US 12,067,530 B2
Systems and methods for logical data processing
Laurie A. Littlecreek, Foristell, MO (US); Corinne M. Bradley-Pollack, Loveland, CO (US); David M. Hutchison, Collinsville, IL (US); Kevin Mulligan, Minneapolis, MN (US); Leah E. Sterman-Kabrt, West Caldwell, NJ (US); and Melissa Orlando, St. Clair, MO (US)
Assigned to Express Scripts Strategic Development, Inc., St. Louis, MO (US)
Filed by Express Scripts Strategic Development, Inc., St. Louis, MO (US)
Filed on May 19, 2023, as Appl. No. 18/199,637.
Application 18/199,637 is a continuation of application No. 17/082,392, filed on Oct. 28, 2020, granted, now 11,694,158.
Application 17/082,392 is a continuation of application No. 15/709,909, filed on Sep. 20, 2017, granted, now 10,853,453, issued on Dec. 1, 2020.
Claims priority of provisional application 62/397,904, filed on Sep. 21, 2016.
Prior Publication US 2023/0289726 A1, Sep. 14, 2023
This patent is subject to a terminal disclaimer.
Int. Cl. G06Q 40/00 (2023.01); G06Q 10/00 (2023.01); G06Q 10/10 (2023.01); G06Q 50/22 (2024.01); G16H 40/20 (2018.01); G06Q 10/087 (2023.01)
CPC G06Q 10/10 (2013.01) [G16H 40/20 (2018.01); G06Q 10/087 (2013.01)] 20 Claims
OG exemplary drawing
 
1. A system comprising:
one or more processors configured to determine whether a pharmacy benefit claim processing request is to be processed according to a variant logic process and not be processed according to a non-variant logic process based on a claims variable associated with the pharmacy benefit claim processing request, the pharmacy benefit claim processing request identifying claims data including the claims variable, the variant logic process defining a modified sequence of various sets of criteria that differs from a predefined sequence defined by the non-variant logic process, the various sets of the criteria in the predefined sequence and the modified sequence associated with different groups of healthcare providers, the modified sequence of the various sets of the criteria differing from the predefined sequence of the various sets of the criteria in that the modified sequence includes (a) at least one additional one of the various sets of the criteria or (b) a different order in which the pharmacy benefit claim processing request is compared to the various sets of the criteria,
the one or more processors determining that the pharmacy benefit claim processing request is to be processed according to the variant logic process and not the non-variant logic process in response to the claims data indicating that one or more of a requested medication or a requested amount of the requested medication violates the criteria defined by the non-variant logic process,
the one or more processors configured to dynamically alter the predefined sequence of the various sets of the criteria in the non-variant logic process to the modified sequence of the various sets of the criteria in the variant logic process in response to determining that the pharmacy benefit claim processing request is to be processed using the variant logic process, at least one of the various sets of the criteria in the predefined sequence denying the pharmacy benefit claim processing request while the various sets of the criteria in the modified sequence approving the pharmacy benefit claim processing request;
the one or more processors configured to compare the claims data identified by the pharmacy benefit claim processing request with the various sets of the criteria in the modified sequence that is defined by the variant logic process; and
the one or more processors configured to process and approve the claims data according to the various sets of the criteria in the modified sequence that is defined by the variant logic process.