Inventors:
Leslie S. Dunham - Lithia FL, US
Carol A. Swirsky - Branford CT, US
George A. French - West Hartford CT, US
Paul C. Castanho - Rocky Hill CT, US
International Classification:
G06Q 40/08
Abstract:
Exemplary embodiments provide systems and methods that automatically gather, organize, present, and communicate data and information that aid a claim handler in making an accurate, informed decision regarding whether or not to allow or approve an authorization request, payment, claim, or action associated with a pharmacy insurance claim. Exemplary embodiments include a software application that reduces the effort required and increases the speed and effectiveness of claim handlers by providing organized, immediate access to claim summary and detailed pharmacy information, which streamlines reviews and the request approval process, including payment requests and prior authorization requests. Various embodiments also activate real-time alerts and reminders to claim handlers for various pharmacy claim management tasks.