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Northstar Infusion

Sales Engineering

Created on March 14, 2023

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Transcript

Introduction Discussion

NextSteps

InovalonOverview

What We Heard

SolutionComponents

ScriptMed History

Our Specialty Pharmacy Roots and Commercialization

Founded as a pharmacy consulting firm for complex workflow

Launched specialty software system: ScriptMed Enterprise

Launched next generation software: ScriptMed Cloud

1990

2004

2020

info

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Launched ScriptMed Cloud Infusion Management

Developed custom technology to launch Merck's Crixivan

Merged with Inovalon for strategic industry differentiation

2022

1996

2016

info

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Empowering Data-Driven Healthcare In Scale

The reach of Inovalon’s platform has grown to touch the vast majority of the United States, able to empower the market’s largest data-driven healthcare initiatives.

100s

Health Plans, Providers, Life Sciences, Pharmacy & Diagnostics Organizations

359M+

(count does not yet include data from ABILITY)

100,000,000+

Patients*

622K+

The MORE2 Registry medical events incidents

Connected Provider Client Sites

Inovalon Headquarters

Provider Sites

Office/Data Center

Hawaii

Puerto Rico

Alaska

ScriptMed Clients

ScriptMed is the leading technology provider for Specialty Pharmacy with ~35% market share, supporting integrated high touch and low touch service levels including proactive case management, free drug and replacement programs, mail order, and specialty wholesale. With the pipeline of Specialty medications, the expanding vertical market integration, increasing value-oriented incentives, ScriptMed Cloud provides the next generation platform across pharmacy delivery models.

~35% Market Share

ScriptMed Cloud Modules

CLINICAL MANAGEMENT

INVENTORY MANAGEMENT

ORDER FULFILLMENT

REVENUE CYCLE

CONTRACT MANAGEMENT

INFUSION MANAGEMENT

REFERRAL MANAGEMENT

REPORTING & VISUALIZATION

ORDER MANAGEMENT

MedicalBilling

Complex Drug Compounding

Data Collect & Assessment

Item Picking

PricingElements

Item Maintenance

Reorder Processing

Image Intake & Rx Entry

Work In Progress

TPN Formula Management

BatchRefills

Financial Reporting

SupplyKits

Clinical Timeline

OrderPacking

Benefits Verification

Patient Collections

Contract Details

Unmatched Remits

Infusion Schedule

Service Level Agreements

CarePlans

Patient Care Coordination

Productivity Analysis

Pharmacist Verification

Shipping & Will Call

Purchase Orders

InterchangeExchange

DatastreamIntegration

Nurse Scheduling

ProtocolBuilder

DataAccess

Partner Collaboration

MySharePortal

API Bundles

Process Timeline

ScriptMed Cloud Evaluation and Implementation

What to expect?

ScriptMed® Cloud focuses on the holistic needs of patients with complex health conditions and high cost medication therapies, and those clinicians who provide care for them. ScriptMed® Cloud provides unique capabilities that allow clients to make a difference for those patients.

Intro Call

Capabilities Overview

Demo

Business Case

Implementation

Contracting

My Dashboard

ScriptMed Cloud features a fully configurable, persona based workflow Dynamic Workstages

  • Workstage Tiles
  • My Tasks
  • Team Tasks
  • Worklist Sorting
  • Filter Groups
  • Advanced Search

Advanced Search

Referral Management Module

Functionality Elements

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Customizable intake workflow to service a patient with respect to clinical and financial considerations including Payer and Pharma requirements.

