Patent ID: 8457992
Filing Date: 2013-06-04
Classification: G06Q

Abstract:
1. A computer implemented method for determining compliance with contracted pharmacy reimbursement rates, comprising: storing in a computer memory pharmacy reimbursement contract information, the pharmacy reimbursement contract information being comprised of information regarding a plurality of contracts between a payor and a pharmaceutical product provider (“PPP”); receiving, via an electronic communications network, and storing in a computer memory a plurality of claims, each claim being comprised of claim information; comparing, via a computer processor, one or more of the plurality of received claims with at least one of the plurality of contracts by: identifying, via a computer processor, one or more of the plurality of contracts having pharmaceutical reimbursement contract information that is common with one or more of the received claims; if only one contract is identified, then associating the one contract with one or more of the received claims; storing in the computer memory an indication of the association of the one identified contract with one or more of the received claims; receiving, via the electronic communications network, pharmaceutical product information including a price of the pharmaceutical product; determining, by the computer processor, for each of the received claims and associated contract, a contracted claim amount, wherein the contracted claim amount is determined according to the terms of the contract and the pharmaceutical product information; determining, by the computer processor, whether the claim amount is different than the contracted claim amount; determining, by the computer processor, for each of the received claims and associated contract, if the received claim is a maximum allowable cost (MAC) exception; transmitting an indication of the difference between the claim amount and the contracted claim amount to the pharmaceutical product provider.