PHARMACEUTICAL CLAIM PROCESSING AND NETWORK ROUTING SYSTEMS

Abstract

ABSTRACT Pharmaceutical Claim Processing and Network Routing Systems The present disclosure introduces a pharmaceutical claim processing and network routing system 100 designed to streamline, secure, and optimize the adjudication of prescription drug claims. The system features a claim processing engine 102 for automated submission, validation, and real-time adjudication, and a network routing and transmission module 104 for low-latency and efficient data transmission. A security and compliance layer 106 ensures data encryption, multi-factor authentication, and blockchain integration for regulatory compliance. A dynamic formulary and policy update engine 108 retrieves real-time updates for accurate processing, while a fraud detection and prevention system 110 identifies anomalies and prevents fraudulent claims. A patient-centric claim tracking portal 112 provides real-time updates to users, and an adaptive load balancing mechanism 120 dynamically distributes tasks for high scalability. Additional components are telemedicine integration module 116 for virtual consultations and an audit trail and regulatory reporting system 122 for compliance and traceability

Specification

Description:Pharmaceutical Claim Processing and Network Routing Systems
TECHNICAL FIELD
[0001] The present innovation relates to pharmaceutical claim processing systems, focusing on secure, efficient, and automated claim routing, adjudication, and communication within the healthcare ecosystem.

BACKGROUND

[0002] The pharmaceutical sector faces significant challenges in processing prescription drug claims efficiently and securely. Traditional claim processing systems are often manual and fragmented, leading to delays in adjudication, inaccuracies in reimbursement, and increased administrative costs. Patients frequently experience delays in accessing necessary medications due to errors, outdated formulary information, or cumbersome claim workflows. Healthcare providers, pharmacies, and insurers rely on outdated systems that lack real-time data sharing, interoperability, and advanced fraud detection, further exacerbating these issues.

[0003] Existing options for claim processing typically involve standalone software solutions or manual interventions. While some systems provide digital interfaces for claim submissions, they often operate in silos, causing data mismatches, redundant entries, and processing delays. Other advanced systems may incorporate basic automation but lack the ability to handle real-time adjudication, fraud detection, and secure multi-stakeholder communication. These limitations result in higher operational costs, reduced efficiency, and poor patient outcomes.

[0004] The present invention addresses these challenges by introducing a comprehensive, automated pharmaceutical claim processing and network routing system. Unlike existing solutions, it integrates advanced features such as machine learning for predictive error detection, blockchain for immutable claim records, and dynamic network routing algorithms for low-latency data transmission. The invention ensures real-time adjudication, multi-protocol interoperability, and robust security through encryption and role-based access controls. Novel features like automated rejection feedback, formulary updates, and patient-centric tracking portals streamline the claim lifecycle while reducing administrative overhead.

[0005] By overcoming the drawbacks of existing systems, this invention delivers faster approvals, enhanced fraud prevention, and seamless integration with healthcare platforms. Its modular and scalable architecture allows stakeholders to adopt tailored solutions, ensuring adaptability to diverse needs. This innovation transforms pharmaceutical claim processing by improving efficiency, accuracy, security, and transparency, setting a new benchmark in healthcare technology.

OBJECTS OF THE INVENTION
[0006] The primary object of the invention is to streamline pharmaceutical claim processing by automating workflows and ensuring real-time adjudication.

[0007] Another object of the invention is to enhance the efficiency of claim routing by utilizing dynamic network algorithms that minimize data transmission latency.

[0008] Another object of the invention is to improve data security in pharmaceutical claim processing through robust encryption, role-based access control, and blockchain integration.

[0009] Another object of the invention is to reduce administrative burdens for pharmacies, healthcare providers, and insurers by providing an integrated, scalable system.

[00010] Another object of the invention is to ensure compliance with regulatory standards such as HIPAA and GDPR through automated audit trails and secure data handling.

[00011] Another object of the invention is to detect and prevent fraudulent claims in real-time using machine learning algorithms and anomaly detection.

[00012] Another object of the invention is to provide patients with greater transparency by enabling real-time claim tracking and personalized notifications.

[00013] Another object of the invention is to reduce errors in claim submissions by integrating real-time formulary and policy updates.

