Granted Patent B2

US 12,198,083 · App. 16/159,471 · Granted Jan 14, 2025

Inventors: Timothy Rourke (San Diego, CA); William J. Barre (San Diego, CA)

Assignee: MEDIMPACT HEALTHCARE SYSTEMS, INC.

G06Q10/06315G06Q10/10G06Q30/0206G06Q40/08G16H10/60G16H20/10

Abstract

Claims (55)

1. A system for adjudicating medical transactions, the system comprising:

a prescription benefit manager communicatively coupled to a computer network via a network interface, the prescription benefit manager communicatively coupled, via the network interface, to a plan database configured to identify a plan to which a patient belongs, and the prescription benefit manager communicatively coupled, via the network interface, to a patient information database configured to identify supplier selection criteria associated with the plan, the network interface including a receiver and a transmitter, the receiver configured to demodulate data received from the computer network including a plurality of prescriptions for the patient from one or more users' computers, and the transmitter configured to transmit the plurality of prescriptions to a plurality of suppliers for fulfillment, wherein at least two of the plurality of suppliers are communicatively coupled to the network interface, the at least two of the plurality of suppliers being selected from a set of certified suppliers to fill two or more of the plurality of prescriptions, the prescription benefit manager configured to perform operations comprising:

electronically receiving, via the network interface, the plurality of prescriptions, at least two prescriptions identifying at least one patient and a prescribed pharmaceutical treatment for the patient;

applying a supplier selection criteria to select at least a first supplier and a second supplier from the set of certified suppliers, the first supplier being selected to fill a first prescription according to provisions of a prescription plan associated with the patient, and the second supplier being selected to fill a second prescription according to the provisions of the prescription plan;

contacting, via the network interface, the patient to determine whether the patient wants to transfer the first prescription to the first supplier and the second prescription to the second supplier for fulfillment;

determining, in response to contacting the patient via the network interface, that a patient question received from the patient via a single generated graphical mobile application interface is to be re-directed to at least one of the first supplier or the second supplier using the network interface;

routing, via the network interface, the patient question electronically to at least one of a first computing system of the first supplier or a second computing system of the second supplier to be addressed, in response to determining that the patient question received from the patient is to be re-directed to at least one of the first computing system of the first supplier or the second computing system of the second supplier using the network interface;

transmitting, via the network interface, the first prescription to the first supplier, and the second prescription to the second supplier for fulfillment in response to the patient authorizing the claim switch, the first computing system of the first supplier and the second computing system of the second supplier being communicatively coupled to the network interface;

receiving status updates, via the network interface, from the first computing system of the first supplier and the second computing system of the second supplier, wherein the status updates comprise at least one of prescription receipt confirmation, fulfillment confirmation, and shipment confirmation from the first computing system of the first supplier and the second computing system of the second supplier that were selected to fulfill the plurality of prescriptions for the patient in most effective manner with respect to at least one of costs, quality, and fulfillment speed as covered by the patient's prescription plan;

transmitting, via the network interface, the status updates from the first computing system of the first supplier and the second computing system of the second supplier to a mobile user device in a format through which the status updates are together viewable simultaneously by the patient within the single generated graphical mobile application interface, the status updates from the first computing system of the first supplier and the second computing system of the second supplier being viewable from a single page at the single generated graphical mobile application interface, the single generated graphical mobile application interface configured to display the status updates prior to a selection to interact, via a portal having a mobile application dashboard, with content related to the status updates from at least one of the first computing system of the first supplier or the second computing system of the second supplier, the status updates being selectable and accessible on the single page to interact, via the portal having the mobile application dashboard, with the content stored on at least one of the first computing system of the first supplier or the second computing system of the second supplier, the portal having the mobile application dashboard configured to facilitate access to the content related to the status updates, and the portal configured to facilitate coordination between the mobile user device and at least one of the first computing system of the first supplier or the second computing system of the second supplier;

identifying the patient;

