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1. 发明授权

US08762181B1 Systems and methods for evaluating healthcare claim transactions for medicare eligibility 有权
标题翻译：用于评估医疗保健申请交易医疗保险资格的系统和方法
公开(公告)号：US08762181B1
公开(公告)日：2014-06-24
申请号：US12650979
申请日：2009-12-31
申请人： James Morgan Ringold
发明人： James Morgan Ringold
IPC分类号： G06Q40/00
CPC分类号： G06Q10/10
摘要： Systems and methods for evaluating healthcare claim transactions for Medicare eligibility are described. A healthcare claim transaction designating a payor other than a Medicare Part B payor may be received from a healthcare provider computer, and a product or service associated with the transaction may be identified as a product or service that is eligible for Medicare Part B coverage. Based at least in part on the identification, a determination may be made as to whether a patient associated with the transaction is eligible for Medicare Part B coverage. The transaction may be routed to a claims processor computer if it is determined that the patient is not eligible for Medicare Part B coverage. However, if it is determined that the patient is eligible for Medicare Part B coverage, then a message indicating that the transaction is rejected may be communicated to the healthcare provider computer.
摘要翻译：描述了用于评估医疗保险资格的医疗保险索赔交易的系统和方法。指定医疗保险B部分付款人以外的付款人的医疗保险索赔交易可以从医疗保健提供者计算机接收，并且与交易相关联的产品或服务可以被识别为符合医保部分B覆盖的产品或服务。至少部分地基于身份识别，可以确定与交易相关联的患者是否符合Medicare B部分的覆盖范围。如果确定患者不符合Medicare B部分覆盖的资格，则交易可以被路由到索赔处理器计算机。然而，如果确定患者符合Medicare B部分的覆盖范围，则可以向医疗保健提供者计算机传送指示交易被拒绝的消息。

2. 发明授权

US07979285B2 Systems and methods for enhanced min/max edit for drug claim submission verification 有权
标题翻译：用于药物索赔提交验证的增强最小/最大编辑的系统和方法
公开(公告)号：US07979285B2
公开(公告)日：2011-07-12
申请号：US11744047
申请日：2007-05-03
申请人： Angela Saterfiel Wiley , James Morgan Ringold
发明人： Angela Saterfiel Wiley , James Morgan Ringold
IPC分类号： G06Q40/00 , G06F19/00
CPC分类号： G06Q10/10 , G06F19/00 , G06Q50/22 , G06Q50/24
摘要： Systems and methods are provided for verification of claims submitted by one or more pharmacies. The systems and methods include storing a Multiple Package Edit (MPE) table that includes drug package size information, storing an audit table that includes drug dose information, and storing a user table that includes pharmacy-supplied drug information. The systems and methods also include receiving a first claim submission from a pharmacy computer, where the first claim submission includes at least one identifier, a quantity, and days supply for a requested drug. The systems and methods further include determining that the first claim submission includes an error in at least one of the quantity and days supply based upon information obtained from at least one of the user table, the MPE table, and the audit table, and messaging the pharmacy computer with an indication of the determined error.
摘要翻译：提供了系统和方法来验证由一个或多个药店提交的索赔。系统和方法包括存储包括药品包装尺寸信息的多包装编辑（MPE）表，存储包括药物剂量信息的审核表，以及存储包括药房提供的药物信息的用户表。系统和方法还包括从药房计算机接收第一索赔提交，其中第一索赔提交包括所要求药物的至少一个标识符，数量和日期供应。系统和方法还包括基于从至少一个用户表，MPE表和审计表中获得的信息确定第一权利要求提交中的至少一个数量和天供应中的错误，并将消息传递药房计算机显示确定的错误。