[00014] Another object of the invention is to promote interoperability across healthcare systems by supporting multiple communication protocols such as HL7, FHIR, and X12.

[00015] Another object of the invention is to optimize resource utilization and cost efficiency through predictive analytics and adaptive load balancing.


SUMMARY OF THE INVENTION

[00016] In accordance with the different aspects of the present invention, pharmaceutical claim processing and network routing system is presented. It provides an automated and secure pharmaceutical claim processing system designed to streamline workflows, reduce errors, and ensure real-time adjudication. It incorporates advanced features like machine learning for fraud detection, blockchain for data integrity, and dynamic network routing for low-latency communication. The system supports interoperability across healthcare platforms, ensuring seamless integration with existing infrastructures. Robust security measures and regulatory compliance mechanisms protect sensitive healthcare data throughout the process. By improving efficiency, transparency, and accuracy, the invention enhances outcomes for patients, healthcare providers, and insurers.

[00017] Additional aspects, advantages, features and objects of the present disclosure would be made apparent from the drawings and the detailed description of the illustrative embodiments constructed in conjunction with the appended claims that follow.

[00018] It will be appreciated that features of the present disclosure are susceptible to being combined in various combinations without departing from the scope of the present disclosure as defined by the appended claims.

BRIEF DESCRIPTION OF DRAWINGS
[00019] The summary above, as well as the following detailed description of illustrative embodiments, is better understood when read in conjunction with the appended drawings. For the purpose of illustrating the present disclosure, exemplary constructions of the disclosure are shown in the drawings. However, the present disclosure is not limited to specific methods and instrumentalities disclosed herein. Moreover, those in the art will understand that the drawings are not to scale. Wherever possible, like elements have been indicated by identical numbers.

[00020] Embodiments of the present disclosure will now be described, by way of example only, with reference to the following diagrams wherein:

[00021] FIG. 1 is component wise drawing for pharmaceutical claim processing and network routing system.

[00022] FIG 2 is working methodology of pharmaceutical claim processing and network routing system.

DETAILED DESCRIPTION

[00023] The following detailed description illustrates embodiments of the present disclosure and ways in which they can be implemented. Although some modes of carrying out the present disclosure have been disclosed, those skilled in the art would recognise that other embodiments for carrying out or practising the present disclosure are also possible.

[00024] The description set forth below in connection with the appended drawings is intended as a description of certain embodiments of pharmaceutical claim processing and network routing system and is not intended to represent the only forms that may be developed or utilised. The description sets forth the various structures and/or functions in connection with the illustrated embodiments; however, it is to be understood that the disclosed embodiments are merely exemplary of the disclosure that may be embodied in various and alternative forms. The figures are not necessarily to scale; some features may be exaggerated or minimised to show details of particular components. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a representative basis for teaching one skilled in the art to variously employ the present invention.

[00025] While the disclosure is susceptible to various modifications and alternative forms, specific embodiment thereof has been shown by way of example in the drawings and will be described in detail below. It should be understood, however, that it is not intended to limit the disclosure to the particular forms disclosed, but on the contrary, the disclosure is to cover all modifications, equivalents, and alternatives falling within the scope of the disclosure.

[00026] The terms "comprises", "comprising", "include(s)", or any other variations thereof, are intended to cover a non-exclusive inclusion, such that a setup, or system that comprises a list of components or steps does not include only those components or steps but may include other components or steps not expressly listed or inherent to such setup or system. In other words, one or more elements in a system or apparatus preceded by "comprises... a" does not, without more constraints, preclude the existence of other elements or additional elements in the system or apparatus.

[00027] In the following detailed description of the embodiments of the disclosure, reference is made to the accompanying drawings and which are shown by way of illustration-specific embodiments in which the disclosure may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the disclosure, and it is to be understood that other embodiments may be utilized and that changes may be made without departing from the scope of the present disclosure. The following description is, therefore, not to be taken in a limiting sense.

[00028] The present disclosure will be described herein below with reference to the accompanying drawings. In the following description, well-known functions or constructions are not described in detail since they would obscure the description with unnecessary detail.

