New Rx Processing Screen

The Rx Processing screen is the starting point for the creation, editing, and deletion of prescriptions.

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Rx and Fill Date Information

• Rx #: When the focus is in the Rx # field make sure the New Rx button is selected. If not, simply type ‘N’ when the focus is in the Rx # field. The program will automatically move to a new Rx number. Press the "Enter" key to go to the Patient field.

If user wants to manually enter a prescription number other than the displayed RX Number, then simply enter the desired Rx Number and press "Enter" key. If the entered Rx Number is higher than the default Rx Number, the system will display the warning message regarding skipping numbers. At this time, please simply answer the question displayed on the screen. If skipping numbers requires a password, please call BestRx for assistance as the required password changes daily.

• Fill Date: This is the fill date for the prescription. It is automatically selected for the current day. You can change the date if necessary when filling a new prescription.

• Original Fill Date: This indicates when the prescription was originally filled. On new prescriptions, this will be the same as the Fill Date.

• Last Fill Date: This indicates the date of the last fill (if any) for this prescription chain.

Patient

Here the user has two options. They can search for an existing patient or they can click the Patient icon to the left of the screen (or press the ‘F3’ key) to add a new patient (when adding a new patient, make sure the Patient field is empty). The user can search for an existing patient in several ways:

• Last Name (ex. GRIFFIN)

• partial Last Name (ex. GRIF)

• Last Name, First Name (ex. GRIFFIN, PETER)

• Last Name, partial First Name (ex. GRIFFIN, PET)

• partial Last Name, First Name (ex. GRIF, PETER)

• partial Last Name, partial First Name (ex. GRIF, PET)

• , First Name (ex. ,PETER) The comma before the First Name must be entered.

• , partial First Name (ex. , PET)

When your search criteria is entered click on the search button directly next to the Patient field or simply press the ‘Enter’ key.

You can also search using the patient’s Insurance card ID, phone number or Quick Code.

If only one match is found then the patient’s name and information will automatically appear on the screen. If there is more than one match the system will bring up a list like the one shown below.

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Here the last name 'Wayne' was searched. To select a patient you can either click anywhere on the patient’s row or enter in the line number in the box below the list if seeing multiple results. When the line number is entered, press the ‘Enter’ key to select that patient.

If a criteria search has more than 15 matches there will be more than one page/screen of names listed. To go to the next page of names simply press the ‘Page Down’ key. Press the ‘Page Up’ key to go to the previous page.

The Address, Date of Birth, Age, Card ID, Group and Phone Number fields are for display only. These can be modified by going into the Patient File (F3). To the right of the Phone Number field is a Bell button that controls the Notification Message Settings for the patient.

The Q Icon allows the user to add the patient to a custom patient delivery queue for events such as consultations, appointments, etc.

The Message Icon will allow the user to initiate a secure, HIPAA compliant message through the use of Akario Backline (add-on requires additional sign up; more info in article).

The C2 magnifying glass icon will allow to integrate with the PDMP registry for a direct integration; this function allows the user to completely avoid having to open up a separate window in the browser which will improve accuracy and save time. If integration for your state is available and you have not yet registered, the software will display the following and allow you to click the link to begin registration:

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Ins Plan

When a patient is selected, his/her primary insurance plan will automatically appear in the Ins. Plan field. To switch to a different insurance plan click on the arrow next to the Ins. Plan field to display a drop-down box containing all the insurance plans applicable to the patient, then select the appropriate insurance plan. You can also press the right or left arrow keys to scroll through the patient’s insurance plans or simply type the first letter of the insurance plan you would like to select.

The Insurance Name and Telephone Number are for display only and can be modified by going into the Insurance Plan File (F5).

The Card ID, Person Code and Group fields display if anything is chosen for the insurance and the fields are populated.

The Balance field displays if the patient (must select the patient as outlined below) has an outstanding Account Receivables (House Charge) balance.

The Remark field is the same as the Short Remark and can be edited by clicking the "R" button or by going into the Patient File (F3)'s Remark section.

