Systems and methods for streamlined patient enrollment for one or more healthcare programs

• US 8,392,219 B1
• Filed: 05/10/2010
• Issued: 03/05/2013
• Est. Priority Date: 05/10/2010
• Status: Active Grant

• Current Assignee: McKesson Corp.
• Original Assignee: Mckesson Financial Holdings Limited (McKesson Corp.)
• Inventors: Pinsonneault, Roger, Harris, Patrick Sr.
• Primary Examiner(s): Cobanoglu, Dilek B
• Application Number:
  US12/776,974
• Time in Patent Office: 1,030 Days
• Field of Search: 705/2, 705/3, 715/733
• US Class Current: 705/3
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

Systems and methods are provided for supporting and validating patient enrollment in one or more healthcare programs. The systems and methods may include receiving a prescription claim request from a pharmacy computer, where the prescription claim request includes at least (i) a first product identifier identifying with a prescribed product for a patient, and (ii) patient information associated with the patient; determining, based at least in part upon the first identifier, that patient is subject to a requirement to enroll in one or more required healthcare programs prior to the prescription product being released to the patient; extracting enrollment information from the prescription claim request, the extracted enrollment information including at least a portion of the patient information from the prescription claim request; and automatically utilizing the extracted enrollment information to complete at least a portion of an enrollment process for the one or more required healthcare programs.

Claims

1. A method, comprising:

receiving a prescription claim request from a pharmacy computer, wherein the prescription claim request includes at least (i) a first product identifier identifying a prescribed product for a patient, and (ii) patient information associated with the patient;

automatically determining, based at least in part upon the first product identifier, that the patient is subject to a requirement to enroll in one or more required healthcare programs based on the prescription product as part of a Risk Evaluation and Mitigation Strategy (REMS) prior to the prescription product being released to the patient;

automatically extracting enrollment information from the prescription claim request, the extracted enrollment information including at least a portion of the patient information from the prescription claim request; and

automatically utilizing the extracted enrollment information to complete at least a portion of an enrollment process for the one or more required healthcare programs, wherein the prior steps are performed by one or more computers associated with a service provider.

2. The method of claim 1, wherein the one or more required healthcare programs includes at least one medication therapy management (MTM) program for the prescribed product, or at least one Disease/Condition Management service.

3. The method of claim 1, wherein prior to extracting the enrollment information from the prescription claim request, the method further comprises:

determining that the patient is not currently enrolled in the one or more required healthcare programs,

wherein the prior step is performed by one or more computers associated with the service provider.

4. The method of claim 3, wherein the extracted enrollment information is utilized to complete all of the enrollment process for the one or more required healthcare programs, and further comprising:

responsive to the completion of all of the enrollment process, facilitating adjudication of the prescription claim request with at least one claims processor computer; and

delivering a response to the pharmacy computer with a result of the adjudication of the prescription claim request,

wherein the prior steps are performed by one or more computers associated with the service provider.

5. The method of claim 3, wherein the extracted enrollment information is utilized to complete only a portion of the enrollment process for the one or more required healthcare programs, and further comprising:

responsive to completing only the portion of the enrollment process, delivering a rejection response for the prescription claim request to the pharmacy computer,

wherein the prior step is performed by one or more computers associated with the service provider.

6. The method of claim 5, wherein the rejection response requests completion of the enrollment process for the one or more required healthcare programs.

7. The method of claim 5, wherein the enrollment process is completed by receiving additional patient information via one or more websites, wherein the one or more websites request at least one of (i) additional information not available from the extracted enrollment information, or (ii) confirmation of accuracy of the extracted enrollment information.

8. The method of claim 7, wherein the one or more websites requests confirmation of accuracy of the extracted enrollment information, wherein the one or more websites automatically populate one or more web pages with the extracted enrollment information for confirmation.

9. The method of claim 5, wherein the rejection response identifies one or more websites to access in order to complete the enrollment process for the one or more required healthcare programs.

10. The method of claim 1, wherein the extracted enrollment information includes one or more of (i) a patient name, (ii) a patient date of birth, (iii) a patient address, (iii) patient telephone number, or (iv) a patient condition.

11. A system, comprising:

at least one memory for storing computer-executable instructions; and

at least one processor in communication with the at least one memory, wherein the at least one processor is configured to execute the computer-executable instructions to;

receive a prescription claim request from a pharmacy computer, wherein the prescription claim request includes at least (i) a first product identifier identifying a prescribed product for a patient, and (ii) patient information associated with the patient;

determine automatically, based at least in part upon the first product identifier, that the patient is subject to a requirement to enroll in one or more required healthcare programs based on the prescription product as part of a Risk Evaluation and Mitigation Strategy (REMS) prior to the prescription product being released to the patient;

extract enrollment information automatically from the prescription claim request, the extracted enrollment information including at least a portion of the patient information from the prescription claim request; and

automatically utilize the extracted enrollment information to complete at least a portion of an enrollment process for the one or more required healthcare programs.

12. The system of claim 11, wherein the one or more required healthcare programs includes at least one medication therapy management (MTM) program for the prescribed product, or at least one Disease/Condition Management service.

13. The system of claim 11, wherein prior to extracting the enrollment information from the prescription claim request, the at least one processor is further configured to execute the computer-executable instructions to:

determine that the patient is not currently enrolled in the one or more required healthcare programs.

14. The system of claim 13, wherein the extracted enrollment information is utilized to complete all of the enrollment process for the one or more required healthcare programs, and wherein the at least one processor is further configured to execute the computer-executable instructions to:

responsive to the completion of all of the enrollment process, facilitate adjudication of the prescription claim request with at least one claims processor computer; and

deliver a response to the pharmacy computer with a result of the adjudication of the prescription claim request.

15. The system of claim 13, wherein the extracted enrollment information is utilized to complete only a portion of the enrollment process for the one or more required healthcare programs, and wherein the at least one processor is further configured to execute the computer-executable instructions to:

responsive to completing only the portion of the enrollment process, deliver a rejection response for the prescription claim request to the pharmacy computer.

16. The system of claim 15, wherein the rejection response requests completion of the enrollment process for the one or more required healthcare programs.

17. The system of claim 15, wherein the enrollment process is completed by receiving additional patient information via one or more websites, wherein the one or more websites request at least one of (i) additional information not available from the extracted enrollment information, or (ii) confirmation of accuracy of the extracted enrollment information.

18. The system of claim 17, wherein the one or more websites requests confirmation of accuracy of the extracted enrollment information, wherein the one or more websites automatically populate one or more web pages with the extracted enrollment information for confirmation.

19. The system of claim 15, wherein the rejection response identifies one or more websites to access in order to complete the enrollment process for the one or more required healthcare programs.

20. The system of claim 11, wherein the extracted enrollment information includes one or more of (i) a patient name, (ii) a patient date of birth, (iii) a patient address, (iii) patient telephone number, or (iv) a patient condition.