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.

Knowledge representationPlanningG06Q 40/08G16H 10/60G16H 20/10G16H 40/20

AI classification

Planning0.96
Knowledge representation0.82
Evolutionary computation0.03
Machine learning0.01
AI hardware0.00
Natural language0.00
Vision0.00
Speech0.00

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.

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