  • Persona based workflow
  • Business drivers for custom workflow
  • Plan and Drug Specific Coordination of Benefits
  • Automated Test Claim Processing
  • Automated Eligbility Verification

REFERRAL MANAGEMENT

Image Intake & Rx Entry

BenefitsVerification

Patient Care Coordination

Image Intake

Referral workstage to begin the intake process

  • Establish patient profile
  • Create new referral
  • Set business drivers
    • Disease State
    • Payer
    • Therapy Cycle
    • Clinic
    • Program
    • Source

REFERRAL MANAGEMENT

Image Intake & Rx Entry

BenefitsVerification

Patient Care Coordination

Add Patient

Business Drivers

Multiple Pages

Annotation

Pre-QA

Referral workstage for prescription entry

  • Set Prescriber
  • Add Rx Line
  • Quantity
  • Refills
  • Days Supply
  • Cycle Days
  • Place of Service
  • Date Written
  • OriginTriple S
  • Signature

REFERRAL MANAGEMENT

Image Intake & Rx Entry

BenefitsVerification

Patient Care Coordination

Outbound Request Line

Add Non-Rx Line

Rx Opportunity

Secondary Details

Conditioning Fill

Dosing Details

Intake Prep

Referral workstage for coordination of benefits

  • Plan Look Up
  • Add Insurances
  • Coordination of Benefits
  • Drug Specific COB
  • Add Claim Modifiers

REFERRAL MANAGEMENT

Image Intake & Rx Entry

BenefitsVerification

Patient Care Coordination

Drug Specific COB

Coordination of Benefits

Insurance Appeals

Prior Authorization

Test Claim Options

Additional Claims Data

Accounts Receivable

Patient Care Coordination

Referral workstage to coordinate care.

  • Review referral information
  • Schedule delivery
  • Discuss copay
  • Patient payment information

REFERRAL MANAGEMENT

Image Intake & Rx Entry

BenefitsVerification

Patient Care Coordination

Clinical Care Management Module

Functionality Elements

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ScriptMed® Clinical Care Management tools provide the ability to systematically define, initiate, track, and enable patient interventions.

  • Rule-Based Clinical Protocols and Interventions
  • Clinical Data Collection and Assessments
  • REMS Management
  • Care Planning & Timeline Development

CLINICAL MANAGEMENT

Data Collect & Assessment

Clinical Timeline

Care Plan Creation

Data Collect & Assessment

Data collects and assessments are fully customizable

  • Clinical Intervention
  • Rule based triggers
  • Clinical data collection
  • Clinical assessment
  • REMS management
  • Therapy adherence

CLINICAL MANAGEMENT

Data Collect & Assessment

Clinical Timeline

Care Plan Creation

Clinical Summary

Clinical Timeline

Multiple workstreams to show patient history

  • Clinical Interventions
  • Data Collects
  • Medication Summary
  • RxActivity
  • Datastream

CLINICAL MANAGEMENT

Data Collect & Assessment

Clinical Timeline

Care Plan Creation

Data Supplementation

Care Plan Creation

Generate custom care plans for patients and health care providers

  • Patient Demographics
  • Medications
  • Allergies
  • Interventions
  • Data Collects
  • Assessments

CLINICAL MANAGEMENT

Data Collect & Assessment

Clinical Timeline

Care Plan Creation

Order Management

Functionality Elements

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ScriptMed Cloud Order Management prioritizes orders, typically multiple prescriptions and supplies by “need date” and help manage exceptions through routing to work stages for resolution.

  • Multi-pharmacy Support
  • Integrated Inventory and Quality Checks
  • Automated COB Adjudication
  • Reorder Processing
  • Returns and Re-shipment Tracking

ORDER MANAGEMENT

Reorder Processing

BatchRefills

Pharmacist Verification

Manual Reorder Processing

Create manual orders for the patient in context

  • Refill an existing prescription on the patient
    • Add supply lines
    • Add new Rx lines

ORDER MANAGEMENT

Reorder Processing

BatchRefills

Pharmacist Verification

Reorders

Automated Batch Refills

Scheduled tasks reorder prescriptions based off of configured parameters

  • Filter include numerous parameters
    • Disease State
    • Drug Short Name
    • Days until needed
    • Facility
    • Referral Source
    • Therapy Cycle

ORDER MANAGEMENT

Reorder Processing

BatchRefills

Pharmacist Verification

Pharmacist Verification

PV1 is an order stage where pharmacists perform checks on all new prescriptions to ensure all of the inputted information is accurate. PV1 allows pharmacists to update any inaccurate information and provide documentation as to why the information was changed.

