Data restructuring for consistent formatting
First Claim
1. A method of providing a recoded eligibility response as a machine-readable data structure comprising:
- receiving, at a computing device that includes a restructuring engine, eligibility data in an original eligibility response;
parsing, by the restructuring engine of the computing device, the eligibility data in the original eligibility response for one or more eligibility benefit data elements and one or more message segments for free-form message text;
removing, by the restructuring engine of the computing device, the free-form message text from the one or more message segments and values of certain eligibility benefit data elements in the original eligibility response;
creating, by the restructuring engine of the computing device, the recoded eligibility response as the machine-readable data structure to include;
a message segment data structure and an eligibility benefit segment data structure, the message segment data structure comprising;
a place of service dimension,a service type dimension,a provider type dimension,a relation of provider to payer dimension,a relation of provider to patient dimension,a reason for service dimension, anda service category dimension;
a coded string to replace removed free-form message text;
one or more coded values for one or more of the place of service dimension, the service type dimension, the provider type dimension, the relation of provider to payer dimension, the relation of provider to patient dimension, the reason for service dimension, and the service category dimension of the message segment data structure;
an embedded tag to indicate a recoding operation for a coded string in a first message segment of the recoded eligibility response when the coded string includes inclusion information; and
an embedded tag to indicate a recoding operation for a coded string in a second message segment of the recoded eligibility response when the coded string includes exclusion information; and
sending, from the computing device, the recoded eligibility response to a requesting healthcare provider computer system.
3 Assignments
0 Petitions
Accused Products
Abstract
Consistently coded eligibility data is provided. Eligibility responses may be received from various payers comprising inconsistently coded eligibility benefit (EB) information provided in EB segments in various locations in the responses. A data restructuring engine may be operable to receive an eligibility response and restructure the response into a consistent format. Co-pay, co-insurance, benefit limitations, and benefit specific deductibles may be clarified by embedding coded strings in one or more message segments attached to EB segments. Service types, network indicators, place of service codes, and message text may be removed when a coded strings is created. Recoded eligibility responses may be provided to healthcare providers, providing coverage, eligibility, and benefit data in a consistent and standardized form, regardless of the payer sending the eligibility response.
-
Citations
18 Claims
-
1. A method of providing a recoded eligibility response as a machine-readable data structure comprising:
-
receiving, at a computing device that includes a restructuring engine, eligibility data in an original eligibility response; parsing, by the restructuring engine of the computing device, the eligibility data in the original eligibility response for one or more eligibility benefit data elements and one or more message segments for free-form message text; removing, by the restructuring engine of the computing device, the free-form message text from the one or more message segments and values of certain eligibility benefit data elements in the original eligibility response; creating, by the restructuring engine of the computing device, the recoded eligibility response as the machine-readable data structure to include; a message segment data structure and an eligibility benefit segment data structure, the message segment data structure comprising; a place of service dimension, a service type dimension, a provider type dimension, a relation of provider to payer dimension, a relation of provider to patient dimension, a reason for service dimension, and a service category dimension; a coded string to replace removed free-form message text; one or more coded values for one or more of the place of service dimension, the service type dimension, the provider type dimension, the relation of provider to payer dimension, the relation of provider to patient dimension, the reason for service dimension, and the service category dimension of the message segment data structure; an embedded tag to indicate a recoding operation for a coded string in a first message segment of the recoded eligibility response when the coded string includes inclusion information; and an embedded tag to indicate a recoding operation for a coded string in a second message segment of the recoded eligibility response when the coded string includes exclusion information; and sending, from the computing device, the recoded eligibility response to a requesting healthcare provider computer system. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
-
-
11. A system to provide a recoded eligibility response as a machine-readable data structure comprising:
-
one or more processors; a restructuring engine comprising executable instructions; and a memory coupled to the one or more processors, the one or more processors to execute the executable instructions of the restructuring engine to; receive eligibility data in an original eligibility response; parse the eligibility data in the original eligibility response for one or more eligibility benefit data elements and one or more message segments for free-form message text remove the free-form message text from the one or more message segments and values of certain eligibility benefit data elements in the original eligibility response; create the recoded eligibility response as the machine-readable data structure to include; a message segment data structure and an eligibility benefit segment data structure, the message segment data structure comprising; a place of service dimension, a service type dimension, a provider type dimension, a relation of provider to payer dimension, a relation of provider to patient dimension, a reason for service dimension, and a service category dimension; a coded string to replace removed free-form message text; one or more coded values for one or more of the place of service dimension, the service type dimension, the provider type dimension, the relation of provider to payer dimension, the relation of provider to patient dimension, the reason for service dimension, and the service category dimension of the message segment data structure; an embedded tag to indicate a recoding operation for a coded string in a first message segment of the recoded eligibility response when the coded string includes inclusion information; and an embedded tag to indicate a recoding operation for a coded string in a second message segment of the recoded eligibility response when the coded string includes exclusion information; and provide the recoded eligibility response to a requesting healthcare provider computer system. - View Dependent Claims (12, 13, 14, 15, 16, 17)
-
-
18. A non-transitory computer readable medium containing computer executable instructions which, when executed by a computing device, implement a restructuring engine to perform a method of providing a recoded eligibility response as a machine-readable data structure comprising:
-
receiving eligibility data in an original eligibility response; parsing, by the restructuring engine, the eligibility data in the original eligibility response for one or more eligibility benefit data elements and one or more message segments for free-form message text; removing, by the restructuring engine, the free-form message text from the one or more message segments and values of certain eligibility benefit data elements in the original eligibility response; creating, by the restructuring engine, the recoded eligibility response as the machine-readable data structure to include; a message segment data structure and an eligibility benefit segment data structure, the message segment data structure comprising; a place of service dimension, a service type dimension, a provider type dimension, a relation of provider to payer dimension, a relation of provider to patient dimension, a reason for service dimension, and a service category dimension; a coded string to replace removed free-form message text; one or more coded values for one or more of the place of service dimension, the service type dimension, the provider type dimension, the relation of provider to payer dimension, the relation of provider to patient dimension, the reason for service dimension, and the service category dimension of the message segment data structure; an embedded tag to indicate a recoding operation for a coded string in a first message segment of the recoded eligibility response when the coded string includes inclusion information; and an embedded tag to indicate a recoding operation for a coded string in a second message segment of the recoded eligibility response when the coded string includes exclusion information; and providing the recoded eligibility response to a requesting healthcare provider computer system.
-
Specification