초록 ▼

A method is provided that includes initiating adjudication of a primary claim in response to a purchase transaction at a primary payer for a client at a point of sale of a healthcare provider, and adjudicating one or more services of a program of the administrator to which the client is enrolled and

A method is provided that includes initiating adjudication of a primary claim in response to a purchase transaction at a primary payer for a client at a point of sale of a healthcare provider, and adjudicating one or more services of a program of the administrator to which the client is enrolled and/or one or more secondary benefits following the adjudication of the primary claim. The purchase transaction is applicable to the respective program and the respective secondary benefit, and the program includes one or more services. The method also includes providing the one or more services and/or secondary benefits to the client in response to adjudicating the one or more services and/or secondary benefits.

대표청구항 ▼

1. An apparatus comprising one or more processors and one or more memories storing executable instructions that in response to execution by the one or more processors cause the apparatus to at least: receive an electronic claim transaction submission at an administrator in response to a purchase tra

1. An apparatus comprising one or more processors and one or more memories storing executable instructions that in response to execution by the one or more processors cause the apparatus to at least: receive an electronic claim transaction submission at an administrator in response to a purchase transaction of a client at a point of sale of a healthcare provider, a primary payer separate and distinct from the administrator also receiving the electronic claim transaction submission from the healthcare provider to initiate adjudication of a primary claim for an offset of at least a portion of a cost associated with the purchase transaction; andadjudicate, in response to receiving the electronic claim transaction submission at the administrator and separate and distinct from adjudication of the primary claim by the primary payer, one or more services of a program of the administrator to which the client is enrolled, the purchase transaction being applicable to the program, the one or more services including one or more marketing services or interventions;wherein the one or more processors also trigger provision of the one or more services to the client in response to adjudication of the one or more services. 2. The apparatus of claim 1, wherein the apparatus is caused to receive the claim transaction submission formatted in accordance with the National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard. 3. The apparatus of claim 1, wherein the one or more memories store further executable instructions that in response to execution by the one or more processors cause the apparatus to further extract one or more items associated with the claim transaction submission in order to trigger provision of one or more additional services to the client. 4. The apparatus of claim 1, wherein the apparatus being caused to adjudicate the one or more services includes being caused to further adjudicate one or more secondary benefits, the purchase transaction being applicable to the program and the one or more secondary benefits, and wherein the apparatus being caused to trigger provision of the one or more services includes being caused to further trigger provision of the one or more secondary benefits to the client in response to adjudication of the one or more secondary benefits. 5. The apparatus of claim 4, wherein the primary payer has received the electronic claim transaction submission to enable the primary payer to determine a primary benefit offsetting at least a portion of the cost associated with the purchase transaction, and wherein the apparatus being caused to adjudicate the one or more secondary benefits includes being caused to determine a monetary secondary benefit further offsetting the cost, the secondary benefit being provided through the administrator. 6. The apparatus of claim 1, wherein the purchase transaction comprises a purchase transaction for a good or service, and wherein the apparatus being caused to adjudicate the one or more services includes being caused to receive information associated with the purchase transaction for the good or service, and maintain, based on the received information, information regarding one or more of historical purchases of the good or service, a timing or a frequency of the historical purchases. 7. An apparatus comprising one or more processors and one or more memories storing executable instructions that in response to execution by the one or more processors cause the apparatus to at least: receive an indication of a purchase transaction of a client at a point of sale of a healthcare provider, the purchase transaction being applicable to a program of an administrator to which the client is enrolled, the program including one or more services; and in response to receipt of the indication of the purchase transaction;send an electronic claim transaction submission for receipt by a primary payer separate and distinct from the administrator to initiate adjudication of a primary claim by the primary payer for an offset of at least a portion of a cost associated with the purchase transaction; andsend the electronic claim transaction submission for receipt by the administrator to initiate adjudication by the administrator of one or more services of the program to which the purchase transaction is applicable, adjudication of the one or more services being separate and distinct from adjudication of the primary claim, the one or more services including one or more marketing services or interventions,wherein receipt of the electronic claim transaction submission by the administrator enables the administrator to provide the one or more services to the client in response to adjudication of the one or more services by the administrator. 8. The apparatus of claim 7, wherein the apparatus being caused to send the electronic claim transaction submission for receipt by the primary payer and for receipt by the administrator includes being caused to send the claim transaction submission formatted in accordance with the National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard. 9. The apparatus of claim 7, wherein the apparatus being caused to send the electronic claim transaction submission for receipt by the administrator includes being caused to send the electronic claim transaction submission to enable the administrator to further determine a secondary benefit. 10. The apparatus of claim 9, wherein the apparatus being caused to send the electronic claim transaction submission for receipt by the primary payer includes being caused to send the electronic claim transaction submission to enable the primary payer to determine a primary benefit offsetting at least a portion of the cost associated with the purchase transaction, and wherein the apparatus being caused to send the electronic claim transaction submission for receipt by the administrator includes being caused to send the electronic claim transaction submission to enable the administrator to determine a monetary secondary benefit further offsetting the cost. 11. The apparatus of claim 7, wherein the purchase transaction comprises a purchase transaction for a good or service, wherein the apparatus being caused to send the electronic claim transaction submission for receipt by the administrator includes being caused to send the electronic claim transaction submission including information associated with the good or service, andwherein the apparatus being caused to send the electronic claim transaction submission for receipt by the administrator includes being caused to send the electronic claim transaction submission to enable the administrator to maintain, based on the received information, information regarding one or more of historical purchases of the good or service, a timing or a frequency of the historical purchases. 