The Insurance Plan button will allow you to see all plans attached to this patient. This allows you to edit the patient’s insurance information from the Rx Processing screen without having to open the Patient File.

Prescriber

After the patient’s information is entered, the system will display the name of the prescriber the patient used for his/her most recent prescription. If the prescriber is the same press the "Enter" key.

If you are not using the most recent prescriber, you have two options. You can search for an existing prescriber or you can click the Prescriber icon to the left of the screen (or press the ‘F2’ key) to add a new prescriber (when adding a new prescriber, make sure the Prescriber field is empty). You can then search for an existing prescriber in the same manner as searching for an existing patient as described previously.

When adding or editing a prescriber’s information, make sure to click the Save & Exit button before you exit the prescriber’s screen.

The Message Icon will allow the user to initiate a secure, HIPAA compliant message through the use of Akario Backline (add-on requires additional sign up; more info in article).

The DEA, State Lic, Type, Phone, NPI and MMIS fields are for display only and can be modified by going into the Prescriber File (F2).

Supervising Prescriber

You can also add a supervising prescriber to any prescription. Click the S button to the right of the prescriber field to open the Supervising Prescriber window to view or link a supervising prescriber. Electronic prescriptions containing supervising prescriber info will add it to the prescription automatically.

Referring Physician

In a case where the prescription is in result of a referral and the insurance requests the primary referring physician's information, you'll need to enter that physician's name in this field. You can search for an existing prescriber in the manner same as searching for the Prescriber as outlined above. This is most common when a general practitioner refers a patient to a specialist, the general practitioner would be considered the referring physician.

Drug

After the prescriber’s information is entered, by default the system will automatically bring up a mini profile of the last 13 prescriptions the patient has received.

The user can now search for the specific drug being prescribed to the patient. They can search in the same manner as described before when searching for a patient or prescriber. For example, the user can type in ‘TYL’ and the system will bring up the list of all the drugs that begin with TYL in the drug file. The user can also make their search more specific. For example, the user can type in ‘TYL,30’ and the system will bring up the list of all the drugs that begin with TYL and have the strength/number 30 in the drug name.

The user can also search the Drug by entering the NDC number or Drug Quick Code. Once the drug is selected and entered drug is the BRAND, the system will display the generic drugs for that are linked to the BRAND drug. At this time, simply select the drug to be dispensed from the displayed list otherwise simply hit "Enter" key. Please see the explanation in Drug File screen on how to link the BRAND and GENERIC DRUG.

Once the Drug to be dispensed is selected (Brand or Generic), the system will check for the Drug Allergies and Interactions for the patient. If any of the warnings are displayed on the screen, please make an appropriate decision before filling the current prescription. The system will not stop the user from filling the prescription.

The NDC, Manufacturer (MFG), Control Class, Package, Package AWP, Package Acquisition and Last Update (price) fields are for display only and can be modified by going into the Drug File (F4).

Ordered Qty

Once the prescribed drug is selected, the user will enter in the ordered/prescribed quantity. The system will default (if any) to the quantity that is entered in to the Min Qty field for the selected drug in the drug master file.

Qty Filled

Upon entering the quantity in the Ordered filled, the system will default the same quantity for the filled and the focus will move to the DAW field. If user wants to change the Qty filled, the simply press up arrow to move to the previous field.

When either of these is entered the Cost, Fee, Co-pay, Discount, Tax, Total and Price Code will automatically appear. If any information has to be changed, enter in the appropriate information in the appropriate field and the rest of the fields will change to the proper numbers.

If the quantity entered is lower than quantity on hand and the software flag is set to warn the user, BestRx will present options on how to proceed. The options will be to 1 - Enter a new Quantity, 2 - Select another Drug, and 3 - Continue filling the prescription. If the user chooses option 2 - Select another Drug, the software will present closest equivalent options to the medication originally entered.

