Patent ID: 7979285

Claim:
A computer-implemented method, comprising: receiving, by a switch provider comprising one or more computers, a first claim submission from a pharmacy computer, wherein the first claim submission includes at least one identifier, a prescribed quantity, and days supply for a requested drug, the first claim submission designated for a pharmacy benefits manager (PBM) computer for benefits processing, wherein the switch provider is configured to route communications between the pharmacy computer and the pharmacy benefits manager (PBM) computer; accessing, by the switch provider using at least a portion of the at least one identifier for the requested drug, a Multiple Package Edit (MPE) table to obtain package size information for the requested drug; determining, by the switch provider whether the prescribed quantity in the first claim submission matches the obtained package size information or a multiple of the obtained package size information; accessing, by the switch provider using at least a portion of the at least one identifier for the requested drug, an Audit table to obtain a daily dose for the requested drug, wherein the MPE table and Audit table are maintained independently of each other; calculating, by the switch provider, a prescribed daily dose by dividing the prescribed quantity by the days supply; determining, by the switch provider, whether the calculated daily dose matches the obtained daily dose or a multiple of the obtained daily dose; determining, by the switch provider, that the first claim submission includes an error in at least one of the prescribed quantity or the calculated daily dose; and transmitting, by the switch provider to the pharmacy computer, a rejection of the first claim submission, wherein the rejection identifies the determined error in at least one of the prescribed quantity or the calculated daily dose, the rejection further resulting in the first claim submission not being delivered by the switch provider to the pharmacy benefits manager (PBM) computer for adjudication.