UC-262
Pharmacy First Triage & Claims Recovery
Checks whether a patient qualifies for a funded consultation before they arrive and assembles a claim-safe record so the fee is paid.
TBDBuild Duration
TBDIndicative ROI
The Challenge
Only 39% of pharmacies hit the 30-consultation threshold, so fees are missed, and ~70% of GP referrals are not qualified for the service. Claim reconciliation is unautomated.
How It Works
- Ingests Pharmacy First pathways, NHSBSA claim rules and referral data.
- RAG screens symptoms across the seven pathways; agents assemble records.
- Returns eligibility results, a pharmacist checklist and a claim-ready record.
What It Removes
- Ineligible consultations
- Lost claim revenue
- Manual eligibility checking
Input Data RequirementsPharmacy First clinical pathways, NHSBSA claim rules, referral data, consultation outcomes (Phase B)
Output FormatEligibility result and pathway, pharmacist checklist, claim-ready consultation record, threshold tracker
“It checks who actually qualifies before they arrive - and makes sure the pharmacy gets paid for the ones that do.”