3. 发明申请

US20080275723A1 Systems and Methods for Enhanced Min/Max Edit for Drug Claim Submission Verification 有权
标题翻译：用于药物索赔提交验证的增强最小/最大编辑的系统和方法
公开(公告)号：US20080275723A1
公开(公告)日：2008-11-06
申请号：US11744047
申请日：2007-05-03
申请人： Angela Saterfiel Wiley , James Morgan Ringold
发明人： Angela Saterfiel Wiley , James Morgan Ringold
IPC分类号： G06Q50/00
CPC分类号： G06Q10/10 , G06F19/00 , G06Q50/22 , G06Q50/24
摘要： Systems and methods are provided for verification of claims submitted by one or more pharmacies. The systems and methods include storing a Multiple Package Edit (MPE) table that includes drug package size information, storing an audit table that includes drug dose information, and storing a user table that includes pharmacy-supplied drug information. The systems and methods also include receiving a first claim submission from a pharmacy computer, where the first claim submission includes at least one identifier, a quantity, and days supply for a requested drug. The systems and methods further include determining that the first claim submission includes an error in at least one of the quantity and days supply based upon information obtained from at least one of the user table, the MPE table, and the audit table, and messaging the pharmacy computer with an indication of the determined error.
摘要翻译：提供了系统和方法来验证由一个或多个药店提交的索赔。系统和方法包括存储包括药品包装尺寸信息的多包装编辑（MPE）表，存储包括药物剂量信息的审核表，以及存储包括药房提供的药物信息的用户表。系统和方法还包括从药房计算机接收第一索赔提交，其中第一索赔提交包括所要求药物的至少一个标识符，数量和日期供应。系统和方法还包括基于从至少一个用户表，MPE表和审计表中获得的信息确定第一权利要求提交中的至少一个数量和天供应中的错误，并将消息传递药房计算机显示确定的错误。

4. 发明授权

US08788296B1 Systems and methods for providing notifications of availability of generic drugs or products 有权
标题翻译：提供通用药物或产品可用性的系统和方法
公开(公告)号：US08788296B1
公开(公告)日：2014-07-22
申请号：US12696717
申请日：2010-01-29
申请人： James Morgan Ringold
发明人： James Morgan Ringold
IPC分类号： G06Q40/00 , G06Q40/08 , G06Q50/22
CPC分类号： G06Q40/08 , G06F19/00 , G06Q10/10 , G06Q50/22
摘要： Systems and methods may provide notifications of availability of generic drugs or products. The systems and methods may include receiving, from a healthcare provider computer, a healthcare claim transaction request that identifies a product for a patient; determining that the product identified by the healthcare claim transaction request is a non-generic product or a branded product; determining that a generic equivalent for the product identified by the healthcare claim transaction request will become available on a future date; generating a generic notification message indicating the availability of generic equivalent for the product on the future date; and delivering or directing a delivery of the generic notification message.
摘要翻译：系统和方法可提供通用药物或产品的可用性通知。系统和方法可以包括从医疗保健提供者计算机接收识别患者的产品的医疗保健索赔交易请求; 确定由医疗保健索赔交易请求确定的产品是非通用产品或品牌产品; 确定由医疗保健索赔交易请求识别的产品的通用等效物将在未来的日期可用; 生成通用通知消息，指示将来日期产品的通用等效物的可用性; 以及递送或指导通用通知消息的传递。

5. 发明授权

US08335672B1 Systems and methods for the identification of available payers for healthcare transactions 有权
标题翻译：用于识别医疗保健交易的可用付款人的系统和方法
公开(公告)号：US08335672B1
公开(公告)日：2012-12-18
申请号：US12732770
申请日：2010-03-26
申请人： James Morgan Ringold
发明人： James Morgan Ringold
IPC分类号： G06Q40/00
CPC分类号： G06Q50/22 , G06F19/00 , G06Q50/24
摘要： Systems and methods are provided for the identification of available payers for healthcare transactions. A reply to a healthcare claim transaction may be received from a claims processor computer. Based at least in part on the reply, a determination may be made that the healthcare claim transaction has been rejected for an eligibility reason. An available payer for a patient associated with the received reply may be identified subsequent to the determination. Information associated with the identified available payer may be communicated to a healthcare provider associated with the healthcare claim transaction.
摘要翻译：提供系统和方法用于识别医疗保健交易的可用付款人。可以从索赔处理器计算机接收对医疗保险索赔交易的答复。至少部分地基于答复，可以确定医疗保健索赔交易因资格原因被拒绝。可以在确定之后识别与接收到的回复相关联的患者的可用付款人。与所识别的可用付款人相关联的信息可以被传送到与医疗保健索赔交易相关联的医疗保健提供者。

