Systems and Methods for Determining Coverage for Medication or Services Related to Specific Conditions or Levels of Care

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United States of America Patent

SERIAL NO

14312424

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ATTORNEY / AGENT: (SPONSORED)

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Abstract

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Systems and methods are provided to determine if a prescription is for patient specific condition or level of care requiring a coverage determination such as hospice care or ESRD for a patient as part of healthcare transaction processing. A service provider computer can receive a healthcare transaction from a healthcare provider that includes a medication identifier and a patient identifier. The service provider computer can determine, based on the medication identifier and/or the patient identifier if the healthcare transaction is for a medication related to a specific condition or level of care. The service provider computer can also generate a rejection response to the healthcare transaction based at least in part on the positive determination that the healthcare transaction is for a medication related to the specific condition or level of care, and can transmit the rejection response to the healthcare provider computer for further action if necessary.

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Patent Owner(s)

Patent OwnerAddress
MCKESSON CORPORATIONONE POST STREET SAN FRANCISCO CA 94104

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Inventor(s)

Inventor Name Address # of filed Patents Total Citations
Irmen, Monique L Richmond, US 1 1
Pinsonneault, Roger G Alpharetta, US 21 276

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