ORDER MANAGEMENT

Reorder Processing

BatchRefills

Pharmacist Verification

Order Fulfillment Module

Functionality Elements

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The ScriptMed® Order Fulfillment Module supports the process of prioritizing, picking, labeling, quality-checking, packing and shipping a prescription

  • Real-time Lot Number Validation
  • Barcode-driven Shipping
  • Personalized Order Documents
  • Standard and Automated Fulfillment
  • Manifest Integration
  • Patient Package Acceptance

ORDER FULFILLMENT

Item Picking

OrderPacking

Shipping & Will Call

Item Picking

Order workstage where the technician picks the product and scans/enters the NDC for verification that the correct item was picked.

  • Input Lot Number information
  • Print Order Documents
  • Print Labels

ORDER FULFILLMENT

Item Picking

OrderPacking

Shipping & Will Call

Lot Tracking

Pharmacist Verification

PV2 is an order stage that occurrs after Picking. This stage allows pharmacists to perform a final verification check of the order.

ORDER FULFILLMENT

Item Picking

OrderPacking

Shipping & Will Call

Order Packing

Order stage that allows for the final quality check to ensure that all items are placed into the package including medications, supplies and associated order documents.

  • Print or reprint needed documents such as Patient Education
  • Ensure all items are packed correctly

ORDER FULFILLMENT

Item Picking

OrderPacking

Shipping & Will Call

Group Order Management

Shipping & Will Call

Final Order stage where orders are shipped to patients

  • Shipping labels are generated
  • Inventory is decremented
  • Revenue is recognized
  • Manage the order's tracking number
  • Order is marked as completed

ORDER FULFILLMENT

Item Picking

OrderPacking

Shipping & Will Call

Inventory Management Module

Functionality Elements

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The ScriptMed® Cloud Inventory Management Module has perpetual inventory functionality supporting the purchasing, stocking, and movement of drug product inventory from multiple suppliers and for multiple pharmacy locations.

  • First In First Out (FIFO) Tracking
  • Lot Management
  • Multiple Inventory Support
  • Drug, Supply, and Service Items
  • Device/Pump Rental & Ownership

INVENTORY MANAGEMENT

Item Maintenance

SupplyKits

Purchase Orders

Item Maintenance

Item inventory allows users to keep track of item information including:

  • Quantity on Hand
  • Quantity on Commit
  • Quantity on Order
  • Cost
  • Reorder Point
  • Order information relating to open orders with the item

INVENTORY MANAGEMENT

Item Maintenance

SupplyKits

Purchase Orders

Supply Kits

Supply Kit Management allows the association of one or more supply items to one or more medications

  • Auto-Add
  • Pre-select
  • Quantity

INVENTORY MANAGEMENT

Item Maintenance

SupplyKits

Purchase Orders

Purchase Orders

  • Users can search for and add items to a newly created inventory order
  • Users can also view and modify items that are already on an existing order, or search for and add additional items to the existing order.

INVENTORY MANAGEMENT

Item Maintenance

SupplyKits

Purchase Orders

Contract Management

Functionality Elements

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The ScriptMed® Cloud Contract Management Module handles contracting scenarios, establishing the appropriate billing requirements, pricing, terms, contact information, and configuration for payers, manufacturers and other partners.

  • Pricing Support
  • U&C and Contract Pricing
  • Pharmacy and Medical Payers
  • Co-pay and Patient Assistance
  • Supplier Contracts
  • Value-Based Contracting

CONTRACT MANAGEMENT

PricingElements

Contract Details

Service Level Agreements

Contract Management

ScriptMed Cloud Contract Management Module is designed to handle multiple contracting scenarios, each managed through a process of establishing the appropriate billing requirements, pricing, terms, contract information and configuration. This module supports pharma contracts, managing specific work activities, data captures, workflows and service levels. This requires integration across multiple entities, this module helps manage those relationships to ensure success across all stakeholders.

CONTRACT MANAGEMENT

PricingElements

Contract Details

Service Level Agreements

Pricing Elements

Designed to support configuration of price schedules on three levels, pharmacy, physician and patient, allowing for the input or automated loading of complex pricing structures.

