US 11,810,201 B2
Method and system for monitoring prescription drug data and determining claim data accuracy
Gary Rutherford, Columbus, OH (US); Michael Blevins, Upper Arlington, OH (US); Jarrod Grossman, Columbus, OH (US); Douglas Bell, Denver, CO (US); Detlef Sarbok, Maineville, OH (US); and Jeff Rabe, Columbus, OH (US)
Assigned to HEALTHPLAN DATA SOLUTIONS, INC., Columbus, OH (US)
Filed by HEALTHPLAN DATA SOLUTIONS LLC, Columbus, OH (US)
Filed on May 16, 2022, as Appl. No. 17/744,807.
Application 17/744,807 is a continuation of application No. 15/936,986, filed on Mar. 27, 2018, granted, now 11,373,247.
Prior Publication US 2023/0077820 A1, Mar. 16, 2023
This patent is subject to a terminal disclaimer.
Int. Cl. G06Q 20/00 (2012.01); G06Q 40/08 (2012.01); G16H 20/10 (2018.01); G16H 10/60 (2018.01)
CPC G06Q 40/08 (2013.01) [G16H 10/60 (2018.01); G16H 20/10 (2018.01)] 20 Claims
OG exemplary drawing
 
1. A method, in a data processing system comprising a processor and a memory, for scanning claims data, the method comprising:
receiving, by a computing system, contract details associated with claims;
receiving, by the computer system, prescription transactions data associated with the claims;
parsing, by the computer system, the transactions data into column values;
executing, by the computer system, analytics on the parsed transactions, the analytics including:
comparing the parsed transactions against the contract details for accurate pricing, fees, and accepted treatment protocols concerning dose and quantity;
comparing the parsed transactions with independent pricing data that is based on third-party pricing data and drug information;
identifying material errors in the parsed transactions; and
determining withholdings from payment of the claims for a portion above a tolerance level based on the identified material errors, and
presenting, by the computer system, results of the execution of the analytics to a portal.