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Exception-based integrated patient access workflow

  • US 10,410,305 B1
  • Filed: 02/19/2013
  • Issued: 09/10/2019
  • Est. Priority Date: 02/18/2012
  • Status: Active Grant
First Claim
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1. A system to transform raw information into actionable intelligence and integrate workflows via an integrated user interface (UI) comprising:

  • a computer processor; and

    a computer storage device that stores instructions that, when executed by the computer processor, integrates outputs of a plurality of workflow engines to generate the integrated UI to display and enable resolution of generated alerts via the integrated UI according to the outputs of the plurality of workflow engines, the instructions to;

    enable a display of a first selectable control with the integrated UI that, when selected, operates to display a demographics UI display as part of the integrated UI;

    in response to selection of the first selectable control of the integrated UI, display the demographics UI display with data provided by a first workflow engine comprising a demographic information verification engine, wherein the demographics UI display displays alerts with patient data that differs from the demographic data stored in one or more third party data sources and marks conflicting demographic data provided by the one or more third party data sources;

    enable a display of a second selectable control with the integrated UI that, when selected, operates to display a coverage UI display as part of the integrated UI;

    in response to selection of the second selectable control of the integrated UI, display the coverage UI display with data provided by a second workflow engine comprising a coverage information verification engine, wherein the coverage UI display displays coverage verification alerts for coverage issues identified between the patient data and coverage information received from the one or more third party data sources;

    enable a display of a third selectable control with the integrated UI that, when selected, operates to display an alert overview UI display as part of the integrated UI; and

    in response to selection of the third selectable control of the integrated UI, display the alert overview UI display with alert data provided by a third workflow engine comprising an alerts engine, the alert overview UI display including an alert status UI display that displays resolved and/or unresolved alerts with alert details that include a type of alert, a current alert status, and an alert category, whereinthe demographic information verification engine outputs the data for the demographics UI display of the integrated UI after cross-matching the patient data with the demographic data stored in the one or more third party data sources to determine if any demographic data is missing from the patient data and that the demographic data in the patient data is consistent with the demographic data stored in the one or more third party data sources,the coverage information verification engine outputs the data for the coverage UI display of the integrated UI after performing a query for coverages claimed by a patient or guarantor corresponding with the patient data and after cross-matching the patient data with insurance coverage data stored in the one or more third party data sources to determine if the coverage data is missing from the patient data and that the coverage data in the patient data is consistent with the coverage data stored in the one or more third party data sources, andthe alerts engine outputs the alert data for the alert overview UI display and one or more of the demographics UI display and the coverage UI display and generates one or more displayable alerts for display in the alert overview UI display and in one or more of the demographics UI display and the coverage UI display corresponding to the alert data affecting one or more downstream patient access workflow processes that depend on accurate data.

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