CONTRACT MANAGEMENT

PricingElements

Contract Details

Service Level Agreements

New Contract Creation

Enables Contract Managers to add contract demographics, associated entities, and applied services to new contracts. Through this, users can ensure that contract information is documented accurately, and can be used for reporting and management of the contract.

CONTRACT MANAGEMENT

PricingElements

Contract Details

Service Level Agreements

Pricing Elements

CONTRACT MANAGEMENT

PricingElements

Contract Details

Service Level Agreements

Contract Details

Contract Demographics

  • Contract Name
  • Contract Timeframe
  • Contact Info
  • Payment Terms

Associated Entities

  • Entity Name
  • Entity Type
  • Clients
  • Associations

Applied Qualifiers

  • Qualifier Name
  • Conditions
  • Filter Groups
  • Services

CONTRACT MANAGEMENT

PricingElements

Contract Details

Service Level Agreements

Service Level Agreements

Associated Services pages within the Applied Qualifiers section allows a contract manager to make modifications. This includes adding/editing payment terms, Service Level Agreement (SLA) related to the service and adding or removing additional associated service options.

CONTRACT MANAGEMENT

PricingElements

Contract Details

Service Level Agreements

Revenue Cycle Management

Functionality Elements

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ScriptMed® Cloud offers a comprehensive Revenue Cycle Management Module with capabilities for pricing, billing, deposit, and payment processing for a patient’s medication, supplies, and services.

  • Billing
  • Deposit Management
  • Cash Applications
  • Collections
  • Clearing Accounts

REVENUE CYCLE

MedicalBilling

Patient Collections

Unmatched Remits

Medical Billing Workflow

  • Bill Claim Record Created in RCM

Pending Edit Workstage

Claim Edits Run Automatically

Auto-edits enabled?

All edits pass?

  • Submission Waiting

REVENUE CYCLE

MedicalBilling

Patient Collections

Exception Stage

Rollover Secondary Billing

Insurance Secondary Billing

Claim Reprocessing Requests

Payer Rejection

Edit Review

Unmatched Remits

Pharmacist Verification

Picking

Medical Billing

Automated medical billing based on data collected

  • Tasked based workflow
  • Edit Reviews
  • Submission Fall Exceptions
  • Claim validations

REVENUE CYCLE

MedicalBilling

Patient Collections

Unmatched Remits

Patient Collections

Collections for outstanding invoices

  • Patient contact
  • Dispusted Rx
  • Balance
  • Item
  • Date of Service
  • Priority Date

REVENUE CYCLE

MedicalBilling

Patient Collections

Unmatched Remits

Unmatched Remit

Full remittance workflow

  • Check number
  • Payment Ammount
  • Payer ID
  • Fill Date
  • Type
  • Patient Search
  • Claim Amount Charge
  • Claim Amount Paid

REVENUE CYCLE

MedicalBilling

Patient Collections

Unmatched Remits

Reporting & Visualization

Functionality Elements

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The ScriptMed® Cloud Reporting and Visualization Module provides data visualization and parameter-driven ad-hoc reports as well as schedule delivery of reports

  • Operational and WIP Reporting
  • Clinical Reporting
  • Financial Reporting
  • Report Visualization and Dashboards
  • Report Access Management

REPORTING & VISUALIZATION

Work In Progress

Financial Reporting

Productivity Analysis

Clinical Work in Progress

  • The Clinical WIP Reports include dashboards used to gain a holistic view of the state of interventions by comparing against work stage, patient disease state, and priority dates.
  • The Stage Volumes dashboard highlights some of the metrics that can drive in-process interventions, such as patient disease state and work stage aging times.
    • Helps prioritize what works needs to be accomplished and determine scale of work by work stage

REPORTING & VISUALIZATION

Managed Medicaid

Work In Progress

Financial Reporting

Productivity Analysis

Financial Reporting

ScriptMed Cloud provides real time financial reporting that can be both scheduled and generated on demand.

