Systems and Methods for Verifying Correlation of Diagnosis and Medication as Part of Qualifying Program Eligibility Verification
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United States of America Patent
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app pub date -
Mar 12, 2014
filing date -
Mar 12, 2014
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Abandoned
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Abstract
Systems and methods are provided for verifying correlation of diagnosis and medication as part of qualifying program eligibility verification for a medication requested in a healthcare transaction. A service provider computer may receive an ADT transaction from a covered entity healthcare provider that includes patient identifiers identifying a patient and a diagnosis code identifying a malady affecting a the patient. The service provider computer may receive a healthcare claim transaction from a pharmacy requesting a medication for the patient. The service provider computer can verify that the requested medication is one typically used for the malady identified by the diagnosis code. The service provider computer may also determine whether the requested medication is eligible under a predefined qualifying program based at least in part on the healthcare claim transaction and patient and/or prescriber registration information.
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