Dynamic claims adjudication
US8781851B2 · kind B2 · utility
Assignee
Inventors
Key dates
| Filing date | Oct 27, 2010 |
| Grant date | Jul 15, 2014 |
| Priority date | — |
| Expiry date | Dec 19, 2032 |
Classification
- Technology area (CPC G)Physics
- CPC primaryG16H20/10
- WIPO fieldIT methods for management
- WIPO sectorElectrical engineering
Abstract
A dynamic claims adjudication system is provided that implements a dynamic claims adjudication process to provide flexible determination of the adjudication rule set to be used to adjudicate a claim for a particular prescription drug regardless of the mandates of the formulary and the rigidity of the tier into which the drug is placed on the formulary. The claims adjudication system and corresponding methods dynamically determine the adjudication rule set to be used to adjudicate a claim based on an analysis of criteria and identification of a tier changing criteria. Accordingly, the rigidity of conventional formulary based claims adjudication is eliminated in favor of dynamic and flexible real time claims adjudication.
Source: USPTO / EPO open patent data. Objective bibliographic and citation counts.