Automatic authorizations

• US 20040153337A1
• Filed: 02/05/2003
• Published: 08/05/2004
• Est. Priority Date: 02/05/2003
• Status: Abandoned Application

• Current Assignee: The Whitestone Group, Inc.
• Original Assignee: The Whitestone Group, Inc.
• Inventors: Cruze, Guille B.
• Application Number:
  US10/358,516
• Publication Number:
  US 20040153337A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06F 21/32 using biometric data, e.g. fingerprints, iris scans or voiceprints
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires

Abstract

A user inputs information identifying a person and the user. A computer system analyzes the user'"'"'s voice to verify or determine the user'"'"'s identity, and allows only valid users to access the system. The input information is compared to benefits information stored in the system to make automatic determinations concerning the benefits, and those determinations are transmitted to the user. The user is prompted to provide information in a format specified by the user and receives information in a format specified by the user. Other users, such as benefit organizations, also receive information in a format that they specify. When automatic authorization (or communication) by a facilitator computer is not appropriate, information is transmitted to a benefit organization computer, and further computer analysis or manual analysis is performed, and determinations concerning benefits are transmitted to the user. In a preferred embodiment, the user inputs diagnosis codes and action codes, and either a facilitator computer or a benefits organization computer or a benefits organization operator makes the determination that is sent to the user.

Claims

1. An information transfer system for transferring information from and to a user about persons or entities and concerning benefits provided by at least one organization comprising:

user inputs enabling the user to input information including voice information into the information transfer system, the information corresponding to at least an identification of at least one s and an identification of at least one user,

at least one computer system for;

(a) receiving information including voice information from at least the user inputs,

(b) identifying the at least one user and producing user identification based on the information,

(c) identifying the at least one person or entity and producing person or entity identification based on the information,

(d) accessing benefits information corresponding to the person'"'"'s or entity'"'"'s benefits provided by the at least one organization, and

(e) comparing the person or entity identification to the benefits information and making automatic determinations for the person or entity concerning the benefits provided by the at least one organization for the person or entity, and

a computer system output for automatically transmitting the automatic determinations to the user concerning the benefits for the person or entity.

2. The information transfer system of claim 1, further comprising:

the computer system storing benefits information corresponding to person or entity'"'"'s benefits provided by a plurality of organizations and comparing the person or entity identifications to benefits information of a plurality of organizations and making automatic determinations on behalf of a plurality of organizations for particular persons or entities concerning the benefits available to the particular persons or entities from the plurality of organizations, and

the computer system output for automatically transmitting the automatic determinations made on behalf of the plurality of organizations by the computers system to the user.

3. An information transfer system for transferring information about a person or entity from and to a provider comprising:

provider inputs enabling providers to input at least voice information into the information transfer system, the voice information corresponding to at least the identification of a person or entity and the identification of a provider,

at least one voice enabled computer system for;

(a) receiving at least voice information from the provider inputs,

(b) identifying at least one provider and producing a provider identification based on the voice information,

(c) identifying at least one person or entity and producing a person or entity identification based on the voice information,

(d) storing coverage information corresponding to benefits provided by an organization associated with persons or entities, and

(e) comparing the person or entity information to the coverage information and determining benefits information corresponding to benefits for the at least one person or entity, and

a computer system output for transmitting benefits information to a provider indicating whether a person or entity is eligible for benefits.

4. The information transfer system of claim 3 further comprising:

the provider inputs for providing voice information corresponding to at least a diagnosis of the person and a proposed action to be performed on the person,

the voice enabled computer system comparing the person information to the coverage information and producing authorization information indicating whether the proposed action is authorized, and

the computer system output for transmitting the authorization information to at least some providers for at least some proposed actions.

5. The information transfer system of claim 3 further comprising:

the provider inputs for providing voice information corresponding to at least a diagnosis of the person and a proposed action to be performed on the person,

the voice enabled computer system comparing the person information to the coverage information and producing authorization information indicating whether the proposed action can be automatically authorized by the computer system because either no authorization is required for a particular action or because the person information justifies the proposed action based on authorization criteria; and

the computer system output for automatically transmitting the authorization information to at least some providers for at least some proposed actions if the proposed action is justified based on the authorization criteria.

6. The information transfer system of claim 3 further comprising:

the provider inputs for providing voice information corresponding to at least a diagnosis of the person and a proposed action to be performed on the person,

the voice enabled computer system comparing the person information to the coverage information and producing authorization information indicating that automatic authorization by the computer system is not appropriate based on authorization criteria; and

the computer system output for automatically transmitting the authorization information to the organization that provides the benefits if authorization by the computer system of the proposed action is not appropriate.

7. The information transfer system of claim 3 further comprising:

the voice enabled computer system prompting the provider for information in a format specified by the provider and generating output information for the organization in a format specified by the organization, and

the computer system output transmitting the output information to the organization that provides the benefits.

8. The information transfer system of claim 3 when it the voice enabled computer system further comprises:

a voice computer system for receiving voice messages from a provider and converting at least some of those voice messages to text,

a facilitator computer system storing user profiles that contain information about the providers and the persons for whom benefits are provided by the organization,

a communications link between the voice computer system and the facilitator computer system for transferring information between the two computer systems, and

the facilitator computer system for receiving information from the voice computer system corresponding to the voice messages including text, and for processing the text to identify at least the patient, and for producing person information on based on the identity of the patient and the information stored in the user profiles.

