Electronic pharmacy adjudication system and associated method and computer program product

An electronic pharmacy adjudication system for performing an adjudication service in connection with healthcare insurance claims originating from a plurality of point of sale (POS) devices, each of the healthcare insurance claims including a plurality of information data elements specifying characteristics of the healthcare insurance claim, the electronic pharmacy adjudication system comprising:

• one or more processors;
• and
• a non-transitory computer readable memory storing computer program instructions, the computer program instructions when executed by the one or more processors implementing:
• a) a service and rules engine layer configured for:
• i) receiving a service call identifying a set of parameters on which the service call is to be applied;
• and
• ii) deriving a partial decision result at least in part by processing the set of parameters identified by the service call according to one or more decision rules from a rules repository, the one or more decision rules corresponding to the service call and being a subset of decisions rules in the rules repository;
• b) an orchestration layer in communication with said service and rules engine layer, said orchestration layer being configured for:
• i) processing the information data elements in at least 20,000 of the healthcare insurance claims to generate a sequence of service calls for each of the at least 20,000 of the healthcare insurance claims and forwarding a first service call in the sequence of service calls to the service and rules engine layer to derive a first partial decision result corresponding to the first service call;
• ii) forwarding one or more subsequent service calls in the sequence of service calls to the service and rules engine layer to derive one or more subsequent partial decision results in a sequence of partial decision results when an adjudication decision corresponding to a respective one of the at least 20,000 of the healthcare insurance claims cannot be derived from a previous partial decision result in the sequence of partial decision results corresponding to a previous service call in the sequence of service calls;
• iii) processing the sequence of partial decision results generated by the service and rules engine layer in response to the generated sequence of service calls to incrementally derive the adjudication decision corresponding to each of the at least 20,000 of the healthcare insurance claims;
• iv) forwarding the derived adjudication decision corresponding to each of the at least 20,000 of the healthcare insurance claims to an interface layer for transmittal to a respective one of the point of sale (POS) devices via a data network.