[00029] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is disclosed in accordance with one embodiment of the present invention. It comprises of claim processing engine 102, network routing and transmission module 104, security and compliance layer 106, dynamic formulary and policy update engine 108, fraud detection and prevention system 110, patient-centric claim tracking portal 112, real-time cost estimation and alternative medication suggestion module 114, telemedicine integration module 116, performance monitoring and analytics dashboard 118, adaptive load balancing mechanism 120, audit trail and regulatory reporting system 122, customizable rule-based workflow engine 124, cross-border claim processing and currency conversion module 126, voice command integration 128.

[00030] Referring to Fig. 1, the present disclosure provides details of pharmaceutical claim processing and network routing system 100. It is designed to streamline and secure the processing, adjudication, and transmission of pharmaceutical claims using advanced automation, network optimization, and fraud detection technologies. The system comprises key components such as claim processing engine 102, network routing and transmission module 104, and security and compliance layer 106, which ensure efficient workflow automation and secure data handling. Additional components like dynamic formulary and policy update engine 108, fraud detection and prevention system 110, and patient-centric claim tracking portal 112 enhance accuracy, transparency, and user engagement. The system incorporates real-time cost estimation and alternative medication suggestion module 114 and telemedicine integration module 116 to support seamless patient care. Furthermore, adaptive load balancing mechanism 120 and audit trail and regulatory reporting system 122 ensure scalability, compliance, and reliable operation across high-volume environments.

[00031] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with claim processing engine 102, which automates the submission, validation, and adjudication of pharmaceutical claims. It uses machine learning algorithms to predict errors and detect fraudulent claims, reducing delays in approvals. This component works closely with network routing and transmission module 104 to ensure validated claims are transmitted efficiently for adjudication. It also integrates with the dynamic formulary and policy update engine 108 to ensure claims are processed using the most current policies. The claim processing engine 102 supports features like real-time adjudication and automated rejection feedback as detailed in the claims.

[00032] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with network routing and transmission module 104, which optimizes the routing of claim data between stakeholders, minimizing latency and ensuring reliability. This module uses advanced algorithms to select efficient communication paths and synchronizes data across systems in real-time. It works in conjunction with claim processing engine 102 to transmit validated claims and with the security and compliance layer 106 to ensure data integrity during transmission. By supporting multi-protocol communication, the module enables interoperability and contributes to the claim features of low-latency transmission and real-time synchronization.

[00033] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with security and compliance layer 106, which ensures the confidentiality and integrity of healthcare data through encryption, multi-factor authentication, and blockchain integration. This layer safeguards all data exchanges between claim processing engine 102 and network routing and transmission module 104, ensuring compliance with HIPAA and GDPR regulations. By generating audit trails and enabling secure access controls, the security and compliance layer 106 directly supports claims related to fraud prevention, compliance, and data integrity.

[00034] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with dynamic formulary and policy update engine 108, which automatically retrieves and applies updates to drug formularies and pricing policies. This component integrates seamlessly with claim processing engine 102 to ensure claims are adjudicated using the latest formulary data. It also interacts with the fraud detection and prevention system 110 to flag discrepancies between claims and updated policies. This engine supports the feature of reducing errors due to outdated policy data as mentioned in the claims.

[00035] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with fraud detection and prevention system 110, which uses machine learning algorithms and rule-based checks to identify fraudulent claims. It analyzes patterns such as duplicate submissions and unusual drug costs to flag potential issues before processing. This system works in collaboration with claim processing engine 102 to block suspicious claims and with security and compliance layer 106 to maintain a secure review process. The fraud detection and prevention system 110 supports the feature of real-time fraud prevention, enhancing trust and accuracy in the claims process.

[00036] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with patient-centric claim tracking portal 112, which enables patients to monitor the status of their claims in real-time. It provides personalized notifications regarding approvals, rejections, or additional requirements, ensuring transparency. This portal interacts with claim processing engine 102 to fetch claim updates and integrates with the network routing and transmission module 104 to ensure timely delivery of notifications. By enhancing user engagement and trust, the patient-centric claim tracking portal 112 supports the features of real-time tracking and patient communication as mentioned in the claims.

[00037] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with real-time cost estimation and alternative medication suggestion module 114, which calculates patient-specific medication costs during claim submission. It also identifies alternative medications based on the patient's formulary and insurance coverage. This module works closely with dynamic formulary and policy update engine 108 to access the latest pricing and coverage data, and with claim processing engine 102 to integrate cost suggestions during adjudication. This component addresses the claims feature of cost transparency and medication alternatives, reducing patient delays and out-of-pocket costs.

