The Client

HSE Primary Care Reimbursement Service (PCRS) is responsible for the processing of almost all claims for the payment of fees provided in the community by General Practitioners, Community Pharmacies, Optometrists and Dentists on behalf of the health boards for the treatment of their patients.

The PCRS have over 4.2 million persons registered as being eligible under the various schemes it administers and process in excess of 60million business transactions valued at over €2.5 billion annually. The PCRS has one of the three largest Oracle databases in Ireland.

The Solution

Quest has provided maintenance and development services for the PCRS since 1989. This has involved working closely with them as they have implemented new processes and procedures and as the services have developed and expanded. The most recent project is a web-based system to allow GPs (doctors) to submit claims directly to the PCRS and to be reimbursed accordingly. The system allows GPs to securely enter details of claims and claim allowances. All details are validated on-line against the central PCRS database ensuring accuracy, speed of processing and reduced bureaucracy. Quest set procedures in place within the PCRS to receive claims electronically from pharmacies and process these claims with the PCRS database.

The Result

At present 80% of pharmacies send in their claims using this method. This translates to about 1,000,000 claims per month involving 2.8 million business transactions. This replaces a paper-based system where pharmacies submitted batches of documents that were entered by PCRS staff and subsequently processed and paid.

Quest have been working together with the HSE for over 20 years, forging a long lasting relationship and sharing noteworthy project success.