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1. 发明授权

US08392214B1 Systems and methods for facilitating claim rejection resolution by providing prior authorization assistance 有权
标题翻译：通过提供事先的授权协助来促进声称拒绝解决的系统和方法
公开(公告)号：US08392214B1
公开(公告)日：2013-03-05
申请号：US12957106
申请日：2010-11-30
申请人： Roger Pinsonneault
发明人： Roger Pinsonneault
IPC分类号： G06Q50/00
CPC分类号： G06Q50/22 , G06F19/00 , G06F19/328
摘要： Systems and methods are provided for providing prior authorization support. The systems and methods may include receiving a first request for prior authorization assistance from a pharmacy computer, wherein the request for assistance includes claim identification information for a prior healthcare claim transaction; identifying a stored transaction history record for the prior healthcare claim transaction, where the stored transaction record is identified based at least in part on the claim identification information, where the stored transaction history record indicates a denial of coverage by a payor of a drug or product for a patient; delivering, to a prior authorization assistance computer, a second request for prior authorization assistance, where the information included in the second request enables the prior authorization assistance computer to initiate a process for completing a prior authorization form and for delivering the completed form to the payor; and delivering, to the pharmacy computer, a response indicating acceptance of the first request for assistance.
摘要翻译：提供系统和方法以提供事先的授权支持。所述系统和方法可以包括从药房计算机接收关于事先授权协助的第一请求，其中所述帮助请求包括用于先前医疗保健索赔交易的索赔识别信息; 识别用于先前医疗保健索赔交易的存储的交易历史记录，其中至少部分地基于权利要求标识信息来识别存储的交易记录，其中所存储的交易历史记录指示拒绝药物或产品的付款人的覆盖为病人向先前的授权协助计算机传送第二请求，其中包括在第二请求中的信息使先前的授权协助计算机能够启动用于完成先前授权形式的过程并将完成的表单传递给付款人 ; 并向药房计算机发送表示接受第一个援助请求的响应。

2. 发明授权

US07912741B1 Systems and methods for copay adjustments 有权
标题翻译：用于共付费调整的系统和方法
公开(公告)号：US07912741B1
公开(公告)日：2011-03-22
申请号：US12165221
申请日：2008-06-30
申请人： Roger Pinsonneault
发明人： Roger Pinsonneault
IPC分类号： G06Q10/00
CPC分类号： G06Q50/22 , G06F19/00 , G06Q10/10 , G06Q30/0224 , G06Q40/08 , G06Q50/24
摘要： Systems and methods may provide for copay adjustment. The systems and methods may include receiving a claim request from a pharmacy computer, where the claim request may be associated with a product requested by a customer, transmitting the claim request to a claims processor for adjudication, and receiving, from the claims processor, a first claim response for the claim request, where the first claim response may include a current copay amount payable by the customer. The systems and methods may also include determining, based upon a historical claim transaction record associated with the customer, that a prior copay amount for the drug is less than the current copay amount, and transmitting a second claim response to the pharmacy computer with a new copay amount lower than the current copay amount of the first claim response.
摘要翻译：系统和方法可以提供共付费调整。系统和方法可以包括从药房计算机接收要求请求，其中权利要求请求可以与客户请求的产品相关联，将权利要求请求发送到权利要求处理器进行裁决，并从索赔处理器接收索赔申请的第一个索赔回复，其中第一个索赔答复可能包括客户应付的当前共付费用。系统和方法还可以包括基于与客户相关联的历史索赔交易记录来确定药物的先前共付量小于当前共付费用量，并且用新的方式向药店计算机发送第二权利要求答复共付量低于第一个索赔答复的当前共付费用量。

