Systems and methods for enhanced min/max edit for drug claim submission verification
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United States of America Patent
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Jul 12, 2011
Issued Date -
N/A
app pub date -
May 3, 2007
filing date -
May 3, 2007
priority date (Note) -
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Abstract
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.
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