6. 发明授权

US08762163B1 Systems and methods for processing healthcare claim transactions that are rejected due to a host error 有权
标题翻译：处理医疗保险的系统和方法由于主机错误而被拒绝的交易
公开(公告)号：US08762163B1
公开(公告)日：2014-06-24
申请号：US12627701
申请日：2009-11-30
申请人： James Morgan Ringold
发明人： James Morgan Ringold
IPC分类号： G06Q50/00
CPC分类号： G06Q50/22 , G06F19/00 , G06Q10/10
摘要： Systems and methods are provided for processing healthcare claim transactions that are rejected due to a host error. The systems and methods may be carried out by a suitable service provider. A healthcare claim transaction received from a healthcare provider computer may be routed to a claims processor computer. A determination may be made that the healthcare claim transaction has not been approved as a result of a host processor error associated with the claims processor computer. Based at least in part on the determination, the healthcare claim transaction may be resubmitted to the claims processor computer.
摘要翻译：提供系统和方法来处理由于主机错误而被拒绝的医疗保健索赔交易。系统和方法可以由合适的服务提供商来执行。从医疗保健提供者计算机接收到的医疗保健索赔交易可以被路由到索赔处理器计算机。作为与权利要求处理器计算机相关联的主机处理器错误的结果，可能确定医疗保健索赔交易未被批准。至少部分地基于确定，可以将保健索赔交易重新提交给权利要求处理器计算机。

7. 发明授权

US08725532B1 Systems and methods for monitoring controlled substance distribution 有权
标题翻译：监测受控物质分布的系统和方法
公开(公告)号：US08725532B1
公开(公告)日：2014-05-13
申请号：US13538377
申请日：2012-06-29
申请人： James Morgan Ringold
发明人： James Morgan Ringold
IPC分类号： G06Q50/22 , G06F19/00
CPC分类号： G06F19/32 , G06F19/00 , G06F19/3456
摘要： Systems and methods for monitoring controlled substance distribution include receiving a healthcare transaction at a service provider computer. The healthcare transaction may be parsed to determine the healthcare provider submitting the healthcare transaction, the drug being prescribed as part of the healthcare transaction and the class of controlled substance to which the drug being prescribed belongs. Counters associated with total scripts prescribed by the healthcare provider and the class of controlled substance may be incremented upward in view of the healthcare transaction being approved by a claims processor. A current percentage of the class of controlled substances being prescribed can be calculated for the healthcare provider and compared to a threshold percentage for the particular class of controlled substance. If the current percentage violates the threshold percentage, a notification can be sent to a corporate level or management level for the healthcare provider for review.
摘要翻译：用于监测受控物质分布的系统和方法包括在服务提供商计算机处接收医疗保健交易。可以解决医疗交易，以确定提交医疗交易的医疗保健提供者，作为医疗保健交易的一部分被规定的药物以及被处方药物所属的受控物质的类别。考虑到由权利要求处理者批准的医疗交易，与医疗保健提供者规定的总脚本和受控物质类别相关联的计数器可以向上增加。可以为医疗保健提供者计算正在处理的受控物质类别的当前百分比，并与特定类别受控物质的阈值百分比进行比较。如果当前百分比违反了门槛百分比，则可将通知发送给医疗保健提供者的公司级别或管理级别进行审核。

8. 发明授权

US08521557B1 System and methods for processing rejected healthcare claim transactions for over-the-counter products 有权
标题翻译：用于处理非处方产品拒收的医疗保险索赔交易的系统和方法
公开(公告)号：US08521557B1
公开(公告)日：2013-08-27
申请号：US12982395
申请日：2010-12-30
申请人： James Morgan Ringold , Roger Pinsonneault
发明人： James Morgan Ringold , Roger Pinsonneault
IPC分类号： G06Q50/00
CPC分类号： G06F19/328 , G06F19/00 , G06Q10/10 , G06Q30/0207 , G06Q50/22 , G06Q50/24
摘要： Systems and methods for processing rejected healthcare claim transactions for over-the-counter (“OTC”) products are provided. A healthcare claim transaction associated with a product requested by a customer may be received from a healthcare provider computer. The healthcare claim transaction may be communicated to a claims processor for adjudication, and a denied claim response for the healthcare claim transaction may be received from the claims processor. Based at least in part upon a classification of the product, the denied claim response may be converted to an approved claim response, and the approved claim response may be communicated to the healthcare provider computer. In certain embodiments, the above operations may be performed by one or more computers associated with a service provider.
摘要翻译：提供了用于处理非处方（“OTC”）产品的拒绝医疗保健索赔交易的系统和方法。可以从医疗保健提供者计算机接收与客户请求的产品相关联的医疗保健索赔交易。医疗保健索赔交易可以被传送到索赔处理器以进行裁决，并且可以从权利要求处理器接收针对医疗保险索赔交易的被拒绝的索赔响应。至少部分地基于产品的分类，被拒绝的索赔答复可以被转换为已批准的索赔答复，并且所批准的索赔答复可以传达给医疗保健提供者计算机。在某些实施例中，上述操作可以由与服务提供商相关联的一个或多个计算机执行。

