SYSTEMS AND METHODS FOR MEDICATION DOSAGE RANGE DETERMINATION AND VERIFICATION BASED ON PATIENT TEST RESULTS
First Claim
1. A system, comprising;
- at least one memory operable to store computer-executable instructions; and
at least one processor configured to access the at least one memory and execute the computer-executable instructions to;
receive a medical test result for a patient, wherein the medical test result comprises a patient identifier identifying the patient, a medical testing date identifying a date a medical test was administered to the patient, and at least one test result for the medical test administered to the patient;
identify a plurality of potential test result categories for comparison to the at least one test result;
compare the at least one test result to the plurality of potential test result categories;
determine, based at least in part on the comparison, one of the plurality of potential test result categories that the at least one test result is within;
identify a dosage range associated with the determined one of the plurality of potential test result categories that the at least one test result is within; and
store the identified dosage range as a determined dosage range for a medication for the patient;
receive a healthcare claim transaction from a pharmacy computer for a pharmacy, wherein the healthcare claim transaction comprises a medication identifier identifying the medication prescribed to the patient, a dosage level for the medication, the patient identifier, and a date of service;
compare the dosage level to the identified dosage range to determine if the dosage level is within the identified dosage range; and
direct communication of the healthcare claim transaction to a claims processor computer associated with a claims processor for adjudication based at least in part on a determination that the dosage level is within the identified dosage range.
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Abstract
Systems and methods are provided for determining and verifying dosage levels for patient medications based on medical test results. Patient medical test results can be received and can include a patient identifier identifying the patient, a medical testing date identifying a date a medical test was administered to the patient, and medical test result data. Test result ranges can be identified for comparison to the medical test result data. The medical test result data can be compared to the test result ranges to determine which of the test result ranges the medical test result data falls within. Based on the determination, a medication dosage range associated with the test result range that the medical test result data falls within can be identified. The medication dosage range can be set as the determined and/or suggested medication dosage range for the particular medication for the patient.
14 Citations
20 Claims
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1. A system, comprising;
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at least one memory operable to store computer-executable instructions; and at least one processor configured to access the at least one memory and execute the computer-executable instructions to; receive a medical test result for a patient, wherein the medical test result comprises a patient identifier identifying the patient, a medical testing date identifying a date a medical test was administered to the patient, and at least one test result for the medical test administered to the patient; identify a plurality of potential test result categories for comparison to the at least one test result; compare the at least one test result to the plurality of potential test result categories; determine, based at least in part on the comparison, one of the plurality of potential test result categories that the at least one test result is within; identify a dosage range associated with the determined one of the plurality of potential test result categories that the at least one test result is within; and store the identified dosage range as a determined dosage range for a medication for the patient; receive a healthcare claim transaction from a pharmacy computer for a pharmacy, wherein the healthcare claim transaction comprises a medication identifier identifying the medication prescribed to the patient, a dosage level for the medication, the patient identifier, and a date of service; compare the dosage level to the identified dosage range to determine if the dosage level is within the identified dosage range; and direct communication of the healthcare claim transaction to a claims processor computer associated with a claims processor for adjudication based at least in part on a determination that the dosage level is within the identified dosage range. - View Dependent Claims (2, 3, 4)
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5. A computer-implemented method comprising:
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receiving, by a service provider computer comprising at least one processor, a medical test result for a patient, wherein the medical test result comprises a patient identifier identifying the patient, a medical testing date identifying a date a medical test was administered to the patient, and at least one test result for the medical test administered to the patient; identifying, by the service provider computer, a first test result range and a second test result range for comparison to the at least one test result; comparing, by the service provider computer, the at least one test result to the first test result range and the second test result range; determining, by the service provider computer and based at least in part on the comparison, that the at least one test result is within the first test result range; identifying, by the service provider computer and based at least in part on the determination, a medication dosage range associated with the first test result range; and setting, by the service provider computer, a determined medication dosage range equal to the identified medication dosage range. - View Dependent Claims (6, 7, 8, 9, 10, 11, 12)
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13. A system, comprising;
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at least one memory operable to store computer-executable instructions; and at least one processor configured to access the at least one memory and execute the computer-executable instructions to; receive a medical test result for a patient, wherein the medical test result comprises a patient identifier identifying the patient, a medical testing date identifying a date a medical test was administered to the patient, and at least one test result for the medical test administered to the patient; identify a first test result range and a second test result range for comparison to the at least one test result; compare the at least one test result to the first test result range and the second test result range; determine, based at least in part on the comparison, that the at least one test result is within the first test result range; identify, based at least in part on the determination, a medication dosage range associated with the first test result range; and set a determined medication dosage range equal to the identified medication dosage range. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20)
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Specification