CPC G06Q 40/08 (2013.01) [G16H 10/60 (2018.01); G16H 20/10 (2018.01)] | 20 Claims |
1. A method, in a data processing system comprising a processor and a memory, 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;
executing, by the computer system, analytics on the parsed transactions, the analytics including:
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; and
determining withholdings from payment of the claims for a portion above a tolerance level based on the identified material errors, and
presenting, by the computer system, results of the execution of the analytics to a portal.
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