Patent ID: 8489411
Filing Date: 2013-07-16
Classification: G06Q

Abstract:
1. A method of electronically auditing reimbursed prescription claims comprising: receiving, by a host server computer, an adjudicated claim, wherein the adjudicated claim was previously adjudicated by a payer system in response to a claim that was received by the host server computer from a pharmacy and delivered to the payer system for adjudication; determining, by a host server computer, an actual spread percentage fee charged by the payer system in excess of a cost reimbursed by the payer system in connection with the adjudicated claim, wherein the actual spread percentage fee is a percentage charged in excess of a cost reimbursed in connection with the adjudicated claim; determining, by a host server computer, an expected spread percentage fee associated with the adjudicated claim, wherein the expected spread percentage fee is an expected percentage fee in excess of the cost reimbursed based on contractual obligations of the payer system; comparing, by a host server computer, the actual spread percentage fee to the expected spread percentage fee to determine a difference value; detecting, by a host server computer, that the difference value is unacceptable based on a comparison of the difference value to at least one tolerance parameter; and storing, by a host server computer when the difference value is determined unacceptable, the difference value.