James L Rowe

US Patent:

20020169955, Nov 14, 2002

Filed:

Apr 25, 2002

Appl. No.:

10/133001

Inventors:

Oliver Bryant - Rex GA, US
Scott Frazor - Amarillo TX, US
James Rowe - Sugar Hill GA, US

International Classification:

H04L009/00
G06F017/60

US Classification:

713/153000, 705/002000

Abstract:

Claim processing system providing an interface to permit pharmacy and medical management systems to use the Internet to transmit third-party insurance claims on a claim-by-claim basis in real-time or near-real-time to one or more claim servers that receive insurance claim requests over the Internet in an encrypted form. The one or more claim servers decrypt the claim requests and forward them to a health network application which facilitates the submission of the claims to insurance payers and the response of the insurance payers to the requests. Payer responses are received by the claim servers, encrypted and forwarded to the pharmacy and medical management systems in real-time or near real-time.

US Patent:

20030229519, Dec 11, 2003

Filed:

May 16, 2003

Appl. No.:

10/439423

Inventors:

Brian Eidex - Stockbridge GA, US
James Rowe - Sugar Hill GA, US

International Classification:

G06F017/60

US Classification:

705/002000

Abstract:

Systems and methods permit the identification of fraud and abuse in electronic prescription transactions by intercepting and analyzing prescription claims to determine the likelihood that a claim is fraudulent. A fraud scoring engine utilizes a compilation of expert rules and profiling engine methodologies to determine the likelihood that a transaction is the result of fraudulent or abusive behavior. The fraud scoring engine assigns a fraud score to rate the probability that a transaction is fraudulent in nature. The fraud score is compared against payer-defined business rules to determine if a claim is rejected as fraudulent. A fraud management interface enables payers to view a rejected claim and the reasons why a claim is rejected so that the reasons can be explained to a pharmacist, should the pharmacist contact the payer.

US Patent:

20040078247, Apr 22, 2004

Filed:

May 16, 2003

Appl. No.:

10/439422

Inventors:

James Rowe - Sugar Hill GA, US
Roger Pinsonneault - Alpharetta GA, US

International Classification:

G06F017/60

US Classification:

705/004000

Abstract:

Systems and methods verify the content of an electronically transmitted claim, such as a healthcare claim by intercepting the claim, reviewing the claim's contents, and comparing the claim to pre-established claim criteria established by a payer or both a healthcare service provider and payer. If the claim contains the appropriate content the claim is forwarded to its intended recipient, typically a payer such as an insurance company or government healthcare payer; otherwise the claim may be returned to the sender, e.g., a pharmacy, with an indication that it does not contain the correct content. Additionally, the claim may be edited by the system and forwarded in correct form to its intended recipient.

US Patent:

20060271402, Nov 30, 2006

Filed:

May 26, 2006

Appl. No.:

11/441554

Inventors:

James Rowe - Sugar Hill GA, US
Warren Williams - Atlanta GA, US

International Classification:

G06Q 10/00
G06Q 40/00

US Classification:

705002000, 705004000

Abstract:

Methods, systems and computer program products alert pharmacies of formulary alternatives. A claim generated by a provider and including at least one drug is received, where the claim is directed to a payer recipient. The claim is reviewed to identify the at least one drug. The at least one drug is then compared to a pre-established formulary alternative table, which may be created or managed, at least in part, by the payer recipient. A preferred drug alternative may then be forwarded to the provider when the at least one drug has a match in the pre-established formulary alternative table.

US Patent:

20070260486, Nov 8, 2007

Filed:

Apr 30, 2007

Appl. No.:

11/742235

Inventors:

Michael Urich - Suwanee GA, US
James Rowe - Sugar Hill GA, US

Assignee:

NDCHEALTH CORPORATION - Atlanta GA

International Classification:

G06Q 10/00
G06Q 40/00

US Classification:

705002000, 705035000

Abstract:

The invention is directed to systems and methods for monitoring, retrieving, and/or reporting a personal medical account balance such as an individual flexible spending account (FSA) balance. In an example of an embodiment of the invention the monitoring, retrieval, and/or display of the personal medical account balance may accompany the processing of a claim submitted by a healthcare provider (e.g., hospital, doctor's office, pharmacy, etc.) or vendor (e.g., retail store, drug store, etc.) to an insurance provider. In such embodiments, the monitoring, retrieval, and/or display of personal medical account balance may occur in real-time (or near real-time) with the submission of the claim.

US Patent:

20080208757, Aug 28, 2008

Filed:

May 2, 2008

Appl. No.:

12/114433

Inventors:

Oliver Ross Bryant - Rex GA, US
Scott N. Frazor - Amarillo TX, US
James Couser Rowe - Sugar Hill GA, US

Assignee:

McKesson Financial Holdings Limited - Hamilton

International Classification:

H04K 1/00

US Classification:

705 64

Abstract:

Claim processing system providing an interface to permit pharmacy and medical management systems to use the Internet to transmit third-party insurance claims on a claim-by-claim basis in real-time or near-real-time to one or more claim servers that receive insurance claim requests over the Internet in an encrypted form. The one or more claim servers decrypt the claim requests and forward them to a health network application which facilitates the submission of the claims to insurance payers and the response of the insurance payers to the requests. Payer responses are received by the claim servers, encrypted and forwarded to the pharmacy and medical management systems in real-time or near real-time.

US Patent:

20150269695, Sep 24, 2015

Filed:

Mar 18, 2014

Appl. No.:

14/218326

Inventors:

- Hamilton, BM
James C. Rowe - Sugar Hill GA, US

Assignee:

MCKESSON FINANCIAL HOLDINGS - Hamilton

International Classification:

G06Q 50/22
G06Q 30/02

Abstract:

Systems and methods are provided for identifying non-insurance related financial assistance opportunities for patients as part of the processing of a healthcare transaction. Upon receiving a healthcare transaction from a healthcare provider, the service provider can identify non-insurance related financial assistance opportunities for the patient. The service provider can reject the transaction and transmit the rejection along with a message identifying the non-insurance related financial assistance opportunity to the healthcare provider and await a resubmitted healthcare transaction. In other examples, the service provider can process the healthcare transaction and include a message or code identifying the financial assistance opportunity in the healthcare transaction or an adjudicated response to the healthcare transaction. In another example, the service provider can identify contact information for the patient identified in the healthcare transaction and can transmit a message identifying the non-insurance related financial assistance opportunity directly to the patient via the contact information.