Software based method for tracking rejected medicare and other insurance claims

• US 20030167184A1
• Filed: 02/26/2001
• Published: 09/04/2003
• Est. Priority Date: 02/26/2001
• Status: Abandoned Application

• Current Assignee: Mark Hamilton Kole
• Original Assignee: Mark Hamilton Kole
• Inventors: Kole, Mark Hamilton
• Application Number:
  US09/793,183
• Publication Number:
  US 20030167184A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires

Abstract

The present invention is a method for using a computer to facilitate the tracking of Medicare and other medical insurance claims by care providers. The present invention relates to a dedicated software program which maintains a database of claim resubmission/review protocols for Medicare and insurance companies and interactively guides the user through all stages of the claims resubmission process to the end of either having a claim paid or disallowed for payment.

Claims

1. A method for using a computer to facilitate the tracking of Medicare and other medical insurance claims by care providers, said method comprising:

inputting into the computer, updateable data base, containing all forms, form letters, procedures, mailing addresses and other administrative information required for the processing of rejected medical insurance claims and providing accurate printed output that said letters and forms generated are in strict compliance with regulatory requirements and can be read with minimal error by optical character readers,

inputting into the computer, a data base for guiding the care provider sequentially through al procedures necessary for resubmission of priorly rejected claims,

inputting into the computer, scaleable applications which can be sized to the needs of those seeking to process priorly rejected claims on a scale from a single individual claim to large multi-medical service providers, and hospital claims,

inputting into the computer a data base for tracking the dates of submissions to the insurance carriers for maintaining acceptable response rates,

inputting into the computer a data base for preventing the care provider from missing steps in the resubmission sequence by requiring specific information concerning the rejection criteria to be entered into the key fields on the computer monitor,

inputting into the computer data base, proactive prompts and lists of approaching response deadlines, and

inputting into the computer data base, a series of screens for walking the user through each level of appeal/resubmission while providing previews of all forms required at each level.

2. The method of claim 1, in which the step of inputting into the computer, a data base for tracking the dates of submissions comprises:

inputting into the computer;

automatic deadline and due date calculation,

automatic aging calculation for warning the user of claims which are aging and due to expire,

automatic internal claims forwarding once data has been entered regarding a denial of claim,

claim status at-a-glance whereby each claim is displayed with a clear status code, and

automatic form filling which correctly fills out each form according to the claim.

3. The method of claim 1, in which the step of inputting into the computer, a data base for guiding the care provider sequentially through all procedures comprises;

inputting into the computer, reports at-a-glance whereby reports at each level are generated to include all fields such as what has been sent, what is working, what has been denied, what has been approved, complete patient history, fair claims schedules, what is due report, a report of all claims in due date order with all hearing and filing dates displayed, and administrative law judge docket schedule.

4. The method of claim 1, in which the step of inputting into the computer, a data base for guiding the care provider sequentially through all procedures comprise:

inputting into the computer;

Medicare claim tracking, using the same criteria defined by Medicare,

automatic claims organization, and

history tracking for providing all historical data on every claim for later review.