12. A non-transitory computer-readable storage medium having computer-readable program code portions stored therein that, in response to execution by one or more processors, cause an apparatus to at least: receive an electronic claim transaction submission at an administrator in response to a purchase transaction of a client at a point of sale of a healthcare provider, a primary payer separate and distinct from the administrator also receiving the electronic claim transaction submission from the healthcare provider to initiate adjudication of a primary claim for an offset of at least a portion of a cost associated with the purchase transaction; andadjudicate, in response to receiving the electronic claim transaction submission at the administrator and separate and distinct from adjudication of the primary claim by the primary payer, one or more services of a program of the administrator to which the client is enrolled, the purchase transaction being applicable to the program, the one or more services including one or more marketing services or interventions;wherein the apparatus is also caused to trigger provision of the one or more services to the client in response to adjudication of the one or more services. 13. The computer-readable storage medium of claim 12, wherein the apparatus is caused to receive the claim transaction submission formatted in accordance with the National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard. 14. The computer-readable storage medium of claim 12, wherein the computer-readable storage medium has further computer-readable program code portions stored therein that, in response to execution by the one or more processors, cause the apparatus to further extract one or more items associated with the claim transaction submission in order to trigger provision of one or more additional services to the client. 15. The computer-readable storage medium of claim 12, wherein the apparatus being caused to adjudicate the one or more services includes being caused to further adjudicate one or more secondary benefits, the purchase transaction being applicable to the program and the one or more secondary benefits, and wherein the apparatus being caused to trigger provision of the one or more services includes being caused to further trigger provision of the one or more secondary benefits to the client in response to adjudication of the one or more secondary benefits. 16. The computer-readable storage medium of claim 15, wherein the primary payer has received the electronic claim transaction submission to enable the primary payer to determine a primary benefit offsetting at least a portion of the cost associated with the purchase transaction, and wherein the apparatus being caused to adjudicate the one or more secondary benefits includes being caused to determine a monetary secondary benefit further offsetting the cost, the secondary benefit being provided through the administrator. 17. The computer-readable storage medium of claim 12, wherein the purchase transaction comprises a purchase transaction for a good or service, and wherein the apparatus being caused to adjudicate the one or more services includes being caused to receive information associated with the purchase transaction for the good or service, and maintain, based on the received information, information regarding one or more of historical purchases of the good or service, a timing or a frequency of the historical purchases. 18. A non-transitory computer-readable storage medium having computer-readable program code portions stored therein that, in response to execution by one or more processors, cause an apparatus to at least: receive an indication of a purchase transaction of a client at a point of sale of a healthcare provider, the purchase transaction being applicable to a program of an administrator to which the client is enrolled, the program including one or more services; and in response to receipt of the indication of the purchase transaction;send an electronic claim transaction submission for receipt by a primary payer separate and distinct from the administrator to initiate adjudication of a primary claim by the primary payer for an offset of at least a portion of a cost associated with the purchase transaction; andsend the electronic claim transaction submission for receipt by the administrator to initiate adjudication by the administrator of one or more services of the program to which the purchase transaction is applicable, adjudication of the one or more services being separate and distinct from adjudication of the primary claim, the one or more services including one or more marketing services or interventions,wherein receipt of the electronic claim transaction submission by the administrator enables the administrator to provide the one or more services to the client in response to adjudication of the one or more services by the administrator. 19. The computer-readable storage medium of claim 18, wherein the apparatus being caused to send the electronic claim transaction submission for receipt by the primary payer and for receipt by the administrator includes being caused to send the claim transaction submission formatted in accordance with the National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard. 20. The computer-readable storage medium of claim 18, wherein the apparatus being caused to send the electronic claim transaction submission for receipt by the administrator includes being caused to send the electronic claim transaction submission to enable the administrator to further determine a secondary benefit. 21. The computer-readable storage medium of claim 20, wherein the apparatus being caused to send the electronic claim transaction submission for receipt by the primary payer includes being caused to send the electronic claim transaction submission to enable the primary payer to determine a primary benefit offsetting at least a portion of the cost associated with the purchase transaction, and wherein the apparatus being caused to send the electronic claim transaction submission for receipt by the administrator includes being caused to send the electronic claim transaction submission to enable the administrator to determine a monetary secondary benefit further offsetting the cost. 22. The computer-readable storage medium of claim 18, wherein the purchase transaction comprises a purchase transaction for a good or service, wherein the apparatus being caused to send the electronic claim transaction submission for receipt by the administrator includes being caused to send the electronic claim transaction submission including information associated with the good or service, andwherein the apparatus being caused to send the electronic claim transaction submission for receipt by the administrator includes being caused to send the electronic claim transaction submission to enable the administrator to maintain, based on the received information, information regarding one or more of historical purchases of the good or service, a timing or a frequency of the historical purchases.