Modules included in our solutions

Allegra's Software solutions consist of different modules which can be combined to form a solution tailor made for your business requirements. Below you'll find a table explaining which modules are included in our software solutions and below the table is a detailed explanation of each of the different modules.

ALLEGRA DISPENSING MODULE

The Allegra Dispensing module is a retail pharmacy management solution that was developed from a pharmacist’s perspective, which was the direct result of many years of collective experience in patient care solutions within Allegra. The Allegra Dispensing solution assists in:

  • the management of multi-branch pharmacy groups,
  • keeping processes consistent,
  • inventories low
  • and profitability high.

The Allegra Dispensing module optimizes operational workflows, centralizes administration and automates repetitive functions to reduce multi-branch complexities performed by pharmacists and admin staff. The Allegra Dispensing module frees your staff to care for your patients’ needs and allows pharmacists to practice pharmaceutical care profitably.

The Allegra Dispensing module isn’t merely a tool with which to dispense scripts, but also gives a detailed overview of the patient’s health record, which assists pharmacists in delivering optimal patient care. It allows you to manage a patient’s compliance, treatment, health risks, patient referral and much more.

In addition to that, you have an overview of the patient’s financial history. This gives you financial control at the point of dispensing, thus reducing your risk of bad debt. The automatic creation of debtor’s transactions and a view for any unpaid services or Rx levy prevents loss of income and enhances financial control that results in increased profitability.

The Allegra Dispensing module automates business processes such as:

  • transaction recording
  • chronic medicine management in pharmacies
  • real-time electronic data interchange between healthcare stakeholders
  • BI extracts
  • financial extracts

The Allegra Dispensing module is a retail pharmacy management solution that includes:

  • touch screen point of sale
  • dispensing
  • financial management system (including debtors and creditors management)
  • electronic remittance advise management
  • procurement, retail selling and promotion management
  • CRM including SMS and email, and
  • management reporting.

CONFIGURATION

Configuration of roles and profiles enable control, security and more efficient workflow as users are limited to functions and workflows as per job description. The system follows client’s business processes and it also reduces user’s resistance to change.

PATIENT PROFILES

Extensive customer database that can be used for:

  • management of medical aid, scheme and option
  • patient/debtor’s account and in line with FICA regulation
  • multiple address

Each patient is searchable as an individual and not reliant on the patient having knowledge of the main member, making finding the relevant patient a quick task.

All the patients’ information - including script, clinical and financial history - is visible on the landing screen.

One patient + One profile= One electronic health record = better care

PROCUREMENT AND INVENTORY MANAGEMENT

The Allegra inventory management module assists organizations in implementing their inventory management methodology centrally across a multi branch organization. The module also assists in ensuring compliance to standard operating procedures with regards to:

  • ordering
  • stock receiving
  • credit note management
  • stock take
  • stock on hand management
  • inter-branch stock movement
  • price and promotion management

The inventory management module, apart from stock receiving, allows for head office taking control of inventory investment management and the financial control over gross profit margins.

The Allegra inventory management module gives you the ability to monitor, plan and replenish the right stock at the appropriate time and correct price that results in minimizing the risk of:

  • stock shrinking
  • over and under stock
  • out of stock
  • dormant stock

POINT OF SALE

The Allegra touch screen Point of sale module assist business owners and managers to optimize cash management by:

  • secure login and transaction audit trails
  • cash management via double blind cash up procedure
  • cash consolidation banking procedure
  • account receipts
  • COD sales, tracking and payment management process
  • prevent loss of sales because clinic and dispensing sales are automatically charged to patient accounts and non-payments end up in patient statements that are issued to clients

FINANCIAL MANAGEMENT

The Allegra Financial module assists organizations to efficiently meet their operational financial needs through automated double entry recording of debtors and creditors transactions at receiving of inventory and at point of service. The automated recording of most transactions also reduces business risk as it reduces user intervention or error.

The financial module provides an electronic remittance advice processing function where electronic remittances are pushed to clients. The Automated reconciliation of receivables allows one user to only review and process exceptions that results in the processing of multiple receivables in limited time and therefore very cost effectively.

The Allegra financial module makes use of a full journal system allowing for accurate traceable journal management.

BUSINESS INTELLIGENCE EXTRACTS

Business Intelligence is one of the core ways to interpret mass amount of info to identify new opportunities and enhance your competitive advantage. Allegra provides you with an easy to use data extract application to create our own Business Intelligence unit. The application automates the extracts with configurable parameters for automation to satisfy your needs.

SMS SYSTEM

The SMS System is an effective communication mechanism and part of the Customer Relationship Management module. It assists with the management of your Clinic and/or Dispensary. You can send SMSs to your customers and receive replies linked to numerous functions in the Allegra System, e.g. Diary Bookings, Prescription Status, Specific Notifications, etc. Through the SMS System you can continuously stay in contact with your patients and build long-lasting relationships.

WELLSCREEN BIOMETRIC DATA MODULE

WellScreen is a health risk assessment module that assists healthcare providers, medical schemes and life insurers with the biometric data to manage their members’ health risks better.

WellScreen offers:

  • WellScreen health risk stratification and report.
  • Basic disease information.
  • Health guidelines.
  • No paperwork.
  • Biometric data switch to funder.
  • Validation of patient information.
  • Benefit checking.
  • Real-time loyalty program integration.