[00038] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with telemedicine integration module 116, which facilitates the real-time submission and adjudication of claims generated during virtual healthcare consultations. It interacts with claim processing engine 102 to validate and process prescriptions and with network routing and transmission module 104 to ensure secure and efficient data transmission. By enabling seamless telemedicine claim handling, the telemedicine integration module 116 supports the claims feature of integration with modern healthcare delivery systems.

[00039] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with performance monitoring and analytics dashboard 118, which provides real-time insights into claim processing metrics such as approval rates, rejection patterns, and system throughput. This dashboard integrates with claim processing engine 102 and fraud detection and prevention system 110 to gather performance data and with adaptive load balancing mechanism 120 to identify bottlenecks and optimize workflows. By enabling data-driven decision-making, this dashboard supports the claims feature of performance analytics and operational efficiency.

[00040] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with adaptive load balancing mechanism 120, which dynamically distributes claim processing tasks across servers or cloud environments based on real-time traffic. It works in conjunction with network routing and transmission module 104 to ensure efficient resource allocation and with performance monitoring and analytics dashboard 118 to adjust loads based on system performance data. This mechanism supports the claims feature of scalability and reliability during high-volume claim processing.

[00041] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with audit trail and regulatory reporting system 122, which generates detailed logs of all claim-related activities to ensure compliance with regulatory requirements. It integrates with security and compliance layer 106 to maintain secure and immutable records and with fraud detection and prevention system 110 to track and report potential anomalies. By simplifying regulatory audits, this system supports the claims feature of compliance and accountability.

[00042] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with customizable rule-based workflow engine 124, which allows stakeholders to define and implement custom claim approval workflows. It interacts with claim processing engine 102 to apply these rules during adjudication and with network routing and transmission module 104 to ensure efficient routing based on predefined criteria. This engine supports the claims feature of tailored workflow management for diverse stakeholder requirements.

[00043] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with cross-border claim processing and currency conversion module 126, which handles international claims by converting transaction amounts into the payer's preferred currency. It integrates with network routing and transmission module 104 to ensure compliance with regional regulations and with dynamic formulary and policy update engine 108 to apply local policy updates. This module supports the claims feature of facilitating global pharmaceutical transactions.

[00044] Referring to Fig. 1, pharmaceutical claim processing and network routing system 100 is provided with voice command integration 128, which enables pharmacy staff to interact with the system hands-free through natural language commands. It works with claim processing engine 102 to submit and track claims and with patient-centric claim tracking portal 112 to retrieve updates for verbal communication. This component enhances efficiency in high-traffic environments, supporting the claims feature of user-friendly and hands-free operation.

[00045] Referring to Fig 2, there is illustrated method 200 pharmaceutical claim processing and network routing system 100. The method comprises:
At step 202, method 200 includes the user submitting a prescription claim through the claim processing engine 102;
At step 204, method 200 includes the claim processing engine 102 automatically validating the claim by checking for completeness, eligibility, and formulary compliance;
At step 206, method 200 includes the claim processing engine 102 interfacing with the dynamic formulary and policy update engine 108 to retrieve the latest formulary rules and policy updates for accurate adjudication;
At step 208, method 200 includes the validated claim being routed to the appropriate insurer or pharmacy benefit manager via the network routing and transmission module 104, utilizing optimized routing algorithms;
At step 210, method 200 includes the security and compliance layer 106 encrypting the claim data to ensure secure transmission and regulatory compliance;
At step 212, method 200 includes the claim processing engine 102 adjudicating the claim in real-time by calculating co-pays, reimbursements, and approvals based on policy data;
At step 214, method 200 includes the fraud detection and prevention system 110 analyzing the claim for potential anomalies or fraudulent activities before finalizing adjudication;
At step 216, method 200 includes the patient-centric claim tracking portal 112 updating the user with the real-time status of the claim via personalized notifications;
At step 218, method 200 includes the real-time cost estimation and alternative medication suggestion module 114 providing cost details and recommending alternatives if the prescribed medication is not covered or is too expensive;
At step 220, method 200 includes the audit trail and regulatory reporting system 122 generating a detailed log of the claim process for compliance and record-keeping purposes;
At step 222, method 200 includes the telemedicine integration module 116 enabling real-time claim submission and adjudication for prescriptions issued during virtual consultations, if applicable;
At step 224, method 200 includes the adaptive load balancing mechanism 120 dynamically distributing claim processing tasks across servers to handle high-volume transactions efficiently;
At step 226, method 200 includes the customizable rule-based workflow engine 124 applying specific workflow rules defined by stakeholders to tailor the adjudication process as needed;
At step 228, method 200 includes the cross-border claim processing and currency conversion module 126 handling international claims, applying currency conversions, and ensuring compliance with regional healthcare regulations;
At step 230, method 200 includes the voice command integration 128 allowing pharmacy staff to verbally interact with the system for claim submission, tracking, and updates, enhancing user convenience.

