System and method for enrollment into patient service programs
Systems and methods for providing an intelligent network to onboard patients to specialty medications are described herein.
1 . A server system for enrolling patients into a patient services program, the server system comprising:
a processor; and
a memory device including instructions, which when executed by the processor, cause the processor to perform operations comprising:
receiving an electronic indication of a non-enrollment transaction from a client device of a healthcare practice via a partner software platform provided by a partner of the server system, the non-enrollment transaction being implemented with a first microservice workflow, the non-enrollment transaction being for a patient of the healthcare practice and the non-enrollment transaction including patient identifying information, partner identifying information to identify the partner, practice identifying information to identify the healthcare practice, and a therapy identifier;
determining, based on the partner identifying information whether enrollment is supported for the partner;
determining, based on the patient identifying information whether the patient is enrolled;
when enrollment is supported for the partner and the patient is not enrolled:
initiating an out of band enrollment of the patient into the patient services program, wherein initiating the out of band enrollment includes activating a second microservice workflow for an enrollment interface and passing control from the first microservice workflow that implements the non-enrollment transaction to the second microservice workflow to initiate the out of band enrollment, wherein the out of band enrollment is performed directly between the partner and the patient; and
receiving, from the partner, an indication that enrollment is complete, and that the patient is enrolled in the patient services program; and
automatically initiating the non-enrollment transaction after the enrollment is complete, wherein initiating the non-enrollment transaction includes reinitiating the first microservice workflow for the non-enrollment transaction by transmitting an event message to the client device from the server system, the event message consumed by an event handler executing on the partner software platform, where the event handler is configured to cause the partner software platform to resubmit the non-enrollment transaction to the server system.
2 . The server system of claim 1 , wherein the memory device includes instructions that cause the processor to perform operations comprising:
determining, based on the partner identifying information and the therapy identifier, whether enrollment in the patient services program is required to perform the non-enrollment transaction,
wherein initiating the out of band enrollment of the patient into the patient services program is conditional based on whether enrollment in the patient services program is required.
3 . The server system of claim 1 , wherein in response to initiating the out of band enrollment, the memory device includes instructions that cause the processor to perform operations comprising:
receiving enrollment information for the patient; and
enrolling the patient into the patient services program.
4 . The server system of claim 1 , wherein the patient identifying information includes a first name of the patient, a last name of the patient, a date of birth of the patient, and a ZIP code of the patient.
5 . The server system of claim 1 , wherein the patient identifying information includes an insurance member identification of the patient and an insurance identifier corresponding to the insurance member identification of the patient.
6 . The server system of claim 1 , wherein the practice identifying information includes a city of operation of the healthcare practice, a ZIP code of the healthcare practice, a national provider identifier (NPI) of the healthcare practice, and a tax identification of the healthcare practice.
7 . The server system of claim 1 , wherein the electronic indication of non-enrollment transaction is a Hypertext Transfer Protocol (HTTP) message request for benefits verification of a patient treatment.
8 . The server system of claim 7 , wherein the Hypertext Transfer Protocol (HTTP) message request is an extended Markup Language (XML) Simple Object Access Protocol (SOAP) message.
9 . The server system of claim 7 , wherein the Hypertext Transfer Protocol (HTTP) message request is a Representational State Transfer (REST) message.
10 . The server system of claim 1 , wherein the electronic indication of non-enrollment transaction is a Hypertext Transfer Protocol (HTTP) message request for prior authorization of a patient treatment.
11 . The server system of claim 1 , wherein the electronic indication of non-enrollment transaction is a Hypertext Transfer Protocol (HTTP) message request for a copay status.
12 . The server system of claim 1 , wherein the electronic indication of non-enrollment transaction is a Hypertext Transfer Protocol (HTTP) message request for a patient assistance program.
13 . The server system of claim 1 , wherein initiating the out of band enrollment and receiving enrollment information comprises transmitting a location of a webpage to the client device, the webpage to be rendered in the client device, the webpage hosted at the server system, and the webpage used to prompt a user of the client device for information used in enrollment.
14 . The server system of claim 13 , wherein the memory device includes instructions that cause the processor to perform operations comprising formatting and transmitting an enrollment request to a drug manufacturer to enroll in a patient services program associated with the drug manufacturer, the enrollment request specifically formatted for an enrollment process specific to the drug manufacturer.
15 . The server system of claim 13 , wherein the memory device includes instructions that cause the processor to perform operations comprising formatting and transmitting an enrollment request to a device manufacturer to enroll in a patient services program associated with the device manufacturer.
16 . The server system of claim 13 , wherein the memory device includes instructions that cause the processor to perform operations comprising formatting and transmitting an enrollment request to a treatment distributor to enroll in a patient services program associated with the treatment distributor.
17 . The server system of claim 13 , wherein the memory device includes instructions that cause the processor to perform operations comprising formatting and transmitting an enrollment request to a treatment distributor to enroll in a patient services program, the patient services program requiring a specifically formatted enrollment.
18 . The server system of claim 1 , wherein receiving the electronic indication of the non-enrollment transaction is performed through an application programming interface (API) exposed to the client device, wherein the API exposes a number of services selected from: a benefits verification service, a prior authorization service, a copay service, a patient assistance program (PAP) service, and an enrollment service.
19 . The server system of claim 1 , wherein receiving, from the partner, the indication that enrollment is complete, is performed through an application programming interface (API).
20 . A computer-implemented method for enrolling patients into a patient services program, the method comprising:
receiving an electronic indication of a non-enrollment transaction from a client device of a healthcare practice via a partner software platform provided by a partner, the non-enrollment transaction being implemented with a first microservice workflow, the non-enrollment transaction being for a patient of the healthcare practice and the non-enrollment transaction including patient identifying information, partner identifying information to identify the partner, practice identifying information to identify the healthcare practice, and a therapy identifier;
determining, based on the partner identifying information whether enrollment is supported for the partner;
determining, based on the patient identifying information whether the patient is enrolled;
when enrollment is supported for the partner and the patient is not enrolled:
initiating an out of band enrollment of the patient into the patient services program, wherein initiating the out of band enrollment includes activating a second microservice workflow for an enrollment interface and passing control from the first microservice workflow that implements the non-enrollment transaction to the second microservice workflow to initiate the out of band enrollment, wherein the out of band enrollment is performed directly between the partner and the patient; and
receiving, from the partner, an indication that enrollment is complete, and that the patient is enrolled in the patient services program; and
automatically initiating the non-enrollment transaction after the enrollment is complete, wherein initiating the non-enrollment transaction includes reinitiating the first microservice workflow for the non-enrollment transaction by transmitting an event message to the client device, the event message consumed by an event handler executing on the partner software platform, where the event handler is configured to cause the partner software platform to resubmit the non-enrollment transaction.