such as Microsoft, Oracle, and all the majors who will be in business for many years.

As to the hardware, each year that passes brings to the user more speed and capacity at lower and lower prices. When compared to the IBM or Sun Systems, the rigid compliance required with their own software greatly limits flexibility. When comparing cost, a complete system with a capacity of 3 million claims per month can be purchased for less than $15,000 USD. This is far less than comparable competitive alternatives.

Finally, the Window’s world of INTEL processors provides a wide breadth of options for the user and developer with a great number of economical application packages and utilities to choose from.

The architects of the TeleCLAIM system established several criteria for software used in the development and maintenance. Development and testing must be robust in tools and ease of use, Maintenance and enhancements must be easy to do by secondary personnel. Object code execution must be advantageous rather than cumbersome. And that any software employed would have a long expected life and be supported by companies that would survive in the industry.

You will find the following software in our systems: SQL, COBOL, C++, Visual Basic, Crystal Reports, PHP and several other special purpose utilities.

Yes. Automatic, daily, late evening backup is recommended and provided by TeleCLAIM with high-speed, high-density tape devices. The company recommends that a 14-day rolling-backup archiving be strictly enforced to ensure continuity of processing of a 24x7 operation. There is a remote possibility that a failure occurs due to any number of circumstances: loss of power; HD failure; unauthorized interruption of operations, etc.; therefore, observance of protective measures is a worthwhile regimen for the minimization of problems emanating from a system failure.

The company strongly recommends that redundant computers be kept in close proximity to the main processors. These redundant systems should be kept up-to-date with system programs.

Yes. Each of the individual processors keeps history of the transactions processed. The FEP (Front End Processor) keeps several days of transaction data; the Adjudicator keeps all month to date transactions; and the Multi-function Server keeps all transactions processed right up to the last one processed. Consequently, it is virtually impossible to lose any current data with any one or two catastrophic component failures. And, of course, longer-term data is secured by archiving on tape each evening.

Yes. The TeleCLAIM system at the local level provides access to all data files that are maintained real-time. This is accomplished by the Windows NT LAN version that enables work stations connected to the Multi-function Server containing all major files.

Yes. The TeleCLAIM system was one of the first package systems available to the pharmacy business. Its predecessor was an IBM 360 package that was developed for the AT&T computer division in 1987.

This system was really the functional development of Managed Care Pharmacists who contributed the vast array of algorithms and techniques that were selected for support of the original formulary approaches for cost containment objectives of Managed Care institutions.

The user will find more flexibility in the wide array of options for plan design than he or she employs. This is due to the various techniques provided for many different organizations whose non-standard algorithms are all contained in the multi-faceted Plan Builder. Some users have even asked DP/Rx to remove some functions for simplicity.

Yes. The TeleCLAIM system is the accumulation of ten years of innovative customization by demanding MC users for their particular resulting in an evolution of incremental development. Several of these users were PBMs that required special treatment for multiple customers operating in the same platform.

DP/Rx determined early in this development that it must provide a simple to use scheme of building benefit plans. DP/Rx devised an approach using parametric tables to enable execution of highly generalized algorithms accommodating most requirements requested.

DP/Rx understood that the most likely individual creating and administering Benefit Plans would be a pharmaceutical clinician or a general pharmacist. The resulting tool was called PlanBuilder and it is designed to enable non-programmers to define a benefit plan by true and false or Yes and No responses and simple designations of quantity, price and percentage.

PlanBuilder, operated off-line, was developed to create a parametric table for each plan execution. Therefore, similar plans are created by copying the base plan and modifications are inserted for rapid deployment of many plans.

Yes. DUR is provided as an optional feature. Presently the system operates this function with Medispan’s DUR database and has done so for 8 consecutive years. Since a separate, connected processor executes the DUR calculations in parallel to adjudication this function does not add any significant time for overall Rx execution.

Users that prefer FirstDataBank DUR can be accommodated with a special installation basis on a T&M arrangement with DP/Rx.

Many users believe that the DUR function should not usurp the role of the dispensing pharmacist. Consequently, DP/Rx treats DUR as an option thereby enabling some savings in the maintenance license.

Yes, with all the tools we provide for maintenance and inquiry and an easy method for users to customize system interaction by a plethora of commonly available software tools provided for Windows’ systems.

For the Administrator we have "PlanBuilder" and "SimPlan". The latter module is for preventing very costly mistakes executing new Plan creations or changes. SimPlan enables safely changing the data by allowing a simulation of adjudication to see if adjudication results provide the anticipated results by using the active data files. The TeleCLAIM system allows real-time modification to all data files and plan files so one must be careful to not deploy any modifications that are not fully checked.

For the executive, pharmacist and the Physician, DP/Rx provides a connected and separate system called "TeleVISTA" for access to all need-to-know data for authorized professionals via the Internet. Any individual with a personal password can access the system 24x7 from the office, home or any site that has Internet accessibility. Over 30 dynamic reports are available for up-to-date perusal of the organized data formulations for analysis and administration. "Dynamic" means that each report is constructed real-time with the latest data.

