Abstract: A method, apparatus and computer program product efficiently verify a transaction, such as an order, in accordance with a multi-stage verification process. In a method, data is extracted from an order submitted pursuant to a program having a plurality of verification qualifications. The method performs a first set of verification checks and, in an instance in which the first set of verification checks is satisfied, the method modifies the order to include a first indication of satisfaction of the first set of verification checks. The method also extracts data from a claim that is based upon the order. The claim includes the first indication that the first set of verification checks was satisfied. The method also performs a second set of verification checks based upon the data extracted from the claim and, in an instance in which the second set of verification checks is satisfied, the method submits the claim via an adjudication network for adjudication.

Abstract: A method, apparatus and computer program product provide for monitoring an adjudication network. In relation to a method, first information is caused to be provided by a request processor in response to an inquiry to be provided to a source. The method also receives an order including second information, different than the first information, from the source. The method further combines at least some of the second information with at least some of the first information to form an updated order and transmits the updated order to a supplier. Additionally, the method monitors the adjudication network, such as for a predefined period of time, to determine a status of the updated order and provides a notification to the source in response to the updated order having a predefined status.

Abstract: A method, apparatus and computer program product are provided for providing a patient with prescribed medication cost information at a point of prescribing. A prescription benefit coverage inquiry is received and provided to a claims processor for processing. Historical data associated with prior prescription transactions is utilized to determine an estimated cost range of a prescribed medication in the event of an insufficient or absent response from a benefits manager. The estimated cost range is then provided to a prescriber to share with a patient. A targeted out-of-pocket cost according to incentives, such as vouchers and drug manufacturer rebates may also be provided.

Abstract: A method, apparatus and computer program product are provided for parsing a message received from a requesting computer to identify an indication of a transaction, an entity identifier, and an identifier of a first evaluation system. The entity identifier is evaluated based on historical data and/or eligibility data to determine an alternative evaluation procedure. The alternative evaluation procedure is preformed to obtain response information regarding the transaction, that may differ from response information otherwise obtained via the first evaluation system. A response to the message is constructed that includes the response information and is transmitted to the requesting computer.

Abstract: A method, apparatus and computer program product are provided for providing a patient with prescribed medication cost information at a point of prescribing. A prescription benefit coverage inquiry is received and provided to a claims processor for processing. Historical data associated with prior prescription transactions is utilized to determine an estimated cost range of a prescribed medication in the event of an insufficient or absent response from a benefits manager. The estimated cost range is then provided to a prescriber to share with a patient.

Abstract: An improved alternative therapy identification system increases the efficiency for obtaining information for alternative therapies. The alternative therapy identification system automates alternative therapy identification information from both a product level and a drug cost level. The improved alternative therapy identification system may also increase the efficiency by improving alternative therapy selection to occur at the prescriber level.

Abstract: Systems and methods are provided for determining and communicating prescription benefit coverage information to a prescriber of the product, service, or medication. A prescription benefit check request may be received by the service provider computer from a healthcare provider computer for the prescriber of the product, service, or medication. The service provider computer may format a prescription request for the prescribed product, service, or medication and transmit the prescription request to a pharmacy claims processor computer for processing. The service provider computer may receive a prescription response that includes a determination of the prescription request from the pharmacy claims processor computer.

Abstract: A computing device, method and computer program product are provided to process messages received from a source and to construct messages transmitted to a recipient that include the information required to elicit the desired response. In relation to a method, an electronic message is received and analyzed relative to requirements of the related message to determine whether the electronic message includes information required by the related message.

Abstract: A method, apparatus and computer program product are provided for parsing a message received from a requesting computer to identify an indication of a transaction, an entity identifier, and an identifier of a first evaluation system. The entity identifier is evaluated based on historical data and/or eligibility data to determine an alternative evaluation procedure. The alternative evaluation procedure is preformed to obtain response information regarding the transaction, that may differ from response information otherwise obtained via the first evaluation system. A response to the message is constructed that includes the response information and is transmitted to the requesting computer.

