Method for improving the consistency of processing pharmacy data

• US 20040148198A1
• Filed: 01/13/2004
• Published: 07/29/2004
• Est. Priority Date: 01/13/2003
• Status: Active Grant

• Current Assignee: Omnicare LLC (CVS Health Corporation)
• Original Assignee: Omnicare Incorporated (CVS Health Corporation)
• Inventors: Kalies, Ralph F.
• Granted Patent: US 8,346,570 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

A method for consistent processing of pharmacy data. An order for a prescription is transmitted from a healthcare facility to a pharmacy. The pharmacy transmits a claim relating to the order from the pharmacy to a processing center. The processing center reviews the claim according to predetermined claim criteria and either accepts the claim if it conforms to the claim criteria or rejects the claim if it does not conform to the claim criteria. The processing center transmits one of an approval notification and a rejection notification to the pharmacy. For rejected claims, the processing center transmits at least one basis for the rejection to the pharmacy. The pharmacy corrects the non-conforming portion of the claim, then transmits the corrected claim to the processing center. The claim review and approval or rejection steps are then repeated until the claim conforms to the predetermined claim criteria.

Claims

1. A method for providing consistent processing of pharmacy data, comprising the steps of:

a) transmitting an order for at least one prescription from a healthcare facility to a pharmacy;

b) transmitting a claim relating to the order from the pharmacy to a processing center;

c) reviewing the claim at the processing center according to predetermined claim review criteria and accepting the claim only if it conforms to the claim review criteria;

d) transmitting one of an approval notification and a rejection notification from the processing center to the pharmacy;

e) for accepted claims,

i) fulfilling the order at the pharmacy,

ii) transmitting the filled prescription from the pharmacy to the healthcare facility, and

iii) transmitting an invoice corresponding to the filled prescription from the pharmacy to the healthcare facility; and

f) for rejected claims,

i) transmitting at least one basis for the rejection of the nonconforming claim from the processing center to the pharmacy,

ii) correcting the non-conforming portion of the claim at the pharmacy,

iii) transmitting the corrected claim from the pharmacy to the processing center as at step (b),

iv) repeating steps (c) through (f) until the claim conforms to the predetermined claim criteria and the filled prescription and corresponding invoice are transmitted to the healthcare facility.

2. The method according to claim 1 wherein at least one of the order, claim, approval notification, rejection notification, basis for rejection, corrected claim, and invoice is transmitted by means of an electronic communication network.

3. The method according to claim 1, further comprising the step of securing the order before transmitting it to the pharmacy.

4. The method according to claim 1 wherein the claim review is accomplished automatically in accordance with predetermined review criteria.

5. A method for providing consistent processing of pharmacy data, comprising the steps of:

a) securing an order for at least one prescription at a healthcare facility;

b) transmitting the secured order from the healthcare facility to a pharmacy by means of an electronic communication network;

c) transmitting a claim relating to the order from the pharmacy to a processing center by means of the electronic communication network;

d) reviewing the claim at the processing center by automatic means, according to predetermined claim review criteria and accepting the claim only if it conforms to the claim review criteria;

e) transmitting one of an approval notification and a rejection notification from the processing center to the pharmacy by means of the electronic communication network;

f) for accepted claims,

i) fulfilling the order at the pharmacy,

ii) transmitting the filled prescription from the pharmacy to the healthcare facility, and

iii) transmitting an invoice corresponding to the filled prescription from the pharmacy to the healthcare facility by means of the electronic communication network; and

g) for rejected claims,

i) transmitting at least one basis for the rejection of the nonconforming claim from the processing center to the pharmacy by means of the electronic communication network,

ii) correcting the non-conforming portion of the claim at the pharmacy,

iii) transmitting the corrected claim from the pharmacy to the processing center by means of the electronic communication network as at step (b),

iv) repeating steps (c) through (f) until the claim conforms to the predetermined claim criteria and the filled prescription and corresponding invoice are transmitted to the healthcare facility.

6. A method for providing consistent processing of pharmacy data, comprising the steps of:

a) transmitting an order for at least one prescription from a healthcare facility to at least one pharmacy;

b) transmitting a claim relating to the order from the pharmacy to a processing center;

c) reviewing the claim at the processing center according to predetermined claim review criteria and accepting the claim only if it conforms to the claim review criteria;

d) transmitting one of an approval notification and a rejection notification from the processing center to the pharmacy;

e) for accepted claims,

i) fulfilling the order at the pharmacy,

ii) transmitting the filled prescription from the pharmacy to the healthcare facility,

iii) aggregating the accepted claim with other accepted claims for the healthcare facility,

f) for rejected claims,

i) transmitting at least one basis for the rejection of the nonconforming claim from the processing center to the pharmacy,

ii) correcting the non-conforming claim at the pharmacy,

iii) transmitting the corrected claim from the pharmacy to the processing center as at step (b),

iv) repeating steps (c) through (f) until the claim conforms to the predetermined claim criteria and the filled prescription is transmitted to the healthcare facility; and

g) periodically transmitting an invoice corresponding to the aggregated accepted claims from the processing center to the healthcare facility.

7. The method according to claim 6 wherein at least one of the order, claim, approval notification, rejection notification, basis for rejection, corrected claim, and invoice is transmitted by means of an electronic communication network.

8. The method according to claim 6, further comprising the step of securing the order prior to transmitting it to the pharmacy.

9. The method according to claim 6 wherein the claim review is accomplished automatically in accordance with predetermined review criteria.

10. The method according to claim 6, further comprising the steps of:

a) preparing at least one report relating to the orders and claims; and

b) transmitting the report from the processing center to the healthcare facility.

11. The method according to claim 10 wherein the report is transmitted to the healthcare facility by means of an electronic communication network.

12. A method for providing consistent processing of pharmacy data, comprising the steps of:

a) securing an order for at least one prescription at a healthcare facility;

b) transmitting the secured order from the healthcare facility to at least one pharmacy by means of an electronic communication network

c) transmitting a claim relating to the order from the pharmacy to a processing center by means of the electronic communication network;

d) reviewing the claim at the processing center by automatic means, according to predetermined claim review criteria and accepting the claim only if it conforms to the claim review criteria;

e) transmitting one of an approval notification and a rejection notification from the processing center to the pharmacy by means of the electronic communication network;

f) for accepted claims,

i) fulfilling the order at the pharmacy,

ii) transmitting the filled prescription from the pharmacy to the healthcare facility,

iii) aggregating the accepted claim with other accepted claims for the healthcare facility,

g) for rejected claims,

i) transmitting at least one basis for the rejection of the nonconforming claim from the processing center to the pharmacy by means of the electronic communication network,

ii) correcting the non-conforming claim at the pharmacy,

iii) transmitting the corrected claim from the pharmacy to the processing center by means of the electronic communication network as at step (b),

iv) repeating steps (c) through (f) until the claim conforms to the predetermined claim criteria and the filled prescription is transmitted to the healthcare facility; and

h) periodically transmitting an invoice corresponding to the aggregated accepted claims from the processing center to the healthcare facility by means of the electronic communication network.