Systems and Methods for Controlled Substance Prescription Monitoring Via Real Time Claims Network
First Claim
1. A controlled substance claims handling system for facilitating real-time processing of claims, the claims handling system comprising:
- a prescription monitoring application operable to;
receive a plurality of claims associated with one or more controlled substances, wherein each of the claims relates to both at least one predefined provider and at least one monitored controlled substance;
validate at least a portion of the plurality of claims; and
transmit data associated with validated claims to a prescription monitoring program system.
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Abstract
Embodiments of the invention can provide systems and methods for controlled substance prescription monitoring via a real time claims network. In one embodiment, a method for facilitating real-time processing of claims associated with one or more controlled substances can be provided. The method can include receiving a plurality of claims from a claims transaction switch, wherein each of the claims relates to both at least one predefined provider and at least one monitored controlled substance. In addition, the method can include validating some or all of the plurality of claims. Furthermore, the method can include formatting and transmitting data from validated claims to a prescription monitoring program system.
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Citations
26 Claims
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1. A controlled substance claims handling system for facilitating real-time processing of claims, the claims handling system comprising:
a prescription monitoring application operable to; receive a plurality of claims associated with one or more controlled substances, wherein each of the claims relates to both at least one predefined provider and at least one monitored controlled substance; validate at least a portion of the plurality of claims; and transmit data associated with validated claims to a prescription monitoring program system. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A method for facilitating real-time processing of claims associated with one or more controlled substances, the method comprising:
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receiving a plurality of claims from a claims transaction switch, wherein each of the claims relates to both at least one predefined provider and at least one monitored controlled substance; validating some or all of the plurality of claims; and formatting and transmitting data from validated claims to a prescription monitoring program system. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24)
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25. A system for facilitating real-time or near real-time processing of controlled substance claims, the system comprising:
a prescription monitoring application operable to; receive a plurality of claims associated with one or more controlled substances, wherein each of the claims relates to both at least one predefined provider and at least one monitored controlled substance; filter at least a portion of the plurality of claims to exclude any reversal transactions and any multiple claims for similar prescription requests; format at least a portion of data from any validated claims in a predefined format prior to transmission; encrypt the data from any validated claims prior to transmission; and transmit the data from any validated claims to a prescription monitoring program system.
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26. A method for facilitating real-time or near real-time processing of controlled substance prescription claims, the method comprising:
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receiving a plurality of claims from a claims transaction switch, wherein each of the claims relates to both at least one predefined provider and at least one monitored controlled substance; filtering some or all of the plurality of claims to exclude any reversal transactions and any multiple claims for similar prescription requests; formatting data from at least a portion of data from any validated claim in a predefined format prior to transmission; encrypting at least a portion of data from any validated claims prior to transmission; and transmitting the data from any validated claims to a prescription monitoring program system.
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Specification