The Other price segment is available to add any cost beyond what's listed above. It allows the user to add Delivery, Shipping, Postage, Administrative, Compound Preparation and/or Incentive Fees to the prescription. Simply click on the "+" and select the qualifier and cost applicable.

DAW (Dispense As Written)

Here the user will enter in the DAW code. To select a code either type in the appropriate number, scroll through the list using the right and left arrow keys or use the drop-down box next to the DAW field. Use the drop-down box to see what the code stands for.

Price Code

Cash prescriptions: The price code that will come up automatically depends on the patient, drug and insurance plan. This is how the Price code is selected.

First, if there is a price code for the selected patient in the patient’s file, the system will choose that price code. If there is no price code for the selected patient, the system will check the selected drug. If there is no price code for the selected drug in the drug file, the system will use the price code for the selected insurance plan.

For Non-Cash Prescriptions: The insurance plan file will have a price code for a brand, generic, and OTC (over-the-counter) drug. The system will automatically select the appropriate price code depending on the selected drug.

Please see the Price Code screen for detail on how to setup the Price code to calculate the appropriate fee.

Refills

Enter the number of refills authorized for this prescription. The user can set up a default to zero if no data is entered in this field. (please see User Preferences)

Rx Acq

This field will automatically display and capture the exact Rx Acquisition at the time of fill. This field is helpful to determine what the acquisition cost was when the prescription was being filled, as these costs can change often. This field should NOT be modified unless it is to correct a price error.

Sig

Enter in the directions on how to take this medication. The Sig section is separated into two fields; you can enter in sig code(s) in the single sig line separated by spaces or enter in the complete instructions manually in the multi-line freehand sig field (big box). The user can not enter the SIG code (quick code) in the big box. This big box is used only to enter the free text. There is not need to hit the "Enter" key to go to the next line. The system will automatically wrap the word to the next line.

Days

Enter in the number of days that this particular subscription will last. If the entered sig code is programmed with an appropriate daily supply then system will calculate the days supply. We've also added a way to adjust Billing Day Supply; this allows you to bill a prescription for a Days Supply that is lower than the actual Days Supply. This is useful for billing things like insulin pens when you don't want to break the pack because the insurance allows a 30 day max for example. To set the Billing Days Supply, click on the "+" button next to the Days Supply on the RxProcessing screen.

RPh & Tech

Enter the Registered Pharmacist and/or Technician initials for the person entering the prescription.

Rx Serial #

If the prescription is a control drug and there is a control triplicate number on the prescription, enter this number here otherwise simply hit the Enter key. The state of New York only accepts electronic prescriptions (with some minor exceptions) by law; in the case of NY pharmacies, the number will automatically populate according to data in the electronic prescription. Aside from the above, here's some other codes commonly used with other purposes (these codes can be modified to send 12 digits instead to comply to insurance requirements):

• 99999999 - Oral prescriptions and products dispensed pursuant to a non-patient specific order

• DDDDDDDD - Prescriptions dispensed as Medically Necessary during a Declared State of Emergency (excluding controlled substances)

• EEEEEEEE - Prescriptions submitted electronically (computer to computer)

• NNNNNNNN - Prescriptions for carve-out drugs for nursing home patients (excluding controlled substances)

• SSSSSSSS - Fiscal orders for supplies

• TTTTTTTT - Transfer prescriptions (traditional, intra-chain, file buys)

• ZZZZZZZZ - Prescriptions written by out-of-state prescribers or by prescribers

Rx Status

The Rx status field will automatically show the status of the prescription on the screen. The status can show up as several different things:

• Paid-Cash — the prescription was paid for in cash

• Unbilled — the prescription has not yet been transmitted

• Hold — the prescription is on hold and will be filled on a later date

• Transmitted — the prescription has been captured/approved by the insurance company but has not yet been reconciled

• Paid-By Ins — the prescription has been accepted and reconciled

• Rejected — the prescription has been rejected

The "Q" button

This refers to the queueing system in the software more explained in the Workflow articles.

