System for pre-processing drug benefit claims according to processed drug lists

US8265950B2 · kind B2 · utility

Assignee

• MEDIMPACT HEALTHCARE SYSTEMS, INC. · US

Inventors

• Frederick Howe · Rancho Santa Fe, US
• Paul M. Momita · San Diego, US

Key dates

• Filing date: Dec 18, 2008
• Grant date: Sep 11, 2012
• Expiry date: Jan 15, 2030

Classification

• Technology area (CPC G): Physics
• CPC primary: G16H20/10
• WIPO field: IT methods for management
• WIPO sector: Electrical engineering

Abstract

A method of processing drug claims, by: (a) receiving a claim; (b) sorting the claim for processing by determining which processed drug list the claim belongs with; and then (c) processing the claim according to the particular processed drug list to which the claim belongs. A hierarchy of drug lists are used in a preferred order. If the drug is found on the first drug list, the system then moves directly to the processing stage. However, if the drug is not found on the first list, the system checks whether the drug is on the second drug list. If the drug is found on the second drug list, the system then moves directly to the processing stage, etc. Preferably, the drug list hierarchy is as follows: (i) home infusion drug list; (ii) drug only listed as a Medicare Part B drug list; (iii) drug listed as either Medicare Part B or D drug list; (iv) required special class drug list; (v) nebulized drug list; (vi) over the counter drug list; (vii) Medicare statutorily excluded non-Part D drug list; (viii) enhanced benefit system drug list; (ix) Medicare Part D or Medicare Part D covered under an enhanced benefit drug list, and (x) a vaccine drug list.