Absolutely, Yes. The TeleCLAIM system was an early pioneer in the development of Formulary management of any drug program. The design was based on the Positive and Negative scheme of controls. The system can globally or selectively include drugs, the "Positive", and enables globally or selectively exclude drugs, the "Negative".

A global over-ride is also provided to make a Formulary very easy to implement and maintain. The user can exclude all (global) drugs of one classification and then develop a list of exceptions or one exception. This plan technique can save hours of creation and maintenance time because it negates the need to mark the many exclusions to make, one-by-one, while bypassing the few exceptions that need to be included.

Yes. TeleCLAIM provides for integrating a Mail-Order system into the customary adjudication process. Of course, the cost savings benefits for the Sponsor and the Recipient of Mail-Order inure to the user by providing methods of easily defining the separate parameters necessary for this different treatment within the same plan.

Yes. The TeleCLAIM system provides over 30 of the most commonly used industry reports for the administrator, for executives, for physicians and for pharmacy managers.

These reports provide detail and summary reports that have corresponding graphical representations for easy analysis when needed. These reports may be off-loaded onto CDs for distribution and archiving if desired.

Another feature of the system is the export data function that allows the user to off-load large data files in a standard format for the development of Ad-Hoc reports for special purposes.

These reports provide analysis of utilization by patients, physicians, pharmacies, by drug, by drug groups and other aspects that enable measurement of dispensing effectiveness. Moreover, whenever essential measurement figures, like PMPM (Cost per person per month), can be inserted into a report to expand its utility, it is done.

Yes. The TeleCLAIM system follows a four level hierarchy of controls. Starting with the patient-member, the next level is the "Group" that the member is attached to ordinarily operating with the same Benefit plan. (Although one member can constitute a group with a special plan definition.)

Next is the "Account" level, which is comprised of attached Groups that will aggregate in the designated Account. Finally, the fourth level is the "Company" level. This is an aggregate of the attached Accounts.

At all levels there is no need for identification to be indexed. Any random identification may be used.

Managed Care fundamentally controls Fraud, Abuse and Waste. The real-time, online aspects go a long way to immediately reduce drug benefit costs if the prospective user is currently using post-facto paper scripts for pharmacy reimbursement.

The sophisticated tools of TeleCLAIM address the next level of controls that also contain drug costs and improve outcomes.

The management of a Formulary regimen is the first cost containment strategy employed. The benefit program can designate those drugs they will allow and those not allowed by use of the Formulary. Additionally, the administrator may exclude non-essential pharmaceuticals from the plan as a class exclusion or individually. The less-than-aggressive administrator will use a soft Formulary that allows certain high cost brands but attaches a more expensive co-pay to influence substitution of the Brand.

The next most effective containment procedure employs a multi-tier co-pay incentive for moving Brand drug dispensing to Generics. Higher and higher co-pays are devised to influence a high degree of conversion to Generics if the Plan deems so.

Another effective containment measure for drug costs can be derived from limiting over-utilization. The TeleCLAIM system measures the dosage prescribed or recommended and refuses dispensing for a "refill too soon" condition. TeleCLAIM allows the patient to submit a Prior Authorization waiver to receive a drug before normal expiration of the last quantity dispensed.

After these high-impact containment measures, TeleCLAIM provides many more popular Managed Care initiatives that may be employed that also contribute to greater containment of costs. (See website details of these other measures: www.dprx.com.)

Yes. PlanBuilder is the "fill-in-the-blanks" scheme for easily created benefit plans that execute as a fixed algorithm during the adjudication process. The user simply checks off items, marks Y or N, fills in a price or percentage, or marks with an "X" something to be excluded. No mark ordinarily means an included default for the designated drug or procedure.

Each plan is unique by the identification that is given to it. TeleCLAIM can literally manage millions of unique benefit plans. There is no practical limit. A benefit plan can be reduced to one individual if need be.

Many of the inclusions and exclusions performed by the PlanBuilder may be global in nature for an entire class of drugs. Exceptions may be designated by one of the attached Appendices. These are really lists that exempt a global exclusion or inclusion by providing a list of one or more exceptions to the global control.

It can be asserted that the PlanBuilder is an accumulation of innovative techniques that represent all or most of the ideas administrators devised to minimize utilization while maximizing beneficial outcomes.

DP/Rx can customize the PlanBuilder for most special needs. The Maintenance contract indicates that ideas submitted for improved PlanBuilder capabilities will be implemented by DP/Rx with a non-exclusivity proviso. In those cases where the user requires exclusivity for a specific period of time or when DP/Rx believes the adaptation does not have a universal appeal, these adaptations will be developed on a T&M basis.

The TeleCLAIM system provides a vast portfolio of inquiry and maintenance screens for the TeleCLAIM user. Many evaluators of the TeleCLAIM system have indicated that the treatment is as good and in most cases better than alternative systems. The Help Desk attendant has readily and easily invoked modules for most Help desk On-line assistance tasks. The maintenance functions are real-time and provide immediate changes to the master files if desired.