Written Date

Enter in the date the prescription was written. For the new prescription, the system will default the written date same as fill date. If written date is different, the simply enter the date here.

Basis of Cost

This field directs how to calculate cost for the medication. The default value is 01 - AWP; however in certain situations this can be changed. Click the drop down menu to see all available qualifiers; 00 - Default, 01 - AWP, 02 - Local Wholesaler, 03 - Direct Price, 04 - EAC, 05 - Acquisition Cost, 06 - MAC, 07 - U&C, 08 - 340B, 09 - Other, 10 - ASP, 11 - AMP, 12- WAC, 13 - Special Patient Pricing. It is very important to understand while these can be changed, they do not guarantee a higher or special reimbursement and have to be used only when required.

U&C Charges

Usual and customary (U&C) prices reflect the costs of the drugs to the consumer at the retail level. The U&C rate is often referred to as the “cash price” for patients. It is meant to display what the average cost to the patient would be without insurance. The percentage markup is calculated based on the AWP, and can be adjusted on the Misc Page 1 of the Pharmacy Setup.

Lot #

This field will display the Lot number for the selected medication if available.

Lot Exp Date

This field displays the lot expiration date if available.

Refill Exp Date

This will display the expiration date for the current refill. The dates can be adjusted in both the Drug File (F4) and the Insurance Plan File (F5).

Auto Refill Indicator & Date

This field will display if correctly utilized the date on which the prescription will enter the Refill Queue automatically. For more information refer to the Auto Refill help article.

Print MAR (nursing home only)

Indicate if this prescription is to be printed on an MAR (medication administration record) form to provide to a nursing home or facility. If "Yes" is selected, a popup box will appear asking for some details like form code and dispense times. This information can also be edited at any time by clicking the "Edit NH Info" button.

Diagnosis Code

Enter or select the diagnosis code to be transmitted with this prescription. To enter more than one code, click the "More" button.

PriorAuth. Type

Select the appropriate Prior Auth Type from the drop-down list (ex: 1-Prior Authorization, 4-exemption from Copay).

For NY Medicaid, the ‘Prior Auth Type’ will usually be ‘1’.

For third parties, the ‘Prior Auth Type’ will usually be ‘1’.

PA Request

This button will bring up the ability to Fax and/or Print a Prior Authorization form. This also offers to send a PA through the service Cover My Meds. This service will send PA forms on behalf of the pharmacy to the appropriate parties. See the CoverMyMeds setup article for more information.

PriorAuth. #

Enter in the appropriate Prior Auth #.

For NY Medicaid, the ‘Prior Auth#’ will usually be the 8-digit authorization number followed by 3 zeros (‘000’).

For third parties the ‘Prior Auth #’ will usually be 5 zeros (‘00000’) followed by the 6-digit authorization number.

Workflow Status

The status indicates the workflow status for the prescription, and is automatically tracked and recorded by the software. This cannot be modified, and is locked for audit purposes.

Dispense By

This field will display how the prescription is to be dispensed. This can be manually changed or can be automatically adjusted based on the selection from the Patient Screen (F3). Available options are Pickup, Delivery or Mail.

Delivery Driver

This field indicates the delivery driver for this prescription. The driver does not have to be selected on the main screen for the prescription to be utilized for delivery, but will have to be selected when the prescriptions are being sent to the delivery device. To Add or Edit delivery drivers, refer to the Delivery Driver File article.

Other Cov Code

This is used when billing more than one insurance company for one prescription. Click on the arrow next to the field to see a drop-down list of the codes. The most common codes are 02 and 03. But the user must select the appropriate code based on the outcome of the primary payer.

Rx Origin

Indicates the origin of the prescription. The prescription could be Written and physically handed to the pharmacy, Telephoned in by the doctor, it could be send Electronically through the internet, could have been Faxed by the doctor or Transferred from another Pharmacy.

Submission Clarification code

Select the appropriate override code from the drop-down box. If you do not know the appropriate code, contact the third party insurance company.