3. 发明授权

US08099339B1 Systems and methods for pharmacy inventory management 有权
标题翻译：药房库存管理的系统和方法
公开(公告)号：US08099339B1
公开(公告)日：2012-01-17
申请号：US12263747
申请日：2008-11-03
申请人： Roger Pinsonneault , Matt McGrath
发明人： Roger Pinsonneault , Matt McGrath
IPC分类号： G06Q10/00 , G06Q40/00 , G06Q20/00 , G06G1/14
CPC分类号： G06Q10/08 , G06F19/00 , G06F19/328 , G06Q10/087 , G06Q20/203 , G06Q40/08
摘要： Systems and methods for tracking prescription drug inventory of a pharmacy at a switch. Embodiments of the invention include receiving, at a switch, a prescription claim transaction from a pharmacy system, where the prescription claim transaction indicates an amount of a drug, and transmitting the prescription claim transaction to a payer system for adjudication. An adjudicated response for the prescription claim is then received from the payer system, and an inventory amount associated with the drug maintained by the switch is updated by the switch. When a determination is made that the inventory amount has met a threshold value, a message is transmitting indicating that the inventory amount has met the threshold value. In some embodiments of the invention the message is sent to the pharmacy or directly to a supplier as part of an order for additional inventory of the drug.
摘要翻译：在开关处追踪药房处方药物库存的系统和方法。本发明的实施例包括在开关处接收来自药房系统的处方索赔交易，其中处方索赔交易指示药物的量，以及将处方索赔交易传送给付款人系统进行裁决。然后从付款人系统接收处方要求的裁定响应，并且由交换机更新与交换机维护的药物相关联的库存量。当确定库存量已经达到阈值时，消息正在发送，指示库存量已经达到阈值。在本发明的一些实施方案中，该信息被发送到药店或直接向供应商发送作为药物额外清单的命令的一部分。

4. 发明授权

US08046242B1 Systems and methods for verifying prescription dosages 有权
标题翻译：用于验证处方剂量的系统和方法
公开(公告)号：US08046242B1
公开(公告)日：2011-10-25
申请号：US12357882
申请日：2009-01-22
申请人： Patricia A. daCosta , Roger Pinsonneault
发明人： Patricia A. daCosta , Roger Pinsonneault
IPC分类号： G06Q50/00
CPC分类号： G06Q10/00 , G06F19/00 , G06F19/3456 , G06Q50/22 , G06Q50/24
摘要： Systems and methods for verifying prescription transaction dosages can be provided according to embodiments of the invention. According to one example embodiment, a method for dosage error verification may be provided. The method may include executing computer program instructions by one or more processors for receiving a prescription transaction including a submitted drug product and a submitted strength of the submitted drug product; comparing the submitted drug product and the submitted strength to dosage error data residing in a dosage error database; determining that the submitted drug product is a member of at least one dosage error pair indicated by the dosage error data; determining that the submitted strength is potentially incorrect based at least in part on strengths indicated by the at least one dosage error pair; and performing an edit action based at least in part on the determination that the submitted strength is potentially incorrect.
摘要翻译：可以根据本发明的实施例提供用于验证处方交易剂量的系统和方法。根据一个示例性实施例，可以提供用于剂量误差校验的方法。该方法可以包括由一个或多个处理器执行计算机程序指令，用于接收包括提交的药物产品的处方交易和所提交的药品的提交的强度; 将所提交的药品与所提供的强度与存在于剂量误差数据库中的剂量误差数据进行比较; 确定所提交的药物产品是由剂量误差数据指示的至少一个剂量误差对的成员; 至少部分地基于所述至少一个剂量误差对指示的强度确定所述提交的强度是潜在的不正确的; 以及至少部分地基于所述提交的强度潜在地不正确的确定来执行编辑动作。

5. 发明授权

US08036918B1 Systems and methods for conversions of denied transactions through patient funding 有权
标题翻译：通过患者资金转换被拒绝的交易的系统和方法
公开(公告)号：US08036918B1
公开(公告)日：2011-10-11
申请号：US12140015
申请日：2008-06-16
申请人： Roger Pinsonneault
发明人： Roger Pinsonneault
IPC分类号： G06Q10/00
CPC分类号： G06F19/328 , G06F19/00 , G06Q10/10 , G06Q40/08 , G06Q50/22 , G06Q50/24
摘要： Systems and methods may be provided for claim denial conversion. The systems and methods may include receiving a prescription claim from a pharmacy, where the prescription claim is associated with a drug or other product requested by a customer, routing the prescription claim to a claims processor for adjudication, and receiving, from the claims processor, a denied claim response for the claim request. The systems and methods may further include determining that funding is available to cover at least a portion of a price of the requested drug or other product, converting the denied claim response to an approved claim response upon determination of the available funding, and transmitting the approved claim response to the pharmacy.
摘要翻译：可以提供系统和方法用于权利要求拒绝转换。系统和方法可以包括从药房接收处方要求，其中处方要求与药物或客户要求的其他产品相关联，将处方权利要求转交给权利要求处理者进行裁决，以及从权利要求书处理器接收，对索赔请求的拒绝索赔回复。系统和方法还可以包括确定资金可用于覆盖所请求的药物或其他产品的价格的至少一部分，在确定可用资金时将被拒绝的权利要求答复转换为已批准的索赔回复，并且发送已批准的声称对药房的回应。

