公开(公告)号：US20240203554A1

公开(公告)日：2024-06-20

申请号：US18537901

申请日：2023-12-13

Applicant: Express Scripts Strategic Development, Inc.

Inventor： Arun Siva ,  Yevgeniya Kuznetsova ,  Damayanti Majumdar ,  KanmaniGowri Jeyaram ,  Ankur Kaneria ,  Harry S. Gangaikondan-Iyer

IPC: G16H20/10 ,  G06N3/08 ,  G16H10/60

CPC classification number: G16H20/10 ,  G06N3/08 ,  G16H10/60

Abstract: Methods and systems for performing multi-platform prescription drug claim adjudication are provided. The methods and systems perform operations comprising: receiving, by a first server associated with a first claim adjudication entity, a claim for a prescription drug for a patient, the first claim adjudication entity managing a prescription drug profile for the patient; accessing initial fulfillment information for fulfilling the prescription drug using the first claim adjudication entity; determining that one or more features associated with the prescription drug of the claim correspond to one or more criteria; in response to determining that one or more features correspond to the one or more criteria, transmitting a communication to a second server associated with a second claim adjudication entity, the communication identifying the prescription drug and requesting alternate fulfillment information; and selecting a claim adjudication process based on the initial fulfillment information and the alternate fulfillment information.