ADJ

This signifies an adjustment transaction; this field should never be populated unless through a function of the program such as Rebilling, or when specifically asked for.

Lbls

Indicate how many labels you'd like to print for this prescription. 1 is the default value.

Make Rx Inactive

If you'd like to inactivate this prescription simply check this box and save the Rx. It will appear gray in the patient's profile. To reactivate, simply pull the prescription up in Edit mode, uncheck this box and save the prescription. When you make a prescription inactive, you will be prompted to enter remarks as to why the prescription was made inactive. Entering the remarks is optional.

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This function offers the ability to enter additional prescription information,

Rx Remark

Enter in any remark you may have for this particular prescription. You can make remarks for the whole prescription, or just the fill you are working on.

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If you are filling an electronic prescription, you’ll be able to enter ERx Remarks relating to the pharmacy or prescriber. ERx Remarks will appear on the ERx printout. Special Remark types can also be selected, such as Written Date Remarks; Special Remarks will not appear on an ERx printout.

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Any previously logged remarks can be printed out from this screen using the Print button, and chosen from the next prompt.

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Rx (F11)

This button opens the Image Scanning Interface. If the RX letters are gray, there is no image attached to the Rx. If the RX letters are blue, there is an image attached to the Rx.

Notification Settings (Bell next to Patient Phone Field)

This button will display a Notification Settings dialogue box that will allow you to control the various ways BestRx can notify patients.

Audit Trail / Workflow process

This outlines the Audit Trail / Workflow update process; this is required in the State of New Jersey and can be flagged by pharmacies outside of the state.

Dashboard

The Dashboard is a new feature that allows quick and easy access to some of the more common/frequent menus of BestRx.

Refill Request Prompt Pop-up

BestRx will now ask if you'd like to send a refill request when processing the final refill for a prescription. This way you can proactively receive authorization for a new prescription before the patient comes in for their next refill. This setting can be customized based on the control class of the drug. This can be done directly from the prompt screen by clicking "Options" or by going to Pharmacy Setup Misc (page 2) and changing the Show Refill Request prompt for option. When sending a refill request via e-prescribing, you can now change the prescriber if the new prescription will come from a different prescriber than the one that wrote the original prescription.

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Claim Transmission

Unlimited claims for the same patient and fill date can now be transmitted all "at once", even if they are for different insurance plans. Previously you were only able to send 1 or 4 claims at a time, depending on the insurance plan. We have now implemented logic that allows you to send an unlimited number of claims at once with just one click. To comply with NCPDP standards, the claims are still separated in the background into batches containing no more than 4 claims per transaction, but from the user's perspective you only have to transmit once.

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You can select whatever prescription(s) you'd like to submit, then click to Transmit Selected to their respective insurances. Alternatively you can also Transmit All Plans if available.

When claims are submitting, the Status will automatically change to display what is happening with the prescription. After the prescriptions have been transmitted, you will have the ability to view the individual responses, one by one, for the prescriptions. If a prescription rejects for the same exact reason like a Card ID for example, prescriptions in the transmit queue that utilize that same Insurance/Card ID will not be processed due to the fact they will most certainly reject for the same reason, thus saving the pharmacy money on transmission fees.

Additional Prescription Information

The Additional Prescription Information pop-up is used when the insurance company requires additional information not typical the claim to be submitted with the prescription. For most claims these options are seldom or never used and should only be used when required as they can cause unnecessary and unexpected rejections.

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Clinical Measurement Information

The Clinical Measurement Information screen stores information about any vital clinical measurements taken like Blood Pressure, Weight, Cholesterol etc.

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Coupon Info

The Coupon Info section allows the pharmacy to enter a coupon and attach it to the prescription based on a Coupon Type of Price Discount, Free Product or Other. The Coupon Number and Coupon Amount can be entered in their appropriate fields.

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Additional Documentation Information

Additional Documentation Information stores and transmits information for Medicare specific equipment requests, like Hospital Beds, Motorized Wheelchairs, Oxygen and the like.

