The patent badge is an abbreviated version of the USPTO patent document. The patent badge does contain a link to the full patent document.
The patent badge is an abbreviated version of the USPTO patent document. The patent badge covers the following: Patent number, Date patent was issued, Date patent was filed, Title of the patent, Applicant, Inventor, Assignee, Attorney firm, Primary examiner, Assistant examiner, CPCs, and Abstract. The patent badge does contain a link to the full patent document (in Adobe Acrobat format, aka pdf). To download or print any patent click here.
Patent No.:
Date of Patent:
Jul. 15, 2014
Filed:
Oct. 27, 2010
Lori L. Anderson, Solana Beach, CA (US);
Mai Ly Thi Hoang, Irving, TX (US);
Chi Shing Chan, San Diego, CA (US);
Jose Eli J. Golez, Jr., Oceanside, CA (US);
Lori L. Anderson, Solana Beach, CA (US);
Mai Ly Thi Hoang, Irving, TX (US);
Chi Shing Chan, San Diego, CA (US);
Jose Eli J. Golez, Jr., Oceanside, CA (US);
Medimpact Healthcare Systems, Inc., San Diego, CA (US);
Abstract
A dynamic claims adjudication system is provided that implements a dynamic claims adjudication process to provide flexible determination of the adjudication rule set to be used to adjudicate a claim for a particular prescription drug regardless of the mandates of the formulary and the rigidity of the tier into which the drug is placed on the formulary. The claims adjudication system and corresponding methods dynamically determine the adjudication rule set to be used to adjudicate a claim based on an analysis of criteria and identification of a tier changing criteria. Accordingly, the rigidity of conventional formulary based claims adjudication is eliminated in favor of dynamic and flexible real time claims adjudication.