METHODS AND SYSTEMS FOR MANAGING PRESCRIPTION LIABILITY
Methods and systems for managing prescription liability are described. In one embodiment, a reimbursement request for filling of a prescription drug on behalf of a worker is received. The reimbursement request is identified as being associated with a claim assumer. A determination that workers' compensation patient eligibility information is available for the worker is made. A modification notification including workers' compensation patient eligibility information associated with the worker is transmitted to a pharmacy administrative device. A replacement reimbursement request for filling of the prescription drug on behalf of the worker is received. The replacement reimbursement request is routed to a benefit manager device based on receipt of the replacement reimbursement request. Additional methods and systems are disclosed.
1 . A method comprising:
receiving a reimbursement request for filling of a prescription drug on behalf of a worker;
identifying the reimbursement request as being associated with a claim assumer;
determining that workers' compensation patient eligibility information is available for the worker;
transmitting a modification notification including workers' compensation patient eligibility information associated with the worker to a pharmacy administrative device;
receiving a replacement reimbursement request for filling of the prescription drug on behalf of the worker; and
routing the replacement reimbursement request to a benefit manager device based on receipt of the replacement reimbursement request.
2 . The method of claim 1 , wherein the reimbursement request includes a claim reimbursement responsibility identifier and the replacement reimbursement request includes a benefit manager identifier.
3 . The method of claim 2 , further comprising:
receiving reimbursement from a benefit manager, a payor, or both the benefit manager and the payor based on routing of the replacement reimbursement request.
4 . A method comprising:
receiving a reimbursement request for filling of a prescription drug on behalf of a worker, the reimbursement request including a claim reimbursement responsibility identifier;
identifying the claim reimbursement responsibility identifier of the reimbursement request as being associated with a claim assumer;
determining that workers' compensation patient eligibility information is available for the worker;
identifying the claim reimbursement responsibility identifier associated with a benefit manager based on the workers' compensation patient eligibility information associated with the worker;
modifying the claim reimbursement responsibility identifier associated with the reimbursement request to reflect that the reimbursement request is associated with a benefit manager; and
routing the replacement reimbursement request to a benefit manager device associated with the benefit manager based on a modification to the claim reimbursement responsibility identifier.
5 . The method of claim 4 , further comprising:
receiving reimbursement from a benefit manager, a payor, or both the benefit manager and the payor based on modification of the claim reimbursement responsibility identifier associated with the reimbursement request to reflect that the reimbursement request is associated with the benefit manager.
6 . The method of claim 4 , wherein the prescription drug is to treat a work-related injury incurred by the worker.
7 . A method comprising:
receiving a prescription for a prescription drug to treat a worker for a work-related injury;
determining that there is no available workers' compensation patient eligibility information associated with the worker;
transmitting a reimbursement request for filling of the prescription drug to a claim assumer device;
receiving a modification notification from a switching company device in response to transmission of the reimbursement request, the modification notification including workers' compensation patient eligibility information associated with the worker;
updating workers' compensation patient eligibility information associated with the worker in response to receipt of the modification notification, the updated workers' compensation patient eligibility information reflecting a benefit manager to process workers' compensation claims;
transmitting a substitute reimbursement request for the prescription drug to a benefit manager device; and
receiving reimbursement for the prescription drug in response to transmission of the substitute reimbursement request.
8 . The method of claim 7 , wherein the reimbursement request includes a claim reimbursement responsibility identifier associated with a claim assumer and a substitute reimbursement request includes a benefit manager identifier associated with the benefit manager.
9 . The method of claim 7 , wherein receiving the prescription comprises:
receiving the prescription for the prescription drug; and
identifying, based on the prescription, that the prescription drug is to treat the worker for a work-related injury.
10 . The method of claim 7 , wherein receiving the prescription comprises:
receiving an electronic transmission of the prescription for the prescription drug.
11 . The method of claim 7 , wherein determining that there is no available workers' compensation patient eligibility information comprises:
determining that there is no workers' compensation benefit manager associated with the worker; and
determining that there is no workers' compensation payor associated with the worker.
12 . The method of claim 7 , wherein determining that there is no available workers' compensation patient eligibility information comprises:
querying a database to determine that there is no available workers' compensation patient eligibility information associated with the worker.