[00046] The pharmaceutical claim processing and network routing system 100 offers transformative applications in healthcare by automating and optimizing the end-to-end workflow of prescription claim submissions. The claim processing engine 102 ensures faster approvals by validating and adjudicating claims in real-time, while the network routing and transmission module 104 enables low-latency communication among healthcare providers, insurers, and pharmacies. With the dynamic formulary and policy update engine 108, the system ensures claims are processed based on the latest rules and policies, reducing errors and delays. The fraud detection and prevention system 110 safeguards against fraudulent activities, enhancing trust and security in the claims process. Additionally, the patient-centric claim tracking portal 112 improves transparency, allowing users to monitor their claim status and receive updates. The adaptive load balancing mechanism 120 ensures scalability and uninterrupted performance during high transaction volumes, while the telemedicine integration module 116 enables seamless claim processing for virtual consultations. These components collectively reduce administrative overhead, improve data security through the security and compliance layer 106, and ensure compliance with regulatory standards, ultimately delivering faster, more reliable access to essential medications for patients and creating efficiency across the healthcare ecosystem.

[00047] In the description of the present invention, it is also to be noted that, unless otherwise explicitly specified or limited, the terms "fixed" "attached" "disposed," "mounted," and "connected" are to be construed broadly, and may for example be fixedly connected, detachably connected, or integrally connected, either mechanically or electrically. They may be connected directly or indirectly through intervening media, or they may be interconnected between two elements. The specific meaning of the above terms in the present invention can be understood in specific cases to those skilled in the art.

[00048] Modifications to embodiments of the present disclosure described in the foregoing are possible without departing from the scope of the present disclosure as defined by the accompanying claims. Expressions such as "including", "comprising", "incorporating", "have", "is" used to describe and claim the present disclosure are intended to be construed in a non- exclusive manner, namely allowing for items, components or elements not explicitly described also to be present. Reference to the singular is also to be construed to relate to the plural where appropriate.

[00049] Although embodiments have been described with reference to a number of illustrative embodiments thereof, it should be understood that numerous other modifications and embodiments can be devised by those skilled in the art that will fall within the spirit and scope of the principles of this disclosure. More particularly, various variations and modifications are possible in the component parts and/or arrangements of the subject combination arrangement within the scope of the present disclosure, the drawings and the appended claims. In addition to variations and modifications in the component parts and/or arrangements, alternative uses will also be apparent to those skilled in the art.
, Claims:WE CLAIM:
1. A pharmaceutical claim processing and network routing system 100 comprising of
claim processing engine 102 to automate the submission, validation, and adjudication of prescription claims;
network routing and transmission module 104 to ensure efficient and low-latency transmission of claim data;
security and compliance layer 106 to provide secure data encryption and regulatory compliance;
dynamic formulary and policy update engine 108 to retrieve and apply real-time updates to drug formularies and policies;
fraud detection and prevention system 110 to identify and mitigate anomalies or fraudulent claims;
patient-centric claim tracking portal 112 to enable real-time tracking and personalized notifications for users;
real-time cost estimation and alternative medication suggestion module 114 to calculate medication costs and recommend alternatives;
telemedicine integration module 116 to facilitate claim submission and adjudication during virtual consultations;
performance monitoring and analytics dashboard 118 to provide real-time insights into claim processing metrics;
adaptive load balancing mechanism 120 to dynamically distribute claim processing tasks for high efficiency;
audit trail and regulatory reporting system 122 to generate logs and compliance reports for regulatory purposes;
customizable rule-based workflow engine 124 to enable stakeholders to define specific workflows for claim adjudication;
cross-border claim processing and currency conversion module 126 to handle international claims and currency conversions; and
voice command integration 128 to allow verbal interaction for claim submission and tracking by pharmacy staff.
2. The pharmaceutical claim processing and network routing system 100 as claimed in claim 1, wherein the claim processing engine 102 is configured to automate submission, validation, and real-time adjudication of prescription claims, utilizing machine learning algorithms to detect errors and fraud, ensuring faster and more accurate processing.

