Real‑Time Prescription Management System Intake & Billing System

Abstract

The prescription management system is an electronic platform for prescription processing and billing adjudication that integrates in real time to optimize pharmacy operations in retail chains. It interfaces with third-party systems such as Pharmacy Benefit Managers, health insurers, Medicare/Medicaid programs, and discount card processors for guaranteed immediate prescription coverage verification, accurate co-pay calculations, and rapid claim submissions. The prescription management system utilizes microservices-based architecture and scalable cloud infrastructure, is capable of processing as many as 10,000 claims per minute with sub-second response times and high levels of concurrency. It applies advanced business rule engines and standardized transaction models to drive real-time rejection handling, prior authorizations, and formulary management. The modular nature of prescription management system facilitates fault tolerance, rapid scalability, and compliance with regulatory requirements such as DSCSA and HIPAA. It structures a tiered adjudication process, dividing up claim processing into distinct service requests managed by dynamic decision rules. The platform employs AI-pushed data to monitor drug cost, improve prescription compliance, and enable telehealth services. The prescription management system has achieved a 40% drop in claim denials, a tripling of transaction throughput, and improvements in SLA compliance during times of high demand.