Claims clinical code editing and procedure management tool
First Claim
1. A health insurance claim entering method comprising:
- generating plurality of health care procedure clinical code editing rules at a health insurance company;
presenting at least a portion of the generated plurality of clinical code editing rules to a health care provider;
reviewing at least a portion of the presented plurality of clinical code editing rules; and
entering a claim for one or more performed health care procedures.
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Accused Products
Abstract
A system, method, and user interface for performing maintenance of procedure clinical edit data and associated clinical code editing rules. The system includes a health insurance company and at least one health care provider. The health insurance company includes a computer system with a graphical user interface tool for generating a plurality of health care procedure clinical code editing rules and clinical edit data, and a component for sending at least a portion of the generated plurality of health care procedure clinical code editing rules to a recipient over a data network. The health care provider includes a computer system coupled to the data network for receiving the sent plurality of health care procedure clinical code editing rules and for presenting the received plurality of clinical code editing rules for review. The health care provider also includes a means for entering a claim for one or more performed health care procedures based on review of the plurality of clinical code editing rules.
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Citations
25 Claims
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1. A health insurance claim entering method comprising:
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generating plurality of health care procedure clinical code editing rules at a health insurance company;
presenting at least a portion of the generated plurality of clinical code editing rules to a health care provider;
reviewing at least a portion of the presented plurality of clinical code editing rules; and
entering a claim for one or more performed health care procedures. - View Dependent Claims (2, 3, 4, 5, 6)
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7. A health insurance claim system comprising:
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a health insurance company comprising;
a computer system with a graphical user interface tool for generating a plurality of health care procedure clinical code editing rules; and
a component for sending at least a portion of the generated plurality of health care procedure clinical code editing rules to a recipient over a data network; and
at least one health care provider comprising;
a computer system coupled to the data network for receiving the sent plurality of health care procedure clinical code editing rules and for presenting the received plurality of clinical code editing rules for review; and
a means for entering a claim for one or more performed health care procedures. - View Dependent Claims (8, 9, 10, 11)
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12. A computer generated graphical user interface (gui) generated by a data base program (ACCESS®
- ) for managing clinical edit data and clinical code editing rules for medical procedures of a medical claims processing applications program, the gui comprising;
a presentation component configured to present at least a portion of the medical procedures and associated clinical edit data; and
a clinical code editing rules presentation component configured to present the clinical code editing rules associated with the medical procedures. - View Dependent Claims (13, 14, 15, 16, 17, 18, 19, 20, 21)
- ) for managing clinical edit data and clinical code editing rules for medical procedures of a medical claims processing applications program, the gui comprising;
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22. A method of processing health insurance claims comprising:
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disclosing code editing logic rules to a health care provider, and reimbursing claims submitted by the health care provider in accordance with the disclosed code editing logic rules. - View Dependent Claims (23)
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24. A method of processing health insurance claims comprising:
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deriving code editing logic rules in part from publicly available code sources, and reimbursing claims submitted by a health care provider in accordance with the code editing logic rules so derived. - View Dependent Claims (25)
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Specification