Insurance claim filing system and method

• US 20020120473A1
• Filed: 02/27/2001
• Published: 08/29/2002
• Est. Priority Date: 06/01/2000
• Status: Active Grant

• Current Assignee: Stephen K. Wiggins
• Original Assignee: Stephen K. Wiggins
• Inventors: Wiggins, Stephen K.
• Granted Patent: US 7,668,738 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

A method and system for enabling a service provider to file insurance claims via the internet directly with the payer rather than through a clearinghouse. The system has three major components. These three components interact with both the existing practice management system used by the service provider and with the online claim filing systems of participating insurance payers. The first component is a software application that is installed on the service provider'"'"'s local computer system. This software seeks out billing information stored on that system and creates data files suitable for filing of properly formatted claims with the payers'"'"' web sites. The second component is a web portal that interacts with both the first component and the payers'"'"' web sites to keep the former up to date with the current formatting requirements of the various payers and to facilitate the filing of the claims electronically via the payers'"'"' web site. The third component enables the resident software to communicate via an internet connection to non-internet payers The present system uses a software 37 cookie” to convey instructions to the first component so that it can automatically connect to the appropriate page of each payer'"'"'s web site for electronic filing the claims.

Claims

1. A method for filing an insurance claim via a payer'"'"'s web site, said insurance claim being based on billing data, said method comprising the steps of:

obtaining a software application that carries formatting instructions for filing a claim online;

obtaining an address for a web site of a payer that permits online filing of claims;

retrieving billing data;

logging on to said payer'"'"'s web site at said address;

formatting said billing data into a billing data file in accordance with said formatting requirements carried by said software application; and

downloading said billing data file to said payer'"'"'s web site to file said claim online.

2. The method as recited in claim 1, further comprising the step of receiving said address for said payer'"'"'s web site in the form of a cookie so that, when said cookie is retrieved, said payer'"'"'s web site can be accessed.

3. The method as recited in claim 1, wherein said software is downloaded from a web site.

4. The method as recited in claim 1, further comprising the step of accessing a web site for downloading said software and for receiving a cookie containing said address for said payer'"'"'s web site.

5. The method as recited in claim 1, wherein said address is obtained from a third party web site.

6. A method for facilitating the filing of an insurance claim via a payer'"'"'s web site, said insurance claim being based on billing data, said method comprising the steps of:

providing a software application that formats billing data into billing data files adapted for filing on line; and

providing a web site address for filing said billing data files on line.

7. The method as recited in claim 6, wherein said software application is provided by downloading said software application to a practice management system of a service provider.

8. The method as recited in claim 6, wherein said web site address is provided by setting a cookie in said software application.

9. The method as recited in claim 6, further providing the step of retrieving billing data from a practice management system of a service provider.

10. The method as recited in claim 6, further comprising the steps of:

polling web sites of payers to obtain changes in format requirements; and

upgrading said software to format billing data in accordance with said changes in format requirements.

11. A method for enabling a practice management system of a service provider to file an insurance claim electronically via a payer'"'"'s web site, said insurance claim being based on billing data stored on said practice management system, said method comprising the steps of:

locating billing data stored on a practice management system of a service provider;

eliminating a portion of said billing data that corresponds to claims for payers that do not permit online filing of claims;

downloading from a payer'"'"'s web site format instructions for formatting billing data for online filing at said payer'"'"'s web site;

determining an address at said payer'"'"'s webs site for filing billing data;

conveying said format instructions and said address to a practice management system of a service provider;

accessing by said practice management system said payer'"'"'s web site;

navigating by said practice management system said payer'"'"'s web site to said address where billing files can be filed;

formatting said billing files; and

uploading said formatted billing files.

12. The method as recited in claim 11, wherein said conveying step further comprises the step of setting a cookie in said practice management system, said cookie containing said address of said payer'"'"'s web site.

13. The method as recited in claim 11, wherein said conveying step further comprises the steps of:

comparing format instructions on said practice management system with instructions downloaded from said payer'"'"'s web site to determine if said format instructions on said practice management software are current; and

conveying said downloaded format instructions if said format instructions on said practice management software are not current.

14. The method as recited in claim 11, further comprising the step of polling said payer'"'"'s web site for changes in format instructions.

15. The method as recited in claim 11, wherein said determining step further comprises the steps of:

logging onto said payer'"'"'s web site; and

navigating said payer'"'"'s web site to locate said address for filing billing files.

17. The system as recited in claim 16, wherein said web portal further comprises means for setting a cookie containing said web page address in said computer.

18. The system as recited in claim 16, wherein said web portal further comprises means for uploading changes to said format instructions to said computer when said computer accesses said portal.

19. The system as recited in claim 16, wherein said web portal further comprises means for polling web sites of said payers for changes in said format requirements.

16. A system for filing an insurance claim at a web site operated by a payer, said web site permitting electronic filing of formatted data files based on billing data corresponding to said insurance claim, said system comprising:

a web portal programed to obtain format instructions and a web page location from a web site operated by a payer for filing a formatted claim; and

a computer having access to stored billing data and programmed to log on to said web portal to receive said format instructions and said web page location, said computer programmed to retrieve and format said data files based on said billing data and in accordance with said format instructions and to file said formatted data files at said web page location.

20. A system for filing an insurance claim at a web site operated by a payer, said web site permitting electronic filing of formatted data files based on billing data corresponding to said insurance claim, said system comprising:

means for collecting billing data;

means for obtaining format instructions and a web page location from a web site operated by a payer;

means for logging onto a web site operated by a payer and navigating said web site to said web page location obtained by said obtaining means;

means for formatting said billing data in accordance with said format instructions obtained by said obtaining means to create formatted data files; and

means for uploading said formatted data files to said web page location from said formatting means.

21. The system as recited in claim 20, wherein said obtaining means is a web portal.

22. The system as recited in claim 20, wherein said obtaining means sets a cookie containing said web page location in said logging means.

23. The system as recited in claim 21, wherein said obtaining means polls said web site operated by a payer to obtain changes in said format instructions and conveys said changes to said formatting means.