System and method for improving performance of authorization for prescription drugs

• US 20060116907A1
• Filed: 11/30/2005
• Published: 06/01/2006
• Est. Priority Date: 11/30/2004
• Status: Abandoned Application

• Current Assignee: Health Information Designs, Inc.
• Original Assignee: Health Information Designs, Inc.
• Inventors: Harper, April M., Rhodes, Neal Alan, DiBenedetto, Guy R., Rhodes, Patricia Lewis
• Application Number:
  US11/290,093
• Publication Number:
  US 20060116907A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 70/40 relating to drugs, e.g. their side effects or intended usage

Abstract

A method is provided for utilizing a history database to process a prescription drug authorization request. One embodiment, among others, comprises the steps of: searching an authorization criteria database, producing authorization category records matching a drug identifier; for each of these records, adding a history record; receiving an authorization request; searching the criteria database, producing another set of authorization category records matching the category of the drug identifier; for each of these records, formulating a key comprising the request patient identifier and the matching authorization category; querying the history database using each formulated key, producing history records; and granting or denying the request based on applying the second set of authorization category records to the history records. The history record contains a composite key combining a portion of received claim information and at least a portion of the matching authorization category record.

Claims

1. A method for utilizing a history database to process a prescription drug authorization request, the method comprising the steps of:

searching an authorization criteria database to produce a first set of authorization category records matching a received drug identifier;

for each category in the first set, adding a history record to the history database, the history record containing a composite key field which combines a portion of the received claim information and at least a portion of the matching authorization category record;

receiving a authorization request comprising a patient identifier and a drug identifier;

searching the authorization criteria database to produce a second set of authorization category records having a category field matching a drug category associated with the received drug identifier;

for each authorization category record in the second set, formulating a key comprising the patient identifier in the authorization request and the authorization category;

querying the history database using each formulated key to produce a set of history records; and

determining if the authorization request is granted or denied based on applying criteria in the second set of authorization category records to the set of history records.

2. The method of claim 1, wherein the determining step further comprises:

granting the authorization request if a dispense date of one of the history records is contained within a time window defined by a date in the authorization request and a period in a corresponding one of the second set of authorization category records.

3. The method of claim 1, wherein the determining step further comprises:

comparing one or more fields in one of the history records with one or more fields in one of the second set of authorization category records; and

granting the authorization request based on the comparison.

4. The method of claim 1, wherein the determining step further comprises:

granting the authorization request if a number field of one of the authorization category records is at least as large as the number of records in the set of history records.

5. The method of claim 1, wherein the step of determining step further comprises:

granting the authorization request if no drug category is associated with the received drug identifier.

6. The method of claim 1, wherein the step of determining step further comprises:

granting the authorization request if the second set of authorization category records is empty.

7. The method of claim 1, further comprising the step of:

building an index for the history database using the composite key.

8. The method of claim 1, further comprising the step of:

determining the authorization category associated with the received drug identifier in the authorization request.

9. The method of claim 1, further comprising the step of:

receiving prescription drug claim information comprising the patient identifier and the drug identifier.

10. A system for utilizing a history database to process a prescription drug authorization request, the system comprising the steps of:

means for searching an authorization criteria database to produce a first set of authorization category records matching a received drug identifier;

means adding a history record to the history database for each category in the first set, the history record containing a composite key field which combines a portion of the received claim information and at least a portion of the matching authorization category record;

means for receiving a authorization request comprising a patient identifier and a drug identifier;

means for searching the authorization criteria database to produce a second set of authorization category records having a category field matching a drug category associated with the received drug identifier;

means for formulating a key for each authorization category record in the second set, the key comprising the patient identifier in the authorization request and the authorization category;

means for querying the history database using each formulated key to produce a set of history records; and

means for determining if the authorization request is granted or denied based on applying criteria in the second set of authorization category records to the set of history records.

11. The system of claim 10, wherein the means for determining further comprises:

means for comparing one or more fields in one of the history records with one or more fields in one of the second set of authorization category records; and

means for granting the authorization request based on the comparison.

12. The system of claim 10, wherein the means for determining further comprises:

means for granting the authorization request if a dispense date of one of the history records is contained within a time window defined by a date in the authorization request and a period in a corresponding one of the second set of authorization category records.

13. The system of claim 10, wherein the means for determining further comprises:

means for granting the authorization request if no drug category is associated with the received drug identifier.

14. The system of claim 10, wherein the means for determining further comprises:

means for granting the authorization request if the second set of authorization category records is empty.

15. A computer readable medium having a program for utilizing a history database to process a prescription drug authorization request, the program comprising logic for performing the steps of:

searching an authorization criteria database to produce a first set of authorization category records matching a received drug identifier;

for each category in the first set, adding a history record to the history database, the history record containing a composite key field which combines a portion of the received claim information and at least a portion of the matching authorization category record;

receiving a authorization request comprising a patient identifier and a drug identifier;

searching the authorization criteria database to produce a second set of authorization category records having a category field matching a drug category associated with the received drug identifier;

for each authorization category record in the second set, formulating a key comprising the patient identifier in the authorization request and the authorization category;

querying the history database using each formulated key to produce a set of history records; and

determining if the authorization request is granted or denied based on applying criteria in the second set of authorization category records to the set of history records.

16. The computer readable medium of claim 15, wherein the determining step further comprises:

comparing one or more fields in one of the history records with one or more fields in one of the second set of authorization category records; and

granting the authorization request based on the comparison.

17. The computer readable medium of claim 15, wherein the determining step further comprises:

granting the authorization request if a dispense date of one of the history records is contained within a time window defined by a date in the authorization request and a period in a corresponding one of the second set of authorization category records.

18. The computer readable medium of claim 15, wherein the determining step further comprises:

means for granting the authorization request if no drug category is associated with the received drug identifier.

19. The computer readable medium of claim 15, further comprising the step of:

building an index for the history database using the composite key.

20. The computer readable medium of claim 15, further comprising the step of:

determining the authorization category associated with the received drug identifier in the authorization request.