9. 发明授权

US08060379B1 Systems and methods for alternate pricing for prescription drugs 有权
标题翻译：处方药替代定价的系统和方法
公开(公告)号：US08060379B1
公开(公告)日：2011-11-15
申请号：US12101997
申请日：2008-04-13
申请人： Roger Pinsonneault , James Morgan Ringold
发明人： Roger Pinsonneault , James Morgan Ringold
IPC分类号： G06Q50/00 , G06Q40/00
CPC分类号： G06Q50/22 , G06F19/00 , G06Q30/06 , G06Q40/08
摘要： Systems and methods may be provided for alternate pricing. The systems and methods may include receiving first information associated with a first claim transaction, where the first information identifies a first drug, a first quantity of the first drug, and a first price for the first drug, determining a first product classification for the identified first drug, where the first product classification indicates that the identified first drug is a preferred drug, and updating an alternate pricing database with the first price for the first drug. The systems and methods may also include utilizing the alternate database to identify one or more lower-cost alternate drugs that are therapeutic alternatives for a requested drug. Customers may be provided with information regarding the identified lower-cost alternate drugs.
摘要翻译：可以提供系统和方法用于替代定价。系统和方法可以包括接收与第一声明交易相关联的第一信息，其中第一信息识别第一药物，第一药物的第一数量和第一药物的第一价格，确定所识别的第一药物的第一产品分类第一种药物，其中第一种产品分类表明所鉴定的第一种药物是首选药物，并以第一种药物的第一种价格更新替代定价数据库。系统和方法还可以包括利用替代数据库来鉴定作为所要求药物的治疗性替代物的一种或多种较低成本的替代药物。可能向客户提供有关所识别的低成本替代药物的信息。

10. 发明授权

US08560340B1 Systems and methods for overriding rejections of healthcare claim transactions 有权
标题翻译：覆盖医疗保险索赔交易拒绝的系统和方法
公开(公告)号：US08560340B1
公开(公告)日：2013-10-15
申请号：US12627676
申请日：2009-11-30
申请人： James Morgan Ringold
发明人： James Morgan Ringold
IPC分类号： G06Q50/00 , G06Q10/00
CPC分类号： G06Q10/10 , G06F19/00 , G06Q50/22
摘要： Systems and methods are provided for overriding rejections of healthcare claim transactions. A healthcare claim transaction is received by a service provider from a healthcare provider computer and at least one edit is performed on the healthcare claim transaction. A rejection for the healthcare claim transaction is identified based at least in part on the at least one edit, and a message comprising an indication of the rejection is communicated to the healthcare provider computer. A reason for overriding the edit is received at an edit override web server from the healthcare provider computer, and override information for the rejection is generated based at least in part on the receipt of the override reason. The healthcare claim transaction is then reprocessed, and the generate override information is utilized to suppress the at least one edit during the reprocessing of the healthcare claim transaction.
摘要翻译：提供系统和方法来覆盖医疗保健索赔交易的拒绝。医疗保健索赔交易由服务提供商从医疗保健提供者计算机接收，并且在医疗保健索赔交易上执行至少一个编辑。至少部分地基于至少一个编辑来识别针对医疗保健索赔交易的拒绝，并且将包括拒绝指示的消息传达给医疗保健提供者计算机。覆盖编辑的原因是在来自医疗保健提供者计算机的编辑覆盖网络服务器处接收到的，并且至少部分地基于接收到覆盖原因来生成针对拒绝的覆盖信息。然后对医疗保健索赔交易进行再处理，并且利用生成覆盖信息来在医疗保健索赔交易的后处理期间抑制至少一个编辑。

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