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SYSTEMS AND METHODS FOR VERIFYING CORRELATION OF DIAGNOSIS AND MEDICATION AS PART OF QUALIFYING PROGRAM ELIGIBILITY VERIFICATION
SYSTEMS AND METHODS FOR VERIFYING CORRELATION OF DIAGNOSIS AND MEDICATION AS PART OF QUALIFYING PROGRAM ELIGIBILITY VERIFICATION
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机译：验证诊断和药物相关性的系统和方法，作为合格程序合格性验证的一部分
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摘要
Systems and methods are provided for verifying correlation of diagnosis andmedication as part of qualifying program eligibility verification for amedication requested ina healthcare transaction. A service provider computer may receive an ADTtransaction froma covered entity healthcare provider that includes patient identifiersidentifying a patient anda diagnosis code identifying a malady affecting a the patient. The serviceprovider computermay receive a healthcare claim transaction from a pharmacy requesting amedication for thepatient. The service provider computer can verify that the requestedmedication is onetypically used for the malady identified by the diagnosis code. The serviceprovidercomputer may also determine whether the requested medication is eligible undera predefinedqualifying program based at least in part on the healthcare claim transactionand patientand/or prescriber registration information.
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