​      Topaz Inc.USA is  a premier developer of  medical office management softwares that customizes program solutions to the  health industry.For over two decades,Topaz Inc.USA has successfully serviced the medical business community in the US by providing software programs that  facilitate electronic claims processing, medical reimbursements and records keeping. As its exclusive distribution arm, Topaz Philippines now makes available a software program designed to electronically link the national health insurer and member hospitals nationwide. With the introduction of the Online Electronic Eligibility Verification software program, Topaz Philippines will bring in electronic media interchange options to the Philippine medical community. After two years of research and development, Topaz Philippines is set to release the software program that allows hospitals to retrieve patients’ critical financial information to ascertain benefit eligibility from a national health insurer.

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​       Apparently, this business venture resulted from a horrific experience of a balikbayan with an extensive business background in software development.“Personally, what prompted me to bring in the same technologies from the US was the circumstances wherein a local hospital made me wait for hours at the billing department."

 

       That’s when I discovered the absence of an electronic mechanism that could greatly simplified the entire process from admission and discharge of patients,” reveals Liza Melendez, operation manager of Topaz USA and the owner of Topaz Philippines.



       On July 22, 2007, Liza Melendez flew back home to visit her ailing mother at the hospital. Made to wait for hours in line at the billing department, Liza concluded that her company may provide the electronic link that could facilitate the verification and billing processes of local hospitals.​


       Start up moves​ Motivated to push the project, Melendez met then president of the Philippine Health Insurance Corp., Lorna Fajardo, at a time when the institution was actively seeking partners for their electronic media communication project.  



       Thus, Topaz Philippines’ proposal to provide the electronic line between hospitals and the PHIC was welcomed. Subsequently, Melendez was encouraged to approach and introduce the electronic link concept to the members of the Philippine Hospital Association. Early in 2008, Topaz Philippines installed its comprehensive management software at the Bautista Hospital in Cavite City. The pilot project tested the electronic eligibility verification process, security features and other internal procedures. After several phases and inclusion of additional features, the final version of the software was unveiled at the Philhealth premises in June 2009.The successful dry run period at Bautista Hospital was completed from July 15 to August 15, 2009.



          Linking up with technology “Currently, both hospital and the patient go through a very 

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lengthy and tedious process to get information from Philhealth. As a result, the hospital reimbursements are delayed for months even for insured patients. But with our software program, information is available instantly even upon admission of the patient,” says Bashir Paracha ,president of Topaz Inc  USA. Aside from verifying the eligibility, the Online Electronic Eligibility Verification program provides information on the available benefits consumed versus the eligibility period. As its two main functions, this information virtually eliminates any financial risk member hospitals may incur. 



          Best exemplifying the “Power of Simplicity” line, records at Philhealth, 40 million in volume, can easily be retrieved by simply logging in the patient’s member identification number and name. “Even though information is accessed through the internet, the user never sees the internet screen because all connections are made behind the scenes. For record purposes, each verification record received is archived and can be recalled at a future date,” explains Paracha. The software program also assigns a special tag number that pre-qualifies the insurance and benefit status of the patient. This tag number eliminates the tedious process of qualifying the payments to be made against the claims received.



           Along with a password, each end-user hospital will be assigned a unique IP address. This will be the safeguard against information pilferage and manipulation of the database and the computer unit that hosts the eligibility software. “With these security features, any eligibility request from other computer terminals will be simply denied and rejected except from those whose IP addresses match the Philhealth list of certified computers,” adds Paracha.

Looking ahead

             Committed to apply electronic media communications to the health sector, Topaz Philippines’ projects down the pipeline are the electronic billing and electronic remittance management programs. “We should be going on line with the electronic billing as soon as Philhealth is ready. This will be followed by electronic remittance. Both of these products will save Philhealth a substantial amount of money while the hospitals will benefit tremendously from prompt and timely payments of services rendered,” shares Paracha of Topaz USA.

             Besides the eligibility software, Topaz Philippines also offers the electronic medical records and inventory control programs. “We will continue to work with other insurers and HMOs to provide the same electronic connections as we have for PHIC. We believe that our products and services will not only substantially improve operations but also give Philippine hospitals a leg up on the competition for medical tourism dollars,” concludes Liza Melendez of Topaz Philippines.