SYSTEMS AND METHODS FOR ACCELERATED PAYMENT OF PHARMACY PRESCRIPTION CLAIMS
First Claim
1. A method for accelerated payment of prescription benefits to a pharmacy, the method comprising:
- receiving identifying information of a patient from a pharmacy;
adjudicating a request for prescription benefit coverage based on the identifying information;
conveying a notification to the pharmacy that the request for prescription benefit coverage is approved;
conveying a notification to the pharmacy that funds are available as payment for the prescription benefit coverage; and
providing a guaranteed payment for the prescription benefit coverage to the pharmacy by approving a charge to be placed on a charge card provided to the pharmacy by a claims management service.
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Accused Products
Abstract
Methods and systems are related to the payment of pharmacy benefits under an insurance policy. The system includes pharmacies, a real-time claims processing adjudication component, an information component and a claims processing or billing component. When a qualified patient submits a prescription to a participating pharmacy, the pharmacy collects identifying information from the patient and conveys a request to the real-time claims adjudication component, which screens the request for a match to data already loaded in the system and conveys a notification of acceptance or error to the pharmacy. The real-time claims adjudication component compiles records of the approved claims and the claims processing component processes the claims, bills third party payors and generates periodic files detailing payments owed to pharmacies. Funds are then made available to the pharmacy. The pharmacy may obtain the funds by initiating a transfer, such as a charge placed on a card issued by the system.
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Citations
20 Claims
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1. A method for accelerated payment of prescription benefits to a pharmacy, the method comprising:
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receiving identifying information of a patient from a pharmacy;
adjudicating a request for prescription benefit coverage based on the identifying information;
conveying a notification to the pharmacy that the request for prescription benefit coverage is approved;
conveying a notification to the pharmacy that funds are available as payment for the prescription benefit coverage; and
providing a guaranteed payment for the prescription benefit coverage to the pharmacy by approving a charge to be placed on a charge card provided to the pharmacy by a claims management service. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
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15. A system for providing accelerated payment of prescription benefits to a pharmacy, the system comprising:
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a real-time processing component for receiving a request for prescription benefits from a pharmacy, the real-time processing component configured to compare information collected from a patient to a database and to accept the request if a match is located and convey the acceptance to the pharmacy before a filled prescription is provided to the patient;
a claims processing component for downloading accepted requests from the real-time processing component and generate a bill to a third-party payor for the accepted request and to generate a periodic pharmacy payment file from the processed accepted requests; and
a payment processing component for releasing funds from a credit line to the pharmacy on a periodic basis in response to the periodic pharmacy payment file. - View Dependent Claims (16, 17, 18, 19, 20)
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Specification