6. 发明授权

US08036914B1 Systems and methods for supporting drug or product recalls 有权
标题翻译：支持药物或产品召回的系统和方法
公开(公告)号：US08036914B1
公开(公告)日：2011-10-11
申请号：US12388956
申请日：2009-02-19
申请人： Roger Pinsonneault
发明人： Roger Pinsonneault
IPC分类号： G06Q50/00
CPC分类号： G06F19/3456 , G06F19/00 , G06F19/328 , G06F19/3462 , G06Q10/08 , G06Q50/22
摘要： Systems and methods may be provided for supporting drug or product recalls. The systems and methods may include receiving a healthcare transaction request from a pharmacy computer associated with a pharmacy, wherein the healthcare transaction request includes an identification of a prescribed drug or product; determining, based upon the identification of the prescribed drug or product, that the prescribed drug or product is associated with a recall; providing, in response to the determination that the prescribed drug or product is associated with the recall, a response that includes information for accessing a web portal interface; receiving, over the web portal interface, lot numbers associated with pharmacy inventory of the prescribed drug or product; determining that one or more of the received lot numbers are affected by the recall; and generating a notification identifying the received lot numbers that are associated with the pharmacy inventory.
摘要翻译：可以提供系统和方法来支持药物或产品召回。系统和方法可以包括从与药房相关联的药房计算机接收医疗保健交易请求，其中医疗交易请求包括处方药物或产品的标识; 根据所规定的药物或产品的识别，确定规定的药物或产品与召回相关联; 提供响应于所述规定的药物或产品与所述召回相关联的确定，包括用于访问网络门户界面的信息的响应; 通过门户界面接收与规定药物或产品的药房库存相关的批号; 确定一个或多个接收到的批号受召回影响; 以及生成识别与药店库存相关联的接收批号的通知。

7. 发明授权

US08626529B1 Systems and methods for identifying risk evaluation and mitigation strategies (REMS) compliance 有权
标题翻译：识别风险评估和减缓策略（REMS）合规性的系统和方法
公开(公告)号：US08626529B1
公开(公告)日：2014-01-07
申请号：US13298806
申请日：2011-11-17
申请人： Roger Pinsonneault
发明人： Roger Pinsonneault
IPC分类号： G06Q50/00
CPC分类号： G06Q50/00 , G06F19/00 , G06Q10/0635
摘要： Systems and methods for identifying REMS compliance are provided. A service provider system that includes one or more computers may route one or more healthcare transactions submitted by a healthcare provider to one or more claims processor computers. One or more respective adjudicated replies received from the one or more claims processor computers for the one or more healthcare transactions may then be routed by the service provider system to the healthcare provider. Based at least in part upon information included in the routed healthcare claim transactions and adjudicated replies, an amount of a product dispensed by the healthcare provider may be determined by the service provider system. The determined dispensed amount may be compared to a purchased amount of the product. Based at least in part upon the comparison, a determination may be made as to whether a REMS condition associated with the product is satisfied.
摘要翻译：提供了用于识别REMS合规性的系统和方法。包括一个或多个计算机的服务提供者系统可以将医疗保健提供者提交的一个或多个保健交易路由到一个或多个权利要求处理器计算机。从一个或多个权利要求处理器计算机接收的用于一个或多个保健交易的一个或多个相应的裁定回复随后可由服务提供商系统路由到医疗保健提供者。至少部分地基于路由保健索赔交易和被判定回复中包括的信息，医疗保健提供者分配的产品的数量可由服务提供商系统确定。可以将确定的分配量与产品的购买量进行比较。至少部分地基于比较，可以确定是否满足与产品相关联的REMS条件。

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

US09734541B1 Systems and methods for a healthcare network survey solution 有权
公开(公告)号：US09734541B1
公开(公告)日：2017-08-15
申请号：US12435597
申请日：2009-05-05
申请人： Roger Pinsonneault
发明人： Roger Pinsonneault
IPC分类号： G06Q10/00 , G06Q50/22
CPC分类号： G06Q50/22 , G06F19/00
摘要： Systems and methods are provided for a healthcare network survey solution. The systems and methods may include receiving a healthcare transaction from a remote computer, where the healthcare transaction identifies at least one of a drug, product, or service for a patient; determining that the healthcare transaction is eligible for a survey based upon an analysis of the drug, product, or service identified in the healthcare transaction request; selecting the eligible healthcare transaction for the survey based at least in part upon a random selection process; and delivering a survey request to a survey recipient associated with the healthcare transaction, where the survey request includes at least a transaction identifier for identifying the survey.

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