Invention Grant
- Patent Title: Electronic pharmacy adjudication system and associated method and computer program product
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Application No.: US16936704Application Date: 2020-07-23
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Publication No.: US11783424B2Publication Date: 2023-10-10
- Inventor: Michael Simpson , Chad Griffin
- Applicant: Express Scripts Canada Co.
- Applicant Address: CA Halifax
- Assignee: Express Scripts Canada Co.
- Current Assignee: Express Scripts Canada Co.
- Current Assignee Address: CA Halifax
- Agency: Stinson LLP
- Priority: CA 3051044 2019.07.31
- Main IPC: G16H40/20
- IPC: G16H40/20 ; G16H20/10 ; G16H70/40 ; G06Q40/08 ; G06Q20/20 ; G06Q20/40 ; G06Q30/018 ; G06Q50/26 ; G06N20/00

Abstract:
An electronic pharmacy adjudication system and associated method and computer program product for performing adjudication service for a healthcare insurance claim is provided. The system includes an interface layer, an orchestration layer and a service and rules engine layer configured for receiving, processing and releasing an adjudication decision. The orchestration layer processes the healthcare insurance claim to generate a sequence of service calls to the service and rules engine layer to derive a sequence of partial decision results, which are derived by processing a set of parameters identified by the service call according to a corresponding subset of decisions rules in a rules repository. The sequence of partial decision results is then processed to derive the adjudication decision corresponding to the healthcare insurance claim.
Public/Granted literature
- US20210035225A1 ELECTRONIC PHARMACY ADJUDICATION SYSTEM AND ASSOCIATED METHOD AND COMPUTER PROGRAM PRODUCT Public/Granted day:2021-02-04
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