PATENT CLAIM ANALYSIS

Application Number: 15936986
Application Type: Utility
Filing Date: 2018-03
Publication Date: 2019-10
Patent Classification: ["705", "004000"]

Abstract:
A method and system for scanning claims data, the method comprising receiving, by a computing system, contract details associated with claims, receiving, by the computer system, prescription transactions data associated with the claims, parsing, by the computer system, the transactions data into column values, and executing, by the computer system, analytics on the parsed transactions. The analytics include comparing the parsed transactions against the contract details for accurate pricing, fees, and accepted treatment protocols concerning dose and quantity, comparing the parsed transactions with independent pricing data that is based on third-party pricing data and drug information, identifying material errors in the parsed transactions, determining withholdings from payment of the claims for a portion above a tolerance level based on the identified material errors. The method further comprising presenting, by the computer system, results of the execution of the analytics to a portal.

Claim (Index 7):
The method of  claim 1  wherein the material errors include at least one of: claims price significantly above the contracted aggregate discount guarantee for a drug's class and source, claims with dispense as written codes (DAW) that are not allowed for brand medications (a price of the generic medication may be calculated and the amount over the plan sponsor's portion of the generic price may be withheld), claims with dispensing fees significantly above contracted terms, claims with incorrect administrative and clinical fees, claims with quantities or days' supply values above the benefit design's limitations with no prior authorization approvals, incorrect billing for company pay and copayment amounts, non-formulary medications dispensed with no prior authorizations, miscategorization of medications with resultant incorrect pricing applied, and claims billed incorrectly to the payer when a different payer is the primary.

Metadata:
- Claim Count in Document: 50.0
- Percentile: 90.0
- Lexical Diversity: 2.30986
- Patent Class: 705.0
- Transitional Phrase Type: none
- Component Type: 0
- Foreign Priority: False
- Related Applications: ['11759767', '11515122', '15817353', '13567941', '10756608']

Analysis Scores:
- 35 USC 101 Eligibility (BERT): 0.1237354003610079
- 35 USC 102 Novelty (BERT): 0.4984003012964649
- Combined Prediction Score: 0.1612018904545536
- Mean Citation Score: 210.3152
- Max Citation Score: 217.45706
- Similarity Product: 140.1843768700421

Labels:
- Claim Label 101: 0
- Claim Label 102: 1
- Claim Label 103: 0
- Claim Label 112: 1
- Combined Label: 0
- Label 101 Adjusted: 0

Dataset: test