×

Fraud, abuse, and error detection in transactional pharmacy claims

  • US 20060217824A1
  • Filed: 02/23/2006
  • Published: 09/28/2006
  • Est. Priority Date: 02/25/2005
  • Status: Abandoned Application
First Claim
Patent Images

1. A computer-implemented method for processing benefits payment claims for prescription medicine, comprising operations of:

  • receiving pharmacy benefits payment claims submitted for payment by a pharmacy benefits claims payor, each claim specifying a patient-drug combination;

    for each claim, performing operations comprising;

    performing computer-driven statistical analysis of predefined aspects of a claims history for the specified patient-drug combination in relation to a history of claims paid by the pharmacy benefits claims payor involving a multiplicity of different patients and drugs;

    generating an indicator of predicted legitimacy by scoring results of the statistical analysis;

    providing an output of at least one of the following;

    the indicator, payment advice prepared by applying predefined criteria to data including the indicator.

View all claims
  • 1 Assignment
Timeline View
Assignment View
    ×
    ×