METHODS AND SYSTEMS FOR CLAIM ADJUDICATION
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United States of America
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Issued Date -
Jan 9, 2020
app pub date -
Aug 30, 2019
filing date -
Aug 30, 2019
priority date (Note) -
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status (Latency Note)
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Abstract
Methods and systems for claim adjudication are described. In one embodiment, a status of a drug benefit plan associated with a member is determined. Claims data associated with the member is accessed. A current-filled prescription is identified based on the claims data. At least one adjudication operation for the current-filled prescription is performed prior to receiving a new request for the current-filled prescription. The new request is determined as fillable based on the performance of the at least one adjudication operation. A notification is generated to the member based on the determination. Additional methods and systems are disclosed.
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