METHOD AND SYSTEM FOR MONITORING PRESCRIPTION DRUG DATA AND DETERMINING CLAIM DATA ACCURACY
Patent №
US 11,810,201
Granted
2023-11-07
Filed 2022
Owner
HEALTHPLAN DATA SOLUTIONS LLC
Lab
—
AI components
2
kr · planning
Assignment
Recorded
Dataset
AIPD
2023_r1 edition
Application
17744807
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.
AI classification
Ownership
HEALTHPLAN DATA SOLUTIONS LLC
assignment · 631760931
Assignors
RUTHERFORD, GARY, BLEVINS, MICHAEL, GROSSMAN, JARROD, BELL, DOUGLAS, SARBOK, DETLEF, RABE, JEFF
On an employer assignment, the assignors are typically the inventors.