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Systems and methods for determining and communicating information to a pharmacy indicating patient eligibility for an intervention service

  • US 10,430,555 B1
  • Filed: 03/13/2014
  • Issued: 10/01/2019
  • Est. Priority Date: 03/13/2014
  • Status: Active Grant
First Claim
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1. A computer-implemented method, comprising:

  • receiving, by one or more service provider computers comprising a switch or a router and associated with a service provider, a first prescription claim transaction for a prescribed product prescribed to a patient and to be filled by a pharmacy, the first prescription claim transaction comprising a prescription number, a product identifier for the prescribed product, a patient identifier for the patient prescribed the prescribed product, a pharmacy identifier, and a claims processor identifier;

    determining, by the one or more service provider computers and based at least on the patient identifier in the first prescription claim transaction, at least one intervention service is available for the patient;

    determining, by the one or more service provider computers and after receipt of the first prescription claim transaction, if an available intervention service notification associated with the at least one available intervention service was previously transmitted to a pharmacy computer for the patient at a time prior to receiving the first prescription claim transaction, wherein determining if an available intervention service notification was previously transmitted comprises parsing intervention notification files stored in a database to determine if the patient identifier matches a patient identifier in the intervention notification files, and in response to the patient identifier matching a patient identifier in the intervention notification files, determine if the intervention notification files include a file having the matching patient identifier corresponding to the available intervention service;

    generating, by the one or more service provider computers and based on a determination that the available intervention service notification has not been previously transmitted, a rejection response for the prescription claim transaction;

    transmitting, by the one or more service provider computers to the pharmacy computer, the rejection response, the response comprising the available intervention service notification, wherein the one or more service provider computers comprises one or more memory devices configured to store data files that include a routing table to identify a destination of communications and a network interface to facilitate connection of the one or more service provider computers with one or more networks;

    generating, by the one or more service provider computers, a patient intervention service form corresponding to the at least one available intervention service for the patient, wherein generation of the patient intervention service form comprises;

    retrieving, from a storage database, a patient intervention service template comprising standardized information to be applied to each of a plurality of intervention types; and

    populating, by the one or more service provider computers, the patient intervention service template based on an intervention type associated with the available intervention service and with patient information included in the first prescription claim transaction, the populated information comprising at least the prescription number, the patient name, and the pharmacy identifier, wherein the generated patient intervention service form comprises at least one element requiring patient input for completion;

    transmitting, by the one or more service provider computers and separate from the rejection response, the patient intervention service form corresponding to the at least one available intervention service for the patient to the pharmacy computer to facilitate provision of an indication of availability of the patient intervention form to a pharmacist in response to receiving a request for the prescription from the patient or an associated patient caregiver in order to permit completion of the patient intervention service form by the pharmacist; and

    receiving, by the one or more service provider computers from the pharmacy computer, a completed patient intervention service form corresponding to the transmitted patient intervention service form, wherein the completed patient intervention service form comprises at least one element completed with patient input.

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