searching, via the network interface, the plan database to identify a plan to which the patient belongs;

searching, via the network interface, the patient information database to identify the supplier selection criteria associated with the plan;

calculating, via the network interface, a copayment amount to be paid by the patient for the at least two prescriptions by identifying the at least two prescriptions from the plurality of prescriptions on the plan database and based on at least one of costs, quality, and fulfillment speed as covered by the patient's prescription plan;

transmitting, via the network interface, data associated with the at least two prescriptions to enable a transaction to obtain the at least two prescriptions, the data specifying the copayment amount to be paid by the patient to the first supplier and the second supplier prior to the at least two prescriptions being scheduled;

receiving two or more additional status updates, via the network interface, from the first supplier and the second supplier, wherein the two or more additional status updates include at least one of prescription receipt confirmation, fulfillment confirmation, and shipment confirmation from the first supplier and the second supplier selected to fulfill the at least two prescriptions; and

transmitting, via the network interface, the two or more additional status updates to the mobile user device in the format through which the status updates are together viewable simultaneously by the patient within the single generated graphical mobile application interface.

2. The system of claim 1 , the operations further comprising adjudicating and authorizing fulfillment of prescriptions, wherein adjudicating and authorizing fulfillment occurs prior to transmitting the prescriptions to the respective suppliers for fulfillment.

3. The system of claim 1 , the operations further comprising:

calculating the copayment amount owed by the patient for two or more prescriptions;

accessing account information for a financial account of the patient from a database;

deducting the copayment amount from the financial account; and

transmitting a payment to the set of certified suppliers.

4. The system of claim 1 , wherein selecting supplier selection criteria to apply to the plurality of prescriptions comprises selecting the identified supplier selection criteria associated with the plan.

5. The system of claim 1 , wherein applying the supplier selection criteria comprises evaluating the set of certified suppliers and selecting the plurality of suppliers based on total amount, wherein the certified supplier offering the lowest total amount is selected.

6. The system of claim 1 , wherein applying the supplier selection criteria comprises evaluating the set of certified suppliers and selecting the plurality of suppliers based on a combination of total amount, performance rating, and ancillary service offerings.

7. The system of claim 1 , wherein the set of certified suppliers comprises suppliers that meet a minimum level of service requirements and have integrated into a healthcare needs fulfillment system operated by a benefits manager.

8. The system of claim 1 , wherein the first supplier and the second supplier are at least one of: a pharmacy, a provider of vitamins and nutritional supplements, a provider of durable medical equipment, or a provider of disposable medical supplies.

9. A computing system for adjudicating medical transactions, the system comprising:

a receiver configured to demodulate data received from a computer network including a plurality of prescriptions for a patient from one or more users' computers, wherein at least one of the plurality of prescriptions identifies the patient and a prescribed treatment;

a transmitter configured to transmit the plurality of prescriptions to a plurality of suppliers for fulfillment, wherein at least two of the plurality of suppliers have been selected from a set of certified suppliers to fill two or more of the plurality of prescriptions, wherein at least two of the plurality of suppliers is communicatively coupled to the transmitter, the at least two of the plurality of suppliers being selected from the set of certified suppliers to fill two or more of the plurality of prescriptions; and

a processor communicatively coupled to the computer network via the transmitter and the receiver, the processor communicatively coupled, via the transmitter and the receiver, to a plan database configured to identify a plan to which the patient belongs, and the processor communicatively coupled, via the transmitter and the receiver, to a patient information database configured to identify supplier selection criteria associated with the plan, the processor configured to perform operations comprising:

selecting the supplier selection criteria to apply to the plurality of prescriptions; and

applying the supplier selection criteria to select the plurality of suppliers from the set of certified suppliers, the plurality of suppliers being selected to fill two or more of the plurality of prescriptions;

contacting, via the network interface, the patient to determine whether the patient wants to transfer a first prescription of the two or more of the plurality of prescriptions to a first supplier and a second prescription to the second supplier for fulfillment;