Abstract: An improved adherence monitoring system increases the efficiency for obtaining patient adherence information. The improved adherence monitoring system reduces network traffic with regards to the communication of patient adherence information. The improved adherence monitoring system automates an adherence notification pathway. The improved adherence monitoring system can increase patient adherence by increasing the efficiency of medication therapy. The improved adherence monitoring system may also increase the efficiency by which patient adherence information is disbursed.

Abstract: A method, apparatus and computer program product are provided for estimating inventory based on distribution data. A requesting computer may submit an order request (e.g., benefit request) indicating a product and merchant attributes. Inventory information of the merchant may not be accessible, so inventory information may be estimated based on distribution data relating to the distribution of product to the merchant. Estimates regarding quantities, high or low inventories, and/or the like may be made based on distribution history and/or estimated subsequent distributions. A prescriber computer, such as one used by a physician, may therefore receive estimated inventory information regarding prescription medication at various pharmacies, prior to submitting the prescription to a pharmacy.

Abstract: A computing device, method and computer program product are provided to process messages received from a source and to construct messages transmitted to a recipient that include the information required to elicit the desired response. In relation to a method, an electronic message is received and analyzed relative to requirements of the related message to determine whether the electronic message includes information required by the related message.

Abstract: A computing device, method and computer program product are provided to process messages received from a source and to construct messages transmitted to a recipient that include the information required to elicit the desired response. In relation to a method, an electronic message is received and analyzed relative to requirements of the related message to determine whether the electronic message includes information required by the related message.

Abstract: A computing device, method and computer program product are provided to process messages received from a source and to construct messages transmitted to a recipient that include the information required to elicit the desired response. In relation to a method, an electronic message is received and analyzed relative to requirements of the related message to determine whether the electronic message includes information required by the related message.

Abstract: An improved adherence monitoring system increases the efficiency for obtaining patient adherence information. The improved adherence monitoring system reduces network traffic with regards to the communication of patient adherence information. The improved adherence monitoring system automates an adherence notification pathway. The improved adherence monitoring system can increase patient adherence by increasing the efficiency of medication therapy. The improved adherence monitoring system may also increase the efficiency by which patient adherence information is disbursed.

Abstract: A database system, computing device and method are provided to construct and process messages in a manner dependent upon the satisfaction of predefined requirements. In regards to a method, an electronic message is received and a determination is made as to whether the subject of the electronic message is a member of a group for which the predefined requirements are to be satisfied. If so, the method determines whether the predefined requirements are satisfied with respect to the subject of the electronic message. The method also constructs a related message, causes the related message to be transmitted to a request processor and receives a response from the request processor. The method then constructs a response to the electronic message and, in an instance in which the predefined requirements are not satisfied, causes a notification regarding a failure to satisfy the predefined requirements to also be constructed.

Abstract: A computing device, method and computer program product are provided to process messages received from a source and to construct messages transmitted to a recipient that include the information required to elicit the desired response. In relation to a method, an electronic message is received and analyzed relative to requirements of the related message to determine whether the electronic message includes information required by the related message.

Abstract: An improved adherence monitoring system increases the efficiency for obtaining patient adherence information. The improved adherence monitoring system reduces network traffic with regards to the communication of patient adherence information. The improved adherence monitoring system automates an adherence notification pathway. The improved adherence monitoring system can increase patient adherence by increasing the efficiency of medication therapy. The improved adherence monitoring system may also increase the efficiency by which patient adherence information is disbursed.

Abstract: Systems and methods are provided for determining and communicating prescription benefit coverage information to a prescriber of the product, service, or medication. A prescription benefit check request may be received by the service provider computer from a healthcare provider computer for the prescriber of the product, service, or medication. The service provider computer may format a prescription request for the prescribed product, service, or medication and transmit the prescription request to a pharmacy claims processor computer for processing. The service provider computer may receive a prescription response that includes a determination of the prescription request from the pharmacy claims processor computer.

Abstract: Systems and methods are provided for determining and communicating prescription benefit coverage information to a prescriber of the product, service, or medication. A prescription benefit check request may be received by the service provider computer from a healthcare provider computer for the prescriber of the product, service, or medication. The service provider computer may format a prescription request for the prescribed product, service, or medication and transmit the prescription request to a pharmacy claims processor computer for processing. The service provider computer may receive a prescription response that includes a determination of the prescription request from the pharmacy claims processor computer.