Pharmacy System for Iterative Screening Data Collection
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Solution Overview
Problem
Pharmacies face challenges in determining the necessary information to collect for intervention services to satisfy claims processors' requirements and in transmitting collected data effectively, leading to incomplete or missing screening parameter data during intervention services, which hampers payment processing and understanding of service completion status.
Innovation Solution
A system and method that determine, collect, configure, and transmit intervention service data by parsing prescription claim transactions to identify required parameters and generate reject responses with specific instructions, ensuring all necessary data is collected and reported to claims processors, facilitating complete intervention service documentation and payment processing.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If pharmacies use existing pharmacy practice management systems to submit prescription claim transactions, then payment for prescription medications can be processed, but the systems are not capable of collecting and sending all the data required during intervention services
Solution Approach 1:
The patent combines multiple functions into a single integrated system. The pharmacy practice management system is enhanced to simultaneously handle prescription claim transactions and intervention service data collection in one unified platform, eliminating the need for separate systems for each function.
Solution Approach 2:
The enhanced pharmacy practice management system is designed to perform multiple functions: processing prescription claims, collecting intervention service data, transmitting screening parameters, and receiving payment information. This multi-functional approach allows a single system to handle diverse healthcare transactions without requiring separate specialized systems.
2Loss of information
If pharmacies collect comprehensive screening parameter data during intervention services, then complete documentation is achieved, but the complexity of determining and transmitting all required data increases
Solution Approach 1:
The system pre-determines and communicates the specific screening parameters that need to be collected before the intervention service occurs. By providing this advance guidance, the pharmacy knows exactly what data to gather, preventing incomplete documentation without requiring complex post-service data determination.
Solution Approach 2:
The system implements a feedback loop where the pharmacy practice management system receives information about required screening parameters, collects the data, transmits it to the claims processor, and receives confirmation or correction instructions. This continuous feedback ensures data completeness while simplifying the process through iterative refinement.
3Productivity
If pharmacies transmit intervention service data to claims processors, then payment processing is enabled, but the current systems cannot effectively transmit the collected data
Solution Approach 1:
The patent merges data transmission with the existing claims processing workflow. Instead of requiring separate transmission steps, the intervention service data is integrated into the claims transaction itself, allowing simultaneous processing of both payment and data reporting functions through a single communication channel.
4Measurement precision
If pharmacies determine necessary information requirements for each claims processor, then accurate data collection is achieved, but the time and complexity of determining requirements increases
Solution Approach 1:
The system pre-establishes and stores the specific data requirements for each claims processor before intervention services are performed. This preliminary configuration eliminates the need for real-time determination of data requirements, allowing pharmacies to quickly retrieve and follow predetermined specifications without time-consuming analysis.
Data Source
AI summary
A healthcare claim transaction may be received by a service provider computer from a pharmacy computer. An intervention service for a patient may be identified and the screening parameters to be obtained from the patient for the intervention service may be identified. The service provider computer may generate a reject response and insert a reject code and/or message notifying the pharmacy of the first screening parameter to obtain from the patient. The rejection response may be sent to the pharmacy computer, which may subsequently send a resubmitted healthcare claim transaction that includes the requested first screening parameter data for the patient. The service provider computer may parse the transaction to identify the data. The iterative process may continue until all of the screening parameter data for the patient is received by the service provider computer, which may transmit that data to a claims processor computer.