Express Scripts Strategic Development, Inc.

Express Scripts, Inc.

Heather D Sundar

Randy Lawrence Canis

Michael Z Chen

John William Vandervoort

Adam W Kautzner

Katherine Harini Sundararaman

Robert F Nease

Krista Lynn Theby

Tina Lynn Bauman Butcher

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.

Methods and systems for claim adjudication

Methods and systems for improving therapy adherence are described. In an embodiment, a disease state associated with a member is identified. A member classification of the member is determined. The member classification may be based on past therapy the member received to treat a condition associated with the disease state. A diagnostic loop is selected based on the disease state associated with the member and the member classification. The diagnostic loop may include a plurality of operations. At least one of the plurality of operations of the diagnostic loop is performed. Other methods and systems are described.

Methods and systems for member messaging

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Edwardsville, IL, United States of America

Heather D Sundar