  • Acounts Receivable
    • Aging
    • Adjusted Sales and Margin
    • Insurance
    • Transaction Details
    • Bill for Denial
    • Check Adjustments
    • Claims Report
    • Fee Schedule
    • HCFA Payment
    • Payer / Plan
    • Shipped Prior to Adjudication
    • Submitted vs Payable
    • Unmatched Payment Report
    • Unsubmitted Claims
  • Sales
    • Calculated Sales Tax
    • New Doctor Report
    • New Patient First Shipment
    • Sales by Drug
    • Sales by Top Prescriber
    • Sales Summary by Month
    • Sales Top ICD
    • Sales Top Payers
    • Sales Validation
    • Transaction Batch Report

REPORTING & VISUALIZATION

Managed Medicaid

Work In Progress

Financial Reporting

Productivity Analysis

Referral Productivity Analysis

  • The Referral Productivity Analysis dashboard provides several ways to assess referrals once they have been indexed into ScriptMed
  • Provides overal metrics on referral statues such as in-process, closed, and No Go.
  • Provides how many referrals are indexed throughout various timeframes.

REPORTING & VISUALIZATION

Managed Medicaid

Work In Progress

Financial Reporting

Productivity Analysis

Order Turnaround Time

  • The Order stage Turnaround Time dashboard helps keep track of completion metrics for order lines and order stages
    • Compare completion and in-process times for order lines and order stages
    • View factors that impact turnaround time such as patient disease states, insurance plans and items.

REPORTING & VISUALIZATION

Managed Medicaid

Work In Progress

Financial Reporting

Productivity Analysis

Infusion Management

Functionality Elements

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The ScriptMed® Cloud Infusion Management Bundle supports specialty infusion, home infusion and ambulatory infusion patients.

  • Complex Drug Compounding
  • Clean Room Management
  • Total Parenteral Nutrition (TPN) Formula
  • Medical Benefit Eligibility Verification
  • DME Pump Rental, Sales and Service

INFUSION MANEGEMENT

Complex Drug Compounding

TPN Formula Management

DME Pump Rental, Sale & Service

Complex Drug Compounding

  • Complete Compounding Record Creation
  • TPN Formula Management
  • Clean Room Environment Quality Tracking Documentation
  • Automatic Compounding Device (ACD) Integrations
  • IV Clean Room Workflow (WFMS) Management Integrations
  • Standard, Batch, Custom Drug Compounding
  • Master Formulation Record
    • ingredients and quantities
    • instructions
    • equipment and supplies
    • beyond use date
    • storage

INFUSION MANAGEMENT

Complex Drug Compounding

TPN Formula Management

DME Pump Rental, Sale & Service

TPN Formula Management

Complex Drug Compounding

  • Reconstitution and dilution of infusion products
  • Combination of NDC drug items
  • Total Parental Nutrition recipe management

INFUSION MANAGEMENT

Complex Drug Compounding

TPN Formula Management

DME Pump Rental, Sale & Service

Infusion Schedule

INFUSION MANAGEMENT

Complex Drug Compounding

TPN Formula Management

DME Pump Rental, Sale & Service

Datastream and Inovalon Interoperability for Data

The Inovalon ONE:

  • provides a comprehensive data and analytics ecosystem with industry leading data depth of more than 359M longitudinally aligned patient records, more than 71B medical events
  • complemented by extensive data connectivity and reach to more than 1 million providers (based on treatment use cases)
  • provides a highly configurable platform and API gateway for pharmacy clients to streamline processes, inform clinical decisions, and improve patient care and outcomes.

Our Approach

Cloud Based EHR

Provider HIE

Direct Connect EHR

Inovalon ONE

ScriptMed Cloud

Clinical Intelligence

Data Filters Logic / Rules ML / NLP Calculations

CDEaaS

EHRInteroperability

API Gateway

Detail Summary Analytic

DDXaaS

CDR

MORE2 Registry

Claims

Authorized Data Retrieval

Clinical Protocol Content

The Clinical Program Subscription provides baseline intervention-based clinical protocols and content to facilitate best practice patient care management.