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Rx Pickup Information

The Rx Pickup Information stores a detailed record of Date, Time, RPh and Customer / Customer Info for the person who picked up the prescription from the pharmacy. It also offers the option to Scan ID if you own a compatible 2D scanner capable of processing government license/ID information.

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Image Scanning

The scanning feature of BestRx is an additional feature that must first be purchased and activated. After the feature has been unlocked, we will help the pharmacy with configuration and setting up their scanner to work with the feature. Manual/prompt scanning is a method of scanning individual scripts at either time of entry or at a later time from the Rx Processing screen.

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The screen is divided into two sections with a transparency and control bar in the middle.

The LEFT side of the screen displays the Scanner Settings Gear, the scanned image with the ability to switch pages with the Next Page / Prev Page buttons on the bottom left. This works for scanners that possess the Duplex scanning ability. You also have the ability to Mark Up and Edit Scans (on scanned images only), Rotate, Print, Download, Delete, Zoom In and Zoom Out when viewing a scanned image.

The MIDDLE control bar gives the ability to change overlay Transparency so you can see the Rx Processing screen, Scan the image again/for the first time, Capture an image/document by utilizing an attached camera, and Close out of the feature.

The RIGHT side of the screen will display some of the more important details about the prescription. This section is mainly for reference to ensure the physical prescription is attached to the correct prescription record in BestRx and for quick, at a glance prescription verification..

Scanning From Verify before Fill/Dispense Screens

This feature will allow pharmacy to scan Rx image from Verify screens. We have now added Rx Image (f11) link at the bottom of the Verify Screens which will open default Rx Image Scan screen to perform a scan.

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Notification Message Settings

The Notification Message settings popup can be accessed by clicking the Bell icon next to the patient's phone number on the main RX Processing Screen.

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These settings will allow per patient control of the Messaging Interface.

Audit Trail

The Audit Trail / Workflow Update feature was first introduced into the BestRx software due to a law change in the State of New Jersey that requires manual input of the four steps of the prescription process (intake/acceptance, process/entry, fill, and dispensing). The feature has since been enabled as a toggle for pharmacies outside of New Jersey that wish to utilize the feature. That flag and other options can be controlled on the Workflow settings page of the Pharmacy Setup file.

Right after entering and saving the prescription, the user will be greeted by a pop-up dialogue box as shown below.

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This dialogue box covers the three steps accessible through BestRx. The first two must be saved before the prescription will be processed as they cover the intake and entry of the RX. The step that indicates the fill can be updated later, as no law requires a prescription to be filled right after it's entered. The Update Workflow Information page will assist in updating the statuses that have not been updated in this dialogue box.

You'll also notice that the Workflow Status is missing; as BestRx itself does not cover the dispensing of prescriptions as that is handled by either the E-Signature program or the BestPOS program. If not using either of those to dispense your medication, you can still use the Update Workflow Information page to update the Workflow Status accordingly.

Workflow History

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On The Rx Processing Screen in the lower right, there is a box displaying the Workflow Status of a prescription. This is the most recent update to Workflow History of a prescription and will provide a snap shot of where the prescription is and what needs to happen before dispense. Next to this field is a small button titled "H". When clicked this will launch the Workflow History Pop-up for that prescription, reference the screenshots above and below.

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In the Workflow History Pop-up it will display all that prescription fill's workflow steps and statuses. Accompanying this will be the dates, times, users, and optionally you can view the source of the workflow events as well. With some integrations additional information is offered; for example if a prescription is sent via a shipping provider, tracking information will be available on this screen for reference, or to check the status of the delivery as well. For pharmacies taking signatures of any kind, electronic or using delivery tickets, the patients signatures will be displayed on the right if captured. Under normal circumstances a smaller window will display as shown in the example below:

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In order to understand how prescriptions will move in your pharmacy's workflow configuration, it is pertinent to familiarize yourself with the potential statuses and steps prescriptions can go through in the BestRx Software, many of which work together.