Method and system for processing physician claims over a network

• US 20020147867A1
• Filed: 02/19/2002
• Published: 10/10/2002
• Est. Priority Date: 02/20/2001
• Status: Active Grant

• Current Assignee: Hartford, Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Original Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Inventors: Satlow, Marcia
• Granted Patent: US 7,921,123 B2
• Time in Patent Office: Days
• US Class Current: 710/100
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A method and system for gathering, collating and sorting information items distributed among a plurality of databases containing information items regarding physician treatment/billing claims, insurance payments, and provider/patient relations over at least one communication networks is disclosed. The method comprises the steps of creating an intermediate data base containing information items related to physician treatment/billing claim data, insurance payment data, and insurance provider. The information items are further cross-referenced with regard to at least one common information item. The information items in the intermediate data base are then filtered using at least one selected information item contained in the intermediate data base to create at least one file containing cross-referenced data items relating to the filtering criteria, and reporting a selected one of the file. In another aspect of the invention, the created files may be selectively filtered using additional filter criteria.

Claims

1. A method for gathering, collating and sorting information items distributed among a plurality of databases containing information items regarding physician treatment/billing claims, insurance payments, and provider/patient relations over at least one communication networks, said method comprising the steps of:

creating an intermediate data base of said physician treatment/billing claim data, insurance payment data, and insurance provider, wherein information items among said databases are cross-referenced with regard to at least one common information item;

filtering said intermediate data base using at least one selected information item contained in said intermediate data base to create at least one file containing cross-referenced data items relating to said at least one filtering information item, and

reporting a selected one of said file.

2. The method as recited in claim 1 further comprising the step of:

iteratively filtering a selected one of said at least one files using at least one additional information item contained in said selected file to create a subsequent at least one file containing cross-referenced data items relating to said at least one additional filtering information item.

3. The method as recited in claim 1 wherein the step of filtering comprises the steps of:

selecting at least one information item contained in said intermediate base;

identifying information items matching said at least one selected information item; and

storing said matching information items and associated cross-referenced information items in a select one of said at least one file.

4. The method as recited in claim 3 wherein the step of filtering further comprises the step of:

storing said selected at least one information item in a corresponding filter file.

5. The method as recited in claim 2 wherein the step of iteratively filtering comprises the steps of:

selecting at least one information item contained in a selected one of said files;

identifying information items matching said at least one selected information item; and

storing said matching information items and associated cross-referenced information items in at least one file.

6. The method as recited in claim 5 wherein the step of iteratively filtering further comprises the step of:

storing said selected at least one information item in a corresponding filter file.

7. The method as recited in claim 1 wherein at least one of said plurality of data bases includes information items selected from the group comprising:

patient name, patient identification number, treatment code, treatment, invoice number, amount billed, physician name, physician identification code, patient residence, physician business address, etc.

8. The method as recited in claim 1 wherein at least one of said plurality of databases includes information items selected from the group comprising:

patient name, patient identification code, physician name, physician identification code, treatment code, treatment, invoice number, payment amount, etc.

9. The method as recited in claim 1 wherein at least one of said plurality of databases includes information items selected from the group comprising:

provider name, provider identification number code, patient name, patient identification code, etc.

10. The method as recited in claim 1 wherein the step of accessing at least one of said data bases includes communicating over at least one network selected from the group comprising:

ISA, PCI, PCMCIA, POTS, PBX, LAN, MAN, WAN, INTERNET, INTRANET.

11. The method as recited in claim 1 wherein the step of creating an intermediate database further comprises the steps of:

validating information item values; and

importing default information item values when a corresponding one of said information item values is outside a known range corresponding to said information item.

12. The method as recited in claim 1 wherein the step of creating said intermediate database further comprises the step of:

creating at least one new information item based on information items associated with information items among at least one of said plurality of databases.

13. The method as recited in claim 1 wherein said plurality of databases provide information items dynamically.

14. The method as recited in claim 1 wherein said at least one file is in a format all substantially similar to that of said intermediate database.

15. The method as recited in claim 11 wherein the step of importing comprises:

manually entering said default information.

16. The method as recited in claim 11 wherein the step of importing comprises:

automatically entering said default information.

18. The system as recited in claim 17 wherein said processor is further operable to execute code for:

iteratively filtering a selected one of said at least one files using at least one additional information item contained in said selected file to create a subsequent at least one file containing cross-referenced data items relating to said at least one additional filtering information item.

19. The system as recited in claim 17 wherein said processor is operable to execute code for filtering by:

selecting at least one information item contained in said intermediate base;

identifying information items matching said at least one selected information item; and

storing said matching information items and associated cross-referenced information items in a select one of said at least one file.

20. The system as recited in claim 18 wherein said processor is further operable to execute code for filtering by:

storing said selected at least one information item in a corresponding filter file.

21. The system as recited in claim 18 wherein said processor is operable to execute code for iteratively filtering by:

selecting at least one information item contained in a selected one of said files;

identifying information items matching said at least one selected information item; and

storing said matching information items and associated cross-referenced information items in at least one file.

22. The system as recited in claim 21 wherein said processor is further operable to execute code for iteratively filtering by:

storing said selected at least one information item in a corresponding filter file.

23. The system as recited in claim 17 wherein at least one of said plurality of data bases includes information items selected from the group comprising:

patient name, patient identification number, treatment code, treatment, invoice number, amount billed, physician name, physician identification code, patient residence, physician business address, etc.

24. The system as recited in claim 17 wherein at least one of said plurality of databases includes information items selected from the group comprising:

patient name, patient identification code, physician name, physician identification code, treatment code, treatment, invoice number, payment amount, etc.

25. The system as recited in claim 17 wherein at least one of said plurality of databases includes information items selected from the group comprising:

provider name, provider identification number code, patient name, patient identification code, etc.

26. The system as recited in claim 17 wherein said at least one network selected from the group comprising:

ISA, PCI, PCMCIA, POTS, PBX, LAN, MAN, WAN, INTERNET, INTRANET.

27. The system as recited in claim 17 wherein said processor is further operable to execute code for creating an intermediate database by:

validating information item values; and

importing default information item values when a corresponding one of said information item values is outside a known range corresponding to said information item.

28. The system as recited in claim 17 wherein said processor is further operable to execute code for:

creating at least one new information item based on information items associated with information items among at least one of said plurality of databases.

29. The system as recited in claim 17 wherein said plurality of databases provide information items dynamically.

30. The system as recited in claim 17 wherein said at least one file is in a format substantially similar to that of said intermediate database.

31. The system as recited in claim 27 wherein said default information is entered manually.

32. The system as recited in claim 28 wherein said default information is entered automatically.

33. The system as recited in claim 17 further comprising:

a memory in communication with said processor, said memory containing code.

34. The system as recited in claim 33 wherein said memory is in communication with said input/output device.

35. The system as recited in claim 34 wherein said input/output device is operable to transmit information over at least one of said networks.

17. A system for gathering, collating and sorting information items distributed among a plurality of databases containing information items regarding physician treatment/billing claims, insurance payments, and provider/patient relations over at least one communication networks comprising:

an input/output device operable to receive said information items over said communication network;

a processor in communication with said input/output device, said processor operable to execute code for;

creating an intermediate data base of said physician treatment/billing claim data, insurance payment data, and insurance provider, wherein information items among said databases are cross-referenced with regard to at least one common information item;

filtering said intermediate data base using at least one selected information item contained in said intermediate data base to create at least one file containing cross-referenced data items relating to said at least one filtering information item, and

reporting a selected one of said file.