3. The pharmaceutical claim processing and network routing system 100 as claimed in claim 1, wherein the network routing and transmission module 104 is configured to optimize data transmission with low-latency routing algorithms, enabling seamless communication between healthcare providers, pharmacies, and insurers.

4. The pharmaceutical claim processing and network routing system 100 as claimed in claim 1, wherein the security and compliance layer 106 is configured to encrypt data, enforce multi-factor authentication, and utilize blockchain for immutable claim records, ensuring compliance with HIPAA, GDPR, and similar regulations.

5. The pharmaceutical claim processing and network routing system 100 as claimed in claim 1, wherein the dynamic formulary and policy update engine 108 is configured to retrieve real-time updates to drug formularies, pricing, and insurance policies, ensuring claims are adjudicated using the most current data.

6. The pharmaceutical claim processing and network routing system 100 as claimed in claim 1, wherein the fraud detection and prevention system 110 is configured to analyze claim patterns using machine learning and rule-based algorithms to identify anomalies, flag suspicious claims, and prevent fraudulent activities.

7. The pharmaceutical claim processing and network routing system 100 as claimed in claim 1, wherein the patient-centric claim tracking portal 112 is configured to provide real-time updates and notifications on claim status, enabling patients to monitor and manage their claims transparently.

8. The pharmaceutical claim processing and network routing system 100 as claimed in claim 1, wherein the adaptive load balancing mechanism 120 is configured to dynamically allocate claim processing tasks across servers or cloud environments, ensuring scalability and uninterrupted performance during high transaction volumes.

9. The pharmaceutical claim processing and network routing system 100 as claimed in claim 1, wherein the telemedicine integration module 116 is configured to process prescription claims generated during virtual consultations in real-time, streamlining the end-to-end claim adjudication process.

10. The pharmaceutical claim processing and network routing system 100 as claimed in claim 1, wherein method comprises of
user submitting a prescription claim through the claim processing engine 102;
claim processing engine 102 automatically validating the claim by checking for completeness, eligibility, and formulary compliance;
claim processing engine 102 interfacing with the dynamic formulary and policy update engine 108 to retrieve the latest formulary rules and policy updates for accurate adjudication;
validated claim being routed to the appropriate insurer or pharmacy benefit manager via the network routing and transmission module 104, utilizing optimized routing algorithms;
security and compliance layer 106 encrypting the claim data to ensure secure transmission and regulatory compliance;
claim processing engine 102 adjudicating the claim in real-time by calculating co-pays, reimbursements, and approvals based on policy data;
fraud detection and prevention system 110 analyzing the claim for potential anomalies or fraudulent activities before finalizing adjudication;
patient-centric claim tracking portal 112 updating the user with the real-time status of the claim via personalized notifications;
real-time cost estimation and alternative medication suggestion module 114 providing cost details and recommending alternatives if the prescribed medication is not covered or is too expensive;
audit trail and regulatory reporting system 122 generating a detailed log of the claim process for compliance and record-keeping purposes;
telemedicine integration module 116 enabling real-time claim submission and adjudication for prescriptions issued during virtual consultations, if applicable;
adaptive load balancing mechanism 120 dynamically distributing claim processing tasks across servers to handle high-volume transactions efficiently;
customizable rule-based workflow engine 124 applying specific workflow rules defined by stakeholders to tailor the adjudication process as needed;
cross-border claim processing and currency conversion module 126 handling international claims, applying currency conversions, and ensuring compliance with regional healthcare regulations;
voice command integration 128 allowing pharmacy staff to verbally interact with the system for claim submission, tracking, and updates, enhancing user convenience.

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