Barrier-free health PBS authorizations

Learn about the new way to access authorizations in our EPS Comfenalco Valle Delagente:

What is MIPRES?
It is an application designed by the Ministry of Health, which has been made available on the internet so that health professionals can formulate patients of the Contributory Regime all the medicines, procedures, supplies and devices that are not covered by the Benefits plan ( NPBS) or (NO POS). Health professionals who can access Mipres can be Doctors, Dentists, Nutritionists and Optometrists.

This application replaces the Scientific Technical Committee (CTC) for users of the contributory regime.
For users of the subsidized regime, the Scientific Technical Committee (CTC) continues to be in force.

What is the Health Benefits Plan (PBS)?
The Health Benefits Plan is the set of services and technologies to which every member of the General Social Security System in Health (SGSS) has access, charged to the UPC

What is a health service or technology not included in the Health Benefits Plan (NPBS)?
It is the set of services and technologies that are not covered by the health benefits plan and require for their effective delivery some additional procedures that have been established by the Ministry of Health.

(Mipres for the contributory regime and CTC for the subsidized regime)
Services that can be prescribed through MIPRES:

  • Only the drugs that are parameterized in MIPRES.
  • Procedures that have a Single Code of Health Procedures (CUPS), that is to say that it is included in resolutions 1132 and 1678 of 2017.
  • Materials or Devices Inputs that are parameterized in MIPRES and the procedure in which they are to be used is always mentioned.

Services that require a meeting: some of the services that may be prescribed by qualified health professionals for this purpose must be evaluated by a meeting of IPS professionals to determine the relevance of the service: 

  • Complementary services that correspond to a service that, although it does not belong to the field of health, its use is essential to improve health or prevent disease. The only services classified as complementary and that must be prescribed when they are currently totally relevant are: sunscreen, shampoo and hair lotions, graduated compression and anti-embolic stockings, diapers, orthopedic shoes and inserts, contact lenses and outpatient transport other than ambulance.
  • Nutrition (nutritional support) when prescribed in an outpatient setting only. It does not apply to nutritional supplements with a Health Registry as a Medication.
  • Medications prescribed for an indication other than that authorized by INVIMA, in these cases, in order for them to be sent to a meeting of professionals, they must be included in the UNIRS LIST (medications from the list of uses not included in the health registry) published on the ministry's website. of health and parameterized in MIPRES.

Scope of the prescription: this term refers to the type of service where the user is attended, which defines different requirements for the prescription, dispensing and their times:

  • Non-prioritized outpatient setting: outpatient care, dispensing that must be done in 5 days and in some cases, such as nutrition, a prior meeting is required for approval.
  • Prioritized outpatient setting: outpatient care, dispensing that must be done in 1 day and in some cases, such as nutrition, a prior meeting is required for approval.
  • Inpatient hospital setting: inpatient care whose service is dispensed during the user's care.
  • Emergency area: emergency care whose service is dispensed during the user's care or derived from this care, within the following 24 hours.
  • Home hospital setting: inpatient care whose dispensing will be made in the outpatient pharmacy to a home service provider, as continuity of treatment and must be dispensed within the following 24 hours

*** The "hospital discharge" process must be taken into account in which the IPS where the user was hospitalized, prescribes services through the "Home Hospital Environment", the EPS guarantees dispensing within 6 hours and the user is transferred to your home for application.

How does the user access a service not included in the PBS?
Access to a health benefit that is not included in the Health Benefits Plan (PBS)
It is defined by the treating physician during medical care, who to prescribe it (Formulate it) must enter the Ministry's MIPRES application online and there formulate the service that the patient needs; As a result of this formulation, the doctor must print the prescription directly from Mipres and deliver it to the user so that he can claim the service within five days after the date of attention.

What is the responsibility of the treating physician?
The treating physician has the following responsibilities in the exercise of his profession and of his medical autonomy:

  • Enter fully and properly in MIPRES the requests for services not included in the Plan of Benefits that you require for your treatment.
  • Climb to the MIPRES help desk provided by the ministry, the services required by you and that you cannot enter. There they will carry out the analysis and give an answer to the professional.
  • Give the user the formula or a management plan with a prescription number that MIPRES displays once the application is successfully entered into the application.
  • Fill out the contingency form according to causes defined by the Ministry: in case there is no electricity, the INTERNET fails, the platform is not available or cannot enter the request due to inconsistency in the user's affiliation.

This form must be sent to the EPS by the professional.

  • Review the status of the prescriptions published by the EPS to make the necessary corrections in case of unsuccessful validations

*** It should be taken into account that only the treating physician can correct the prescriptions generated by him, the EPS is not authorized to adjust its formulation. 

What are the EPS obligations?

  • Download the prescription that the doctor has registered in the Mipres application.
  • Carry out the administrative validations defined in the current regulations to the prescriptions made by medical professionals.
  • Receive and manage the contingency forms sent by professionals.
  • Inform the user of the cases of multi-affiliation and crossings with the databases of the registry for any clarifications that may be made by the user.
  • Publish the result of the validations to the prescribing doctors.
  • Inform the user where to go to supply the prescribed service or technology.
  • Inform the user of the result of the prescription and what to do.
  • Arrange the service so that the user can claim it within the established times for dispensing (maximum five days).

What is the responsibility of the user?

  • Go to the consultation and provide all the medical information required by the treating doctor or health professional who attends you.
  • Keep the formula or management plan for the necessary time with a prescription number provided by the treating physician in the consultation.
  • Present the formula each time the service is required to be delivered.
  • Be attentive to the results of the prescription made by the doctor.
  • Manage clarifications in case of multi-affiliation and / or the National Registry of Civil Status before the corresponding EPS for inconsistencies in the identification document.
  • Claim the NPBS service within five days from the date of the consultation in which the service was formulated.
  • Carry out the treatment according to medical indications.
  • Request your control consultation in a timely manner if necessary.

How does the user who has been formulated a MEDICATION not included in the PBS access?

  • You receive from your treating physician the printed prescription of the NPBS Medication with the recommendation to avoid its loss or deterioration.
  • He goes to the pharmacy to deliver the medicine in five days.
  • Verify that the medication delivered corresponds to the one that was formulated by the treating physician.
  • Comply with the medical indications to carry out the treatment.
  • Users with special management pathologies (cancer, hemophilia, rheumatoid arthritis, among others) should wait for the call from the provider who will apply the drug to indicate the date, time and place of application.

How does the user who has been ordered a SERVICE not included in the PBS other than medicines access?

  • You receive from your treating physician the printed prescription of the NPBS service other than drugs with the recommendation to avoid their loss or deterioration.

It goes in five days to the comprehensive care points (PAI) (Click here directory) of the EPS from Monday to Friday from 7 am to 5 pm, a continuous day where you will be informed about the provider of your service.

  • Comply with the medical indications to carry out the treatment.

What is the responsibility of the collaborator?

  • When a user requests information about a NON PBS service:
  • If you are affiliated with the POS at the EPS comprehensive care points (PAI)
  • If the user is affiliated with the Complementary Care Plan, he will escalate the case to the service manager in the Edificio de Colores Calle 5D with Carrera 39 Torre 2 Piso 4.

If you have questions about the prescription in the Mipres application, you can do it by clicking here contact us EPS, and option Services "MIPRES Scientific Technical Committee".

ACT: 26052017

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