Systems and methods for obtaining approval for medical reimbursements

• US 20020082863A1
• Filed: 12/21/2000
• Published: 06/27/2002
• Est. Priority Date: 12/21/2000
• Status: Abandoned Application

• Current Assignee: Health Strategies Network Incorporated
• Original Assignee: Health Strategies Network Incorporated
• Inventors: Kleinke, John D.
• Application Number:
  US09/747,614
• Publication Number:
  US 20020082863A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

Systems and methods for requesting and providing payer attributes corresponding to a medical treatment. The payer attributes can include procedures and/or documents necessary to secure payment for a medical treatment from the payer. The methods comprise receiving an indicator from a user node at a system node and determining payer attributes based on the indicator. The payer attributes are communicated to the user across a computer network. The systems comprise a system node associated with a database and in communication with the Internet. The database embodies at least one interactive request for approval of a medical treatment.

Claims

1. A method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, the method comprising:

receiving an indicator from the user node at the system node;

determining a payer attribute based on the indicator; and

communicating the payer attribute to the user node across a computer network.

2. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, wherein the indicator identifies a treatment.

3. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 2, wherein the payer attribute comprises a diagnosis which support the treatment.

4. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 2, wherein the treatment is a medical procedure.

5. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 2, wherein the treatment is a medication.

6. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, wherein the indicator identifies a payer.

7. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 6, wherein the payer is an insurance company.

8. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 6, wherein the payer attribute comprises a treatment commonly denied by the payer.

9. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, wherein the user node comprises a browser in communication with the Internet.

10. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, wherein the payer attribute comprises a payer requirement for approving a medical treatment.

11. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, wherein the payer attribute comprises a suggested substitute treatment.

12. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 11, wherein the payer attribute further comprises a difference between the suggested substitute treatment and a desired treatment.

13. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 12, wherein the payer attribute further comprises at least one diagnosis for which the suggested substitute treatment is less optimal than the desired treatment.

14. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, wherein the user node is operated by a patient.

15. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, wherein the user node is located at a physician'"'"'s office.

16. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, wherein the user node is located at a pharmacy.

17. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, wherein the system node is a server in communication with the Internet.

18. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, wherein the system node is associated with a computer readable medium, the computer readable medium comprising:

treatment data associated with a treatment identifier;

payer data associated with a payer identifier; and

the payer attribute associated with a combination of the treatment identifier and the payer identifier.

19. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 18, wherein determining the payer attribute comprises:

associating the payer identifier with the medication identifier; and

retrieving the payer attribute associated with the medication identifier and payer identifier.

20. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 18, wherein the computer readable medium further comprises:

a first statistical datum associated with the payer identifier; and

a second statistical datum associated with the medication identifier.

21. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, the method further comprising:

receiving a request for access from a provider; and

providing the identity of the provider to a treatment supplier, wherein the treatment supplier provides the provider with a password.

22. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 1, wherein the indicator is a first indicator, the method further comprising:

receiving a second indicator from the user node at the system node.

23. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 22, the method further comprising:

providing a database interface at the user node, the database interface automatically retrieving one of the first or the second indicators from the user node and communicating the first and the second indicators to the system node.

24. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 22, wherein the first indicator identifies a treatment and the second indicator identifies a payer.

25. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 24, wherein the payer attribute is specific to both the payer and the treatment.

26. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 24, the method further comprising:

displaying an interface at the user node, wherein the first and second indicators are entered via the interface.

27. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 26, wherein the interface is an Internet page.

28. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 26, wherein the treatment is a medication and the interface is a first interface, the method further comprising:

providing a second interface at the user node, the second interface operable to receive an order for the medication;

receiving the order for the medication; and

ordering the medication.

29. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 28, the method further comprising:

communicating the order for the medication to a shipper.

30. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 29, the method further comprising:

receiving compensation from the shipper for communicating the order to the shipper.

31. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 26, wherein the interface is a first interface, the method further comprising:

providing a second interface at the user node for creating an approval request; and

communicating a created approval request to the payer.

32. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 31, wherein the second interface comprises an interactive letter.

33. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 31, wherein the second interface comprises a form letter.

34. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 31, the method further comprising:

receiving a response from the payer, the response denying the created approval request;

communicating the response to the user; and

providing a third interface at the user node for creating an appeal corresponding to the response.

35. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 31, wherein the second interface is an Internet page comprising a field for entering data.

36. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 35, wherein the Internet page comprises a radio button for selecting a diagnosis.

37. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 36, wherein the radio button is a first radio button and the diagnosis is a first diagnosis, and wherein:

the Internet page further comprises a second radio button for selecting a second diagnosis, the second diagnosis related to the first diagnosis.

38. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 26, wherein the interface is a first interface, the method further comprising:

providing a second interface at the user node for creating an approval appeal.

39. The method for providing a payer attribute corresponding to a medical treatment from a system node to a user node, according to claim 38, the method further comprising:

communicating the approval appeal to the payer.

52. A system for providing a payer attribute corresponding to a medical treatment to a user node in communication with a computer network, the system comprising:

a system node, the system node operable to perform the steps of claim 1.

53. A computer readable medium executable by a computer, the computer readable medium comprising:

program data, the program data executable by the computer to perform the steps of claim 1.

40. A method for securing approval for a particular medical treatment, the method comprising:

providing a system node in communication with the Internet;

receiving at the system node a first indicator and a second indicator, the first indicator identifying a medication and the second indicator identifying a payer;

providing to a user node across the Internet a first interface for creating a request for approval corresponding to the first and second indicators.

41. The method for securing approval for a particular medical treatment, according to claim 40, wherein the first interface is an interactive letter.

42. The method for securing approval for a particular medical treatment, according to claim 40, wherein the first interface is a first Internet page.

43. The method for securing approval for a particular medical treatment, according to claim 40, the method further comprising:

receiving a created request for approval from the user node; and

communicating the created request for approval to the payer.

44. The method for securing approval for a particular medical treatment, according to claim 43, the method further comprising:

receiving a denial of the created request for approval, the denial comprising an indication of a treatment denied and the payer; and

providing to a user an appeal request corresponding to the denial.

45. The method for securing approval for a particular medical treatment, according to claim 44, wherein the appeal request is an interactive letter.

46. The method for securing approval for a particular medical treatment, according to claim 44, wherein the appeal request is created via an interactive Internet page.

47. The method for securing approval for a particular medical treatment, according to claim 44, wherein the appeal request comprises an electronic signature.

48. The method for securing approval for a particular medical treatment, according to claim 43, wherein the created request for approval comprises an electronic signature.

49. The method for securing approval for a particular medical treatment, according to claim 43, wherein communicating the created request for approval is done by facsimile.

50. A method for appealing a denial of a medical treatment by a payer to secure approval for the medical treatment, the method comprising:

receiving a denial of a request to approve a medical treatment; and

providing to a user across the Internet an appeal request corresponding to the denial of the request to approve.

51. A method of securing approval for a particular medical treatment from a payer, the method comprising:

operating a user node to provide an indicator to a system node, wherein the system node associated with a database, the database comprising;

a payer and an attribute associated with the payer, wherein the indicator selects the payer and the attribute;

receiving the attribute from the system node; and

receiving a customizable request for approval corresponding to the attribute.

54. A system for securing approval for a medical treatment from a payer, the system comprising:

a system node in communication with the Internet, wherein the system node associated with a computer readable medium; and

the computer readable medium embodying an interactive request for approval of a medical treatment.

55. The system for securing approval for a medical treatment from a payer, according to claim 54, wherein the interactive request for approval is an interactive letter.