Insurance administration system

• US 20020077869A1
• Filed: 09/13/2001
• Published: 06/20/2002
• Est. Priority Date: 06/30/1987
• Status: Abandoned Application

• Current Assignee: NGS American, Inc. (Trustmark Mutual Holding Company)
• Original Assignee: NGS American, Inc. (Trustmark Mutual Holding Company)
• Inventors: Alcott, William D. III, Doyle, Findley C.
• Application Number:
  US09/951,585
• Publication Number:
  US 20020077869A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

The computerized insurance claim processing system links the physician'"'"'s office and the provider of insurance coverage by means of a central administration computer. The system provides up-to-date information to the provider of health care services as to insurance coverage of a patient. The system also allows real time modification of the information, including the identity of patients covered and the type of insurance benefits.

Claims

1. A system for providing up-to-date information to a provider of health care services as to insurance coverage of a patient and which allows real-time modification of the information, including patients covered and the type of insurance benefits.

2. A system for processing health benefits claims, comprising:

(a) a computer for maintaining a roster of individuals having insurance benefits;

(b) first data link means which is able to delete individuals from the roster in real time; and

(c) notification means for providing notice to an individual in response to his deletion from the roster.

3. A system for processing health benefits claims, comprising:

(a) an administration computer which contains a roster of insured individuals and a list of medical treatments; and

(b) first data link means for inquiring, in real time, whether a given individual is on the roster and a given medical treatment is on the list.

4. A system for making payments from a payor for the benefit of a beneficiary, comprising:

(a) computer means for storing a roster of beneficiaries;

(b) a first data link to the computer for doing the following in real time;

(i) ascertaining whether the roster contains a given beneficiary and

(ii) requesting payment for the benefit of the beneficiary; and

(c) a second data link to the administration computer for changing the roster in real time.

5. A system for processing health benefits claims, comprising:

(a) an administration computer which contains a roster of insured individuals and a list of medical treatments; and

(b) first data link means for inquiring, in real time, whether

(i) a given individual is on the roster and

(ii) a given medical treatment is on the list.

6. A system according to claim 5 and further comprising

(c) a second data link means for inquiring in real time whether

(i) a given individual is on the roster and

(ii) a given medical treatment is on the list, and

(iii) for changing the roster in real time.

15. A method according to claim 5 and further comprising the following step:

(j) at a second remote terminal, changing the provisions of the plan and the beneficiaries of the plan, in real time.

16. A method according to claim 5 and further comprising the following steps:

(k) at a second remote terminal, auditing the status of the plan by obtaining, in real time, data from the administration computer which indicates at least

(i) the identities of persons receiving medical treatment during an identified period;

(l) using the second remote terminal, deleting beneficiaries from the plan;

(m) using the administration computer, in response to a deletion,

(i) causing a printer to print notice for the deleted person'"'"'s benefit and which offers to the deleted person to maintain insurance coverage for a fee, and

(i) when a predetermined type of response is received from the deleted person by a predetermined date, causing the printer to print a group of payments of coupons for use by the deleted person in making periodic payments for insurance; and

(n) after a beneficiary is deleted, and prior to the predetermined date, when making a response to a validity inquiry, including a statement which indicates that the insurance coverage of the respective person is presently uncertain.

7. A system for disbursing money for the benefit of a beneficiary comprising:

(a) an administration computer which contains a roster of beneficiaries;

(b) a first data link means under control of a first party which can address the roster in order to ascertain, in real time, whether a given individual is listed thereon; and

(c) a second data link under control of a second party which can, in real time,

(i) address the roster and

(ii) add and delete names from the roster.

8. A system according to claim 7 and further comprising:

(d) means for disbursing money to a party which is identified to the administration computer by using the first data link.

9. A system for processing health benefits claims, comprising:

(a) a computer which stores a database which includes

(i) a roster of beneficiaries and

(ii) a list of medical treatments for which benefits are available; and

(b) data link means for changing the roster in real time.

10. A system for processing medical insurance claims, comprising:

(a) an administration computer which contains a roster of insured individuals, a list of reimbursable medical treatments, and the amount of reimbursement for each treatment;

(b) first data link means which can connect to the administration computer for inquiring in real time whether;

a given individual is an insured individual and a given treatment in a reimbursable treatment;

(c) second data link means which can connect to the administration computer for changing the roster, the list, and the reimbursements, in real time.

11. A system for providing a notice to an individual having medical insurance, comprising:

(a) a computer;

(b) a printer under control of the computer;

(c) means for causing the printer to print a message for the individual in response to a predetermined event and, if a predetermined type of response to the message is made by the individual within a predetermined time, then printing a collection of coupons for the individual.

12. A system for processing medical insurance claims, comprising:

(a) an administration computer which contains a data base for each of several insurance companies, each data base including a roster of insured individuals, a list of medical treatments for which payment is made by each respective insurance company, and the amount of the payment for each treatment;

(b) first means under the control of a provider of medical treatment for allowing the provider to make the following inquiries of a selected data base;

whether a given individual is listed on the roster for a given insurance company;

whether the insurance company at the time of inquiry will pay for one or more specified treatments, and the amount of payment for each treatment;

(c) second means under control of a second party for modifying the data base of a respective insurance company, including modifications to the roster of insured individuals, to the list of medical treatments for which payment is made, and to the amounts of the payments.

13. A method of processing medical insurance claims comprising the following steps:

(a) storing, in an administration computer, a data base for each of several insurance companies, each data base containing data which indicates the monetary reimbursement allowed for each of several types of medical treatment;

(b) transmitting, from a remote location, the name of a patient and names of one or more medical treatments to the administration computer;

(c) transmitting, to the remote location, information which indicates whether an insurance policy will pay for part or all of the medical treatments;

(d) when insurance coverage for an insured individual is terminated, undertaking the following steps using the administration computer;

(i) storing in the data base an indicia indicating the termination, and

(ii) printing a notice and sending the notice to the insured individual which notifies the individual of the termination and offers the individual an option, which has an expiration date, to continue insurance coverage at a cost to the individual.

14. A method of processing medical insurance claims comprising the following steps:

(a) entering data, at a remote terminal, which identifies a patient, including

(i) a number unique to the patient and

(ii) the patient'"'"'s date of birth;

(b) entering data which describes the medical treatment to be received;

(c) transmitting the data of paragraphs (a) and (b) to an administration computer which contains information about an insurance plan;

(d) using the administration computer, ascertaining

(i) whether the patient has insurance coverage and, if so,

(ii) whether the insurance company providing the coverage will pay for the medical treatment to be received, and

(iii) the monetary amounts which the insurance company will pay for each treatment;

(e) transmitting to the remote terminal the data ascertained in paragraph (d) (i), (ii), and (iii);

(f) after medical treatment has occurred, transmitting from the remote terminal, data which indicates the types of treatments and the identity of the patient;

(g) using the administration computer, computing the payment based on the types of treatment in paragraph (f);

(h) transmitting to the remote terminal the payment computed in paragraph (g); and

(i) using the administration computer, causing funds to be transferred to the provider of the medical treatment.