Next day at end of month. The TeleCLAIM automatically commences month end processing for the reports designated (up to 30 different reports; 16 standard). The user can off-load the print files and transport to other high-speed printing devices, create CDs for distribution or be prepared for Email delivery to designated recipients.

An important feature of the TeleCLAIM system is to export claims data files in a common format (e.g. – dBase) for ad hoc or special printing preparation. Crystal reports can be used very effectively in this capacity.

As many years as you wish to keep available and is practical. Three years is ordinarily adequate for most companies for use in comparative analysis or for search of member history for re-enrollment.

It was mentioned earlier that all transaction data is archived to tape as an ordinary and regular system function. This enables rapid and accurate restore and restart procedures for assured continuity of operation.

Short cycle safety measures are built-into the TeleCLAIM processors. Each keeps at least several days or month-to-date history in the event any one of the processors has a catastrophic failure that prevents recovery of data.

The Front End Processor connects with the pharmacies and other functionaries for Rx submissions and inquiries. The "FEP" is TCP/IP compatible and is flexible enough to be adapted to most protocols if necessary.

No additional adaptation needs to be performed to the FEP for POS software that is compliant with NCPDP v1-v3 standards. Other protocols are usable with adaptation.

For remote sites that do not have the data connectivity used in high-density environments there is an DP/Rx Internet product that uses the regular TeleCLAIM system for adjudication. This product is called "TeleRx" and requires a second server operating under Linux. This web-enabled application needs only a web browser to send/reverse a claim. This facility for remote areas will not require any in-store-management software at the POS site; however, the user may also interface with the TeleVISTA Internet product to have access to reconciling data of Rxs recorded as dispensed for the pharmacy using TeleRx.

Not as much as you might think. Most alternative system have NCPDP as a standard for data files and data communication formats. If this is the case, there may be variations in reports, which is a manageable project, that should be projected at 3 to 6 man-days per report

Another consideration is the screen layouts for language and currency differences from our three basic country standards of language (Spanish, Portuguese and English) and currencies (2 decimal and no decimal).

Variations from these basics should be guesstimated at three man-months for language alternatives. Currency is automatically provided for the known standards by specifying a system parameter.

DUR is another aspect of conversion. This consideration is determined only by the vendors for DUR databases. Ordinarily FirstDataBank or Medispan of the USA will quote a adaptation fee for countries where there is no existing DUR database.

The drug price database is another conversion consideration. This data file should be compliant with NCPDP standards. DP/Rx ordinarily programs conversion programs that take existing local databases to be NCPDP compliant. This task should be estimated at 1 to 2 man-months of programmer effort.

TeleVISTA is implemented on a separate processor that is connected to TeleCLAIM for rapid access to prescription data: current and historical. Over 30 reports with optional graphical portrayals are provided for the Administrator and executives. Other authorized individuals are restricted to only those reports that are on a "need-to-know" basis.

TeleVISTA therefore is available to responsible individuals in the benefit program including pharmacies and physicians. Consequently, and uniquely, everyone is seeing the same information on a timely basis. Since the system is Internet based using the MS Explorer browser all up-to-today data is viewable at the office, at home or anywhere where the Internet is available.

TeleQUEST is a product with a very special purpose – to enhance buyer conversion of Brand prescribed drugs to Generics by substitution.

This product performs a virtual adjudication that presents the results of a Brand Rx and displays the alternative substitution of a comparable Generic drug. This virtual process does not record the first results as a dispensed transaction. The pharmacist has an opportunity to have the member choose the drug that they wish given the option of two co-pays, which may be significantly different.

When the choice is made, one simple key invokes the chosen drug and records the transaction.

Some benefit sponsors may have clients in remote areas that are serviced by pharmacies outside commercial networks of data connectivity. TeleRx is an alternate adjudication process for dispensing drugs to benefit members for these remote clients. The processing is performed on the Internet under a controlling browser such as MS Explorer.

There is no data locally at the user premises as Rx data is recorded and stored at the Web Server, which can be accessed at any time by the remote users. TeleVISTA can then be used as the reporting tool for the TeleRx users. This Internet module enables the user to reconcile his recorded dispensing activity day-by-day, week-by-week or month-by-month.

The alternative to this option for the remote location is the paper script submitted for reimbursement after dispensing the drug.

Yes with TeleCHECK. This is an important option that assists Pharmacists attempting to serve a customer who does not have identification. It also can be used to determine the amounts remaining, if any, to satisfy a deductible figure or the remaining amount to have the maximum amount be exceeded.

All this can be automatically performed by touch tone phones. The Pharmacist will take a few letters of the last name and a birth date and find the member in the benefit program. A programmed, recorded message is compiled and returns to the pharmacist the answers to his inquiry. This feature is particularly valuable during off-hours when no Help Desk is operative.