Systems and methods for healthcare transaction routing with destination-based throttling

1. A computer-implemented method, comprising:

receiving a healthcare transaction request from a source computer, wherein the healthcare transaction request includes at least a first destination identifier that identifies a destination of the healthcare transaction request;

identifying, based at least in part on the first destination identifier, a first current transaction count, the first current transaction count indicating an extent to which one or more prior healthcare transaction requests remain unprocessed by the destination;

comparing the identified first current transaction count to at least one first threshold value;

determining, based at least in part on the comparison, whether to deliver the healthcare transaction request to the destination;

responsive to a determination to not deliver the healthcare transaction request to the destination, determining, based at least in part on the first destination identifier, that an alternate route computer is available to provide an alternate route to the destination, the alternate route computer associated with a second destination identifier;

identifying, based at least in part on the second destination identifier, a second current transaction count, the second current transaction count indicating an extent to which one or more prior healthcare transaction requests remain unprocessed by the alternate route computer;

comparing the identified second current transaction count to at least one second threshold value; and

determining, based at least in part on the comparison involving the second current transaction count, whether to deliver the healthcare transaction request to the alternate route computer for indirect delivery to the destination;

responsive to a determination to deliver the healthcare transaction request to the alternate route computer, delivering the healthcare transaction request to the alternate route computer; and

modifying the second current transaction count to reflect at least one additional healthcare transaction request that remains unprocessed by the alternate route computer,

wherein the prior steps are performed by one or more computers associated with a service provider.

2. The computer-implemented method of claim 1 , wherein a determination is made to deliver the healthcare transaction request to the destination, and further comprising:

delivering the healthcare transaction request to a destination computer associated with the destination, and

modifying the first current transaction count to reflect at least one additional healthcare transaction request that remains unprocessed by the destination,

wherein the prior steps are performed by one or more computers associated with the service provider.

3. The computer-implemented method of claim 2 , wherein modifying the first current transaction count includes incrementing the first current transaction count.

4. The computer-implemented method of claim 2 , further comprising:

receiving, from the destination computer, a healthcare transaction response associated with the healthcare transaction request, the healthcare transaction response indicating a result of processing the healthcare transaction request by the destination computer; and

modifying the first current transaction count to reflect at least one less healthcare transaction request that remains unprocessed by the destination,

wherein the prior steps are performed by one or more computers associated with the service provider.

5. The computer-implemented method of claim 1 , wherein a determination is made to not deliver the healthcare transaction request to the destination, wherein the healthcare transaction request is not delivered to the destination, and further comprising:

delivering a healthcare transaction response to the source computer, the healthcare transaction response indicating that the healthcare transaction request was not delivered to the destination,

wherein the prior step is performed by one or more computers associated with the service provider.

6. The computer-implemented method of claim 5 , wherein the healthcare transaction response is in a form of a rejection response or a timed-out response.

7. The computer-implemented method of claim 1 , wherein the source computer is associated with a healthcare provider, wherein the destination is associated with a payor, and wherein the healthcare transaction request is associated with an eligibility request, a preauthorization request, a claim status request, or a claim request.

8. The computer-implemented method of claim 1 , wherein the first current transaction count is incremented when a healthcare transaction request is delivered to the destination, and wherein the first current transaction count is decremented when a healthcare transaction response is received from the destination.

9. A system, comprising:

at least one memory for storing computer-executable instructions; and

at least one processor in communication with the at least one memory, wherein the at least one processor is configured to execute the computer-executable instructions to:

receive a healthcare transaction request from a source computer, wherein the healthcare transaction request includes at least a first destination identifier that identifies a destination of the healthcare transaction request;

identify, based at least in part on the first destination identifier, a first current transaction count, the first current transaction count indicating an extent to which one or more prior healthcare transaction requests remain unprocessed by the destination;

compare the identified first current transaction count to at least one first threshold value;

determine, based at least in part on the comparison, whether to deliver the healthcare transaction request to the destination;

responsive to a determination to not deliver the healthcare transaction request to the destination, determine, based at least in part on the first destination identifier, that an alternate route computer is available to provide an alternate route to the destination, the alternate route computer associated with a second destination identifier;

identify, based at least in part on the second destination identifier, a second current transaction count, the second current transaction count indicating an extent to which one or more prior healthcare transaction requests remain unprocessed by the alternate route computer;

compare the identified second current transaction count to at least one second threshold value;

determine, based at least in part on the comparison involving the second current transaction count, whether to deliver the healthcare transaction request to the alternate route computer for indirect delivery to the destination;

responsive to a determination to deliver the healthcare transaction request to the alternate route computer, deliver the healthcare transaction request to the alternate route computer; and

modify the second current transaction count to reflect at least one additional healthcare transaction request that remains unprocessed by the alternate route computer.

10. The system of claim 9 , wherein a determination is made to deliver the healthcare transaction request to the destination, and wherein the at least one processor is further configured to execute the computer-executable instructions to:

deliver the healthcare transaction request to a destination computer associated with the destination, and

modify the first current transaction count to reflect at least one additional healthcare transaction request that remains unprocessed by the destination.

11. The system of claim 10 , wherein the first current transaction count is modified by incrementing the first current transaction count.

12. The system of claim 10 , wherein the at least one processor is further configured to execute the computer-executable instructions to:

receive, from the destination computer, a healthcare transaction response associated with the healthcare transaction request, the healthcare transaction response indicating a result of processing the healthcare transaction request by the destination computer; and

modify the first current transaction count to reflect at least one less healthcare transaction request that remains unprocessed by the destination.

13. The system of claim 9 , wherein a determination is made to not deliver the healthcare transaction request to the destination, wherein the healthcare transaction request is not delivered to the destination, and wherein the at least one processor is further configured to execute the computer-executable instructions to:

deliver a healthcare transaction response to the source computer, the healthcare transaction response indicating that the healthcare transaction request was not delivered to the destination.

14. The system of claim 13 , wherein the healthcare transaction response is in a form of a rejection response or a timed-out response.

15. The system of claim 9 , wherein the source computer is associated with a healthcare provider, wherein the destination is associated with a payor, and wherein the healthcare transaction request is associated with an eligibility request, a preauthorization request, a claim status request, or a claim request.

16. The system of claim 9 , wherein the current transaction count is stored in the at least one memory in association with the first destination identifier or another identifier associated with the first destination identifier, wherein the first current transaction count is incremented when a healthcare transaction request is delivered to the destination, and wherein the first current transaction count is decremented when a healthcare transaction response is received from the destination.