Po-Wen Chang, Ismail Abouamal, Ozkan Demir, Axel La Salle, Victoria Uribe
CoverMyMeds is a healthcare technology company that provides electronic prior authorizations (ePA)s for medical claims rejected by insurance companies. When a doctor sends a prescription to the pharmacy, the pharmacy runs a claim against the patient’s insurance. If the insurance company accepts the claim, the pharmacy dispenses the drug to the patient. If the insurance company rejects the claim, however, a doctor can use CoverMyMeds to complete an ePA. This gives the doctor an opportunity to submit additional information to the insurance company in support of the patient needing the treatment (drug). Our project, MedEvalPro, uses the simulated pharmacy-claim, PA, and date data provided by CoverMyMeds to discover the drug formulary for each payer (insurance company), predict the chance of claim approval, predict the chance of a PA approval, and forecast future PA volume.