determining, in response to contacting the patient via the network interface, that a patient question received from the patient via a single generated graphical mobile application interface is to be re-directed to at least one of the first supplier or the second supplier using the network interface;

routing, via the network interface, the patient question electronically to at least one of a first computing system of the first supplier or a second computing system of the second supplier to be addressed, in response to determining that the patient question received from the patient is to be re-directed to at least one of the first computing system of the first supplier or the second computing system of the second supplier using the network interface;

transmitting, via the network interface, the first prescription to the first supplier, and the second prescription to the second supplier for fulfillment in response to the patient authorizing the claim switch, the computing system of the first supplier and the second supplier communicatively coupled to the network interface;

identifying the patient;

searching, via the network interface, the plan database to identify a plan to which the patient belongs; and

searching, via the network interface, the patient information database to identify the supplier selection criteria associated with the plan;

determining, via the network interface, a copayment amount to be paid by the patient for the at least two prescriptions by identifying the at least two prescriptions from the plurality of prescriptions on the plan database and based on at least one of costs, quality, and fulfillment speed as covered by the patient's prescription plan;

transmitting, via the network interface, data associated with the at least two prescriptions to enable a transaction to obtain the at least two prescriptions, the data specifying the copayment amount to be paid by the patient to at least one of the first supplier and the second supplier prior to the at least two prescriptions being scheduled;

receiving two or more additional status updates, via the network interface, from the first supplier and the second supplier, wherein the two or more additional status updates include at least one of prescription receipt confirmation, fulfillment confirmation, and shipment confirmation from the first supplier and the second supplier selected to fulfill the at least two prescriptions; and

transmitting, via the network interface, the two or more additional status updates from the first computing system of the first supplier and the second computing system of the second supplier to a mobile user device in a format through which status updates are together viewable simultaneously by the patient within the single generated graphical mobile application interface,

the receiver being further configured to receive the status updates from the plurality of suppliers, the status updates comprising prescription receipt confirmation, fulfillment confirmation, and shipment confirmation, and

the transmitter being further configured to transmit the status updates from the first computing system of the first supplier and the second computing system of the second supplier to the mobile user device in the format through which the status updates from all the plurality of suppliers are together viewable simultaneously by the patient within the single generated graphical mobile application interface, the status updates from the first computing system of the first supplier and the second computing system of the second supplier being viewable from a single page at the single generated graphical mobile application interface, the single generated graphical mobile application interface configured to display the status updates prior to a selection to interact, via a portal having a mobile application dashboard, with content related to the status updates from at least one of the first computing system of the first supplier or the second computing system of the second supplier, the status updates being selectable and accessible on the single page to interact, via the portal having the mobile application dashboard, with the content stored on at least one of the first computing system of the first supplier or the second computing system of the second supplier, the portal having the mobile application dashboard configured to facilitate access to the content related to the status updates, and the portal configured to facilitate coordination between the mobile user device and at least one of the first computing system of the first supplier or the second computing system of the second supplier.

10. The system of claim 9 , wherein the receiver is further configured to receive data from the set of certified suppliers on which the set of certified suppliers are evaluated, the data comprising one or more of pricing data and ancillary service offerings.

11. The system of claim 9 , wherein the processor is further configured to perform operations comprising adjudicating and authorizing fulfillment of each of the plurality of prescriptions prior to transmission of the plurality of prescriptions to the plurality of suppliers for fulfillment.

12. The system of claim 9 , wherein the processor is further configured to perform operations comprising:

calculating the copayment amount owed by the patient for each of the plurality of prescriptions;

accessing account information for a financial account of the patient from a database; and

deducting the copayment amount from the financial account; and

wherein the transmitter is further configured to transmit a payment to each of the plurality of suppliers.

13. The system of claim 9 , wherein selecting supplier selection criteria to apply to the plurality of prescriptions comprises selecting the identified supplier selection criteria associated with the plan.

Assignments (2)

Continuity (3)

References Cited (127)