  • Crohn’s Disease
  • Cystic Fibrosis
  • Growth Hormone Deficiency
  • Hepatitis C
  • HIV/AIDS
  • Multiple Sclerosis
  • Oncology – General Oncology
  • Oncology – Prostate Cancer
  • Psoriasis
  • Rheumatoid Arthritis
  • RSV
  • Ulcerative Colitis
  • Migraine
  • Transplant
  • Hemophilia
  • Cholesterol
  • Fertility

Data Access

ScriptMed Cloud Data Access provides visibility into the data ingested, produced, and stored as a result of using ScriptMed.

Protocol Builder

Design and optimize workflows and assessments.

  • Data Elements
  • Decision Points
  • Interventions
  • Transaction Row
  • Work Stage

Transaction Row

Decision Point

API Integrations

My Share

ScriptMed® MyShare is an online patient portal that allows for self-service, personalized patient engagement.

  • Intuitive medication management and ordering​
  • Patient communication preferences​
  • Text, email, or phone reminders​
  • Actionable patient alerts​
  • Self-service interactive health assessments

SMS Alerts

Partner Collaboration

ScriptMed® Partner Collaboration is a web-based portal that allows for secure, interactive patient care workflows to be established among pharmacies, physicians and other healthcare providers.

  • Supports collaborator relationships and role-based security and configuration​
  • Enables submission of eReferrals via the web for expedited processing in ScriptMed®​
  • Allows healthcare partners to look up referred patients​
  • Facilitates scheduling and coordination of nursing services​
  • Facilitates alternate site of care assessments

Nurse Scheduling and Resource Management

Improve Patient Outcomes

ProblemPayer Preferred Pharmacy Network Agreements and Pharma Limited Distribution Drug Agreements require specific patient care protocols and actions along with related service level agreements Solution ScriptMed provided customized clinical protocols configured (using ScriptMed Protocol Builder and Clinical Tools) to support the specific rules, workflows, data collection and data reporting requirements of each program.

Capabilities

  • Access in workflow to real-time patient data and predictive analytics
  • Accessible, accurate, and self-serviced clinical and operational reporting
  • Visibility into patient trends and charts
  • Configurable and automated workflows and interventions
  • Intuitive, persona-based user interface
  • Disease based clinical protocol library developed, updated, and maintained by clinicians
  • Partnership with industry leader
  • Comprehensive system designed for Specialty Pharmacy
  • Ability to securely extend system to external stakeholders

Increase Patient Acquisition

Capabilities

ProblemUninformed and undifferentiated account reps calling on referral sources Solution Implement ScriptMed®’s Partner Collaboration with the sales team management features Result Improved partner relationships, incremental patient referrals to the pharmacy, and improved turnaround time on speed to therapy

  • Single customizable platform to support winning contracts
  • Configurable workflows
  • Single source of clinical truth
  • Meet the custom data collection and reporting requirements of each Payer and Pharma contract
  • Centralize guidance on contract navigation and administration
  • Agile support of LDD requirements, including data transmission
  • Meeting specific requirements for de-identified of data sets

Optimize Operations and Efficiency

Capabilities

ProblemHigh labor cost associated with routine reorder scheduling calls Solution Implemented ScriptMed® MyShare for digital self-service patient engagement for reorders Result Reduced approximately 25% of reorder scheduling calls resulting in labor cost savings, improved patient satisfaction, and improved SLAs

  • Single, comprehensive system which drives data-driven workflow
  • Automated and configurable solution to support varying business models
  • Robust reporting and analytics
  • Interoperability and data sharing across stakeholders
  • Proven, scalable platform that is secure and technically compliant (HITRUST, SOC2, HIPAA)

Secure Patient Data

ProblemSignificant time, effort, and cost to achieve HITRUST Certification to meet minimum criteria for potential Payer Preferred Pharmacy contracts Solution Implemented ScriptMed® Cloud Result Met and exceeded minimum requirement of HITRUST Certification for prospective payer contracts; multiple payer contract awards

Capabilities

  • Optimized single sign-on and user authentication
  • Role-based user access
  • HITRUST certification
  • User date and time access and change tracking
  • Tier X (Tier 1 is the lowest)
  • Redundant data center with automated failover
  • One partner to host and manage infrastructure
  • Highest level of data encryption available