Authorization Dispensation

Authorization dispensation is how healthcare providers provide beneficiaries medications, medical services, lab tests, imaging exams, and other healthcare-related items. This process ensures the transaction's authenticity and enables administrative and financial tracking of dispensed prescriptions or authorizations through the settlement module.

To enable the dispensation of authorizations via the Osigu platform, several tasks need to be completed, categorized into the following key areas:

1. Integration with Payer

To ensure seamless communication between Osigu and the payer, the method of reporting dispensations must be defined. The available integration methods are:

• Webhook Notifications: When a dispensation occurs, the payer receives real-time notifications.
• Consolidation Files: These files follow a standard format defined by Osigu and can be transferred securely via email, SFTP, API, or AWS S3 buckets.
• Authorization Web Portal and Dashboard: The payer can access dispensation details through Osigu’s portal and dashboard interface.

2. Payer Configurations

Specific configurations must be completed on the payer’s side to enable the dispensation process. These include:

• Provider Network Setup: Registration of network providers authorized to perform dispensations.
• Cancellation Rules: Setting limits and rules for dispensation cancellations.
• Anti-Fraud Rules: Configurations to prevent fraudulent activity, such as:
  • Medication substitution controls (e.g., Brand-to-Generic).
  • Single-use authorizations.
  • Validity checks for authorizations.
• Manual Review Protocols: Defining scenarios and workflows for manual reviews.
• Provider Settlement Configurations: Establishing settlement processes, including cut-off dates or on-demand settlements for specific date ranges.

3. Integration with Providers

For each provider, the integration method for dispensing authorizations must be defined. Providers can interact with the Osigu platform through:

• REST API: Enables programmatic communication for dispensing processes.
• Provider Web Portal: A user-friendly interface where providers can manage dispensation workflows.

4. Provider Configurations

To ensure providers are fully integrated with the Osigu platform, the following configurations must be completed:

• REST API Credentials: Issued to providers for secure access to Osigu’s REST API.
• Provider Web Portal Credentials: Granted to providers for access to the web interface.
• Product Standardization: Includes the initial upload of the product catalog and ongoing synchronization of product data.

The Osigu platform enables a seamless and secure process for dispensing medications, medical services, and other healthcare-related items. This ensures real-time communication between providers, payers, and the platform, improving operational efficiency and ensuring compliance with administrative and financial protocols.