Method and system for monitoring prescription drug data and determining claim data accuracy
US12266019B2 · kind B2 · utility
Assignee
Inventors
Key dates
| Filing date | Sep 28, 2023 |
| Grant date | Apr 1, 2025 |
| Priority date | — |
| Expiry date | Sep 28, 2043 |
Classification
- Technology area (CPC G)Physics
- CPC primaryG16H40/20
- WIPO fieldMedical technology
- WIPO sectorInstruments
Abstract
A method and system for scanning claims data, the method comprising receiving, by a computing system, contract details associated with claims, receiving, by the computer system, prescription transactions data associated with the claims, parsing, by the computer system, the transactions data into column values, and executing, by the computer system, analytics on the parsed transactions. The analytics include comparing the parsed transactions against the contract details for accurate pricing, fees, and accepted treatment protocols concerning dose and quantity, comparing the parsed transactions with independent pricing data that is based on third-party pricing data and drug information, identifying material errors in the parsed transactions, determining withholdings from payment of the claims for a portion above a tolerance level based on the identified material errors. The method further comprising presenting, by the computer system, results of the execution of the analytics to a portal.
Source: USPTO / EPO open patent data. Objective bibliographic and citation counts.