Patents Assigned to HEALTHPLAN DATA SOLUTIONS, INC.
  • METHOD AND SYSTEM FOR MONITORING PRESCRIPTION DRUG DATA AND DETERMINING CLAIM DATA ACCURACY
    Publication number: 20240104666
    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.
    Type: Application
    Filed: September 28, 2023
    Publication date: March 28, 2024
    Applicant: HEALTHPLAN DATA SOLUTIONS, INC.
    Inventors: Gary Rutherford, Michael Blevins, Jarrod Grossman, Douglas Bell, Detlef Sarbok, Jeff Rabe
  • Method and system for monitoring prescription drug data and determining claim data accuracy
    Patent number: 11810201
    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.
    Type: Grant
    Filed: May 16, 2022
    Date of Patent: November 7, 2023
    Assignee: HEALTHPLAN DATA SOLUTIONS, INC.
    Inventors: Gary Rutherford, Michael Blevins, Jarrod Grossman, Douglas Bell, Detlef Sarbok, Jeff Rabe