公开(公告)号：US20140222456A1

公开(公告)日：2014-08-07

申请号：US14247586

申请日：2014-04-08

Applicant: Express Scripts, Inc.

Inventor： Jo-Ellen Abou Nader ,  Suzanne B. Mitchell

IPC: G06F19/00

CPC classification number: G06F19/328 ,  G06F19/3456 ,  G06Q50/22

Abstract: Methods and systems for drug purchase validation are described. In an example embodiment, drug sale data is accessed from a prescription drug wholesaler regarding prescription drugs sold to the pharmacy by the prescription drug wholesaler during a period of time. A number of units of a prescription drug sold to the pharmacy are determined based on the drug sale data during the period of time. Pharmacy claims data over the period of time is accessed, where the pharmacy claims data reflects a plurality of adjudicated claims, and the plurality of adjudicated claims are a plurality of claims that were submitted for adjudication by the pharmacy during the period of time. A number of units of a prescription drug associated with the plurality of claims submitted during the period of time by the pharmacy for adjudication are determined based on the pharmacy claims data. The number of units of the prescription drug associated with the plurality of adjudicated claims that were submitted for adjudication by the pharmacy is compared with the number of units of the prescription drug sold to the pharmacy. A determination is then made as to whether a discrepancy exists based on the results of the comparison. Additional methods and systems are disclosed.

Abstract translation: 描述了药物购买验证的方法和系统。 在一个示例性实施例中，药物销售数据从处方药批发商处获得，处方药在一段时间内由处方药批发商销售给药店。 销售给药房的处方药的单位数量是根据药物销售数据确定的。 访问药房要求在一段时间内的数据，其中药房索赔数据反映了多个被裁决的权利要求，并且多个被裁决的权利要求是多个权利要求，这些权利要求被提交给药房在一段时间内进行裁决。 根据药房索赔数据确定了药房审判期间在一段时间内提交的与多个索赔相关的许多处方药单位。 将提交给药房审判的多个裁定权利要求相关的处方药单位数与销往药房的处方药单位数进行比较。 然后根据比较结果确定是否存在差异。 公开了附加的方法和系统。