WellScreen assists healthcare providers to identify patient health risks and provide informed lifestyle and healthcare management advice based on accepted national and international guidelines. The WellScreen solution also provides suggested patient health interventions ensuring informed preventative care provision.

WellScreen empowers Managed Care and Wellness Management Organisations, and Life Insurers to communicate with their members in real-time at point of care. This happens via funder branded individual patient reports consisting of health risk stratification and health guidelines. Member biometric information is transferred electronically to the relevant party and the report is generated and returned to point of care.

THE VALUE PROPOSITION OF WELLSCREEN
Screen for Money

Allegra WellScreen solution has a direct integration with multiple loyalty programs that enable you to offer claimable health risk assessments to clients. All you have to do is perform the screening/health risk assessment for members.

Members receive a health risk report in real-time at point of care and you receive payment from the loyalty companies and funders.

Electronic diary with SMS reminders ensures that patients return for follow-ups when they are due.

PRACTICE MANAGEMENT MODULE

The Allegra Practice Management module offers electronic patient health records in multiple branches.

The Allegra Practice Management module includes:

  • Comprehensive electronic health record per patient in multiple branches with complete history.
  • Electronic patient follow up (to re-invite patients)
  • Financial and Procurement Management abilities.
  • Time based billing feature.
  • Electronic Diary that can be used for patient follow-up appointments and SMS reminders.
  • Bulk SMS filtering by age, date of birth, gender, repeat Rx and more.
  • Printable patient health guidelines.
  • No more paperwork.
  • Hosted in the cloud with auto back-up.
  • Service protocols to ensure uniform service delivery across multiple service providers.

ALLEGRA SWITCHING MODULE

Allegra switching solution provides Electronic Data Interchange (EDI) and Real Time Transaction Processing for many leading Medical Schemes and is active in South Africa, Namibia, Botswana and Swaziland. These solutions include real-time as well as batch claims processing for more than 40 medical disciplines and we handle in excess of 3.5 million claim transactions per month.

Some of the main electronic claiming objectives include:

  • Speed up claims processing.
  • Improve scheme member/service provider/administrator relations.
  • Reduce number of queries.
  • Enhance claim payment cycles.
  • Minimise duplicate claims.
  • Enhance the quality of service provided by the Medical Aid Administrator.
  • Alleviate backlogs.
THE DATA SWITCHING PROCESS
Transaction triggers at Health Care Professional

The Claims Transaction is initiated by the healthcare professional when a medical aid member wants to claim from the Scheme for required healthcare products or services.

The healthcare professional submits the claim via the selected Practice Management Software (PMS) running in the practice. A key aspect of this is that the PMS Software must integrate with the Allegra Switching module via Web Services or Proprietary API. Allegra also caters for Providers without Electronic Practice Management systems that can capture claims directly onto the system via a web-based claims capturing interface.

Allegra switching accepts claim messages in a variety of formats, including:

  • XML (Real-time)
  • Batch
  • Customer-specific formats

Format and mandatory field checks are processed on all messages. Messages that fail these checks are stored in Allegra’s error database and passed back to the sender with appropriate error messages.

Valid claims are converted into a standard internal format, regardless of source. Further validation is rule-driven at a combination of:

  • Administrator
  • Scheme
  • Plan
  • Discipline

Different validations may be applied according to the client‘s requirements and may typically include:

  • Provider validation
  • Referring provider validation
  • Reversal validation
  • Duplicate claim check
  • Administrator/Fund validation, configuration and routing
  • Response delivery validation

Claims that fail validation are returned to the Healthcare Professional without switching to the Administrator.

The Administrator process

Claims that pass the selected validation rules are then converted to the appropriate administrator format, switched to the administrator and a response received.

Timeouts at the administrator are communicated back to the Healthcare Professional, who may resubmit the claim without having to reverse the first, failed, claim.

The data received from and sent to both Healthcare Professional and Administrator is stored in the Allegra switching database in case of later queries.

Finally, the response, together with claim or claim-line specific messages, is converted back into the Healthcare Professional‘s format and transmitted back to the service provider.

A detailed financial response is sent to the Healthcare Professional after payment has been processed including:

  • Amount charged
  • Amount approved for payment
  • Amount not payable by scheme with reason codes and breakdown
Central Master Files

It is imperative that the various Master Files are stored and maintained in one central location and called upon at point of claiming via the Real-time interface. These master files include (but are not limited to):

  • Beneficiary /Patient Database
  • Benefits & Limits
  • DSP & Network Contract Management
  • Scheme Specific Price File
Statutory Reporting

Allegra does not process actual claims payments and does not maintain the Clinical Rules, Benefits and Limits. It is the responsibility of the Administrator and Managed Care Organisation to deliver these reports.

Central Rules Maintenance

As with the central storage and maintenance of the above Master Data Files, the same goes for the maintenance of specific rule engines. These rule engines can be maintained either within the Managed Care Organisation or with the Administrator – depending on the type of rule/protocol to be applied.

These engines should apply the appropriate rule at time of claiming via the Real-time claim interface. These Rule Engines include (but not limited to):

  • Validation Rule Engine
  • Pricing Rule Engine
  • Chronic Authorization Engine
  • Clinical Rule Engine
  • Benefits & Limits Engine