G - Physics – 06 – Q
Patent
G - Physics
06
Q
G06Q 40/08 (2012.01) G06Q 50/22 (2012.01)
Patent
CA 2482370
Systems, methods and computer program products enable pharmacies and other healthcare providers to obtain the best available reimbursement price for filling pharmaceutical prescriptions. The present invention provides for the tracking of reimbursement transaction data, which is utilized to derive a best available price for pharmaceutical prescriptions. One way of determining the best available price is to compare the requested reimbursement unit value to the best unit cost (BUC). The BUC represents the highest price paid by an insurance carrier or group of insurance carriers in a similar transaction, typically qualified by provincial location, drug and insurance carrier, and/or third party processor. The BUC values are utilized to determine if the reimbursement amount requested should be sent back for modification, flagged for a warning message to be sent to the pharmacy after the request has been submitted to the insurance carrier or third party processor, increased to more closely approximate the BUC, or submitted as is. The requested reimbursement amount is then modified accordingly and then sent to the insurance carrier or third party processor for payment. The response from the insurance carrier or third party processor is processed for capture of certain data that may be used to update the BUC values before being sent to the submitting pharmacy or other healthcare provider.
Finlayson & Singlehurst
Ndchealth Corporation
LandOfFree
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