9. The information transfer system of claim 3 wherein the voice enabled computer system further comprises:

a voice computer system for receiving voice messages from a provider and converting at least some of those voice messages to text,

a facilitator computer system storing user profiles that contain information about the providers and the persons for whom benefits are provided by the organization,

a communications link between the voice computer system and the facilitator computer system for transferring information between the two computer systems, and

the facilitator computer system for receiving information from the voice computer system corresponding to the voice messages including text, and for processing the text to identify at least the patient, and for producing person information on based on the identity of the patient and the information stored in that the user profiles,

an organization computer system for storing information about persons including coverage information for each person, and

a communications link between the facilitator computer system and the organization computer system for transferring information between the two computer systems, the organization computer system receiving at least person information from the facilitator computer system and the facilitator computer system receiving at least coverage information from the organization computer system.

10. The information transfer system of claim 3 wherein the voice enabled computer system further comprises;

a voice storage module for storing voice signatures corresponding to the voices of providers,

a voice analysis module for comparing the voice of a provider to the voice signatures and for making a determination concerning the identity of the provider based on the voice comparison, and

an access control module for allowing further access by a provider to the voice enabled computer system to thereby receive additional information from the provider, the further access being based upon the determination concerning identity.

11. The information transfer system of claim 10 wherein the voice analysis module receives information in text form as to the identity of the provider and then verifies the identity of the provider by comparing the provider'"'"'s voice to a voice signature stored in the voice storage module.

12. The information transfer system of claim 10 wherein the voice analysis module identifies the provider by comparing the provider'"'"'s voice to the voice signatures stored in the voice storage module.

13. The information transfer system of claim 3 when the voice enabled computer system prompts the provider to spell out certain information by stating the name of each number or character in the certain information.

14. The information transfer system of claim 3 wherein the provider input includes an alpha-numeric input device and the voice enabled computer system prompts the provider to input certain information through the alpha-numeric input device.

15. The information transfer system of claim 3 wherein the voice enabled computer system identifies the number called by the provider (the called number) and responsive to the called number determines the computer program that it will execute on a particular call.

16. The information transfer system of claim 3 wherein the voice enabled computer system prompts the provider to spell out certain information by stating the name of each number or character in the certain information and the voice enabled computer interprets and converts the certain information from a voice format into a text format.

17. The information transfer system of claim 3 when the voice enabled computer system prompts the provider to speak certain information in a normal speaking voice speaking numbers as single whole numbers and the voice enabled computer interprets and converts the certain information from a voice format into a text format.

18. The information transfer system of claim 3 further comprising:

the provider inputs providing voice information corresponding to at least a diagnosis of the person and a proposed action to be performed on the person,

the voice enabled computer system comparing the person information to the coverage information and producing authorization information indicating that automatic authorization by the computer system is not appropriate based on authorization criteria,

the computer system output automatically transmitting the authorization information to the health care organization computer system if automatic authorization of the proposed action is it not appropriate, and

the health care organization computer system transmitting a manual authorization decision to the health-care provider based on user inputs to the health care organization computer system.

19. An information transfer system for transferring information about a patient from and to a health care provider concerning health-care benefits provided by a health care organization comprising:

provider inputs enabling providers to transmit input information including at least voice information including a voice sample into the information transfer system, the input information corresponding to at least the identification of a person and the identification of a provider,

at least one voice enabled computer system for;

(a) receiving at least input information from the provider inputs,

(b) storing voice signatures with at least one voice signature being stored for each health care provider using the system, comparing the health care provider'"'"'s voice sample with the stored voice signatures and allowing or disallowing further access to the information transfer system based on the comparison,

(c) identifying persons and producing person identifications based on the input information,

(d) storing coverage information corresponding to the health care benefits provided by a health care organization organization, and

(e) comparing the person information to the coverage information and determining health care benefit information for a particular person, and

a computer system output for transmitting health care benefit information to a provider.

20. The information transfer system of claim 19 wherein the voice enabled computer system receives voice information in alphanumeric form and converts at least part of the voice information to text form, identifies the provider based on the voice information in text form, and verifies the identity of the provider by comparing the provider'"'"'s voice sample to a voice signature stored in the voice enabled computer system.

21. The information transfer system of claim 19 wherein the voice enabled computer system identifies the provider by comparing the provider'"'"'s voice sample to the voice signatures stored in the voice enabled computer system, identifying the voice signature that corresponds to the provider'"'"'s voice sample, and determines the identity of the provider based upon the identified voice signature.

22. The information transfer system of claim 19 wherein the voice enabled computer system is operable to perform a second test when further access to the information transfer system is disallowed based on the comparison of the voice sample to the voice signatures, the voice enabled computer system being operable to allow further access to the information transfer system based on the second test that requires the provider to input private information known to the provider but generally unknown to the public.

23. The system of claim 22 wherein the second the test further comprises a comparison of the provider'"'"'s voice sample to the voice signature stored for a particular provider and allows access to the information transfer system if the provider'"'"'s voice sample correlates to the stored voice signature based on a relaxed standard of correlation and the provider inputs the correct private information.

24. An information transfer system for transferring information about a patient from a health care provider concerning health-care benefits provided by a health care organization comprising:

provider inputs enabling providers to input information including a voice file containing information about patient into the information transfer system, the information corresponding to at least the identification of a patient and the identification of a provider,

at least one voice enabled computer system for;

(a) receiving at least voice information including a voice file from the provider inputs,

(b) identifying providers and producing provider identifications in a digital non-voice format,

(c) identifying persons and producing person identifications in a digital non-voice format,

(d) identifying a health care organization corresponding to each person identification,

(e) producing output information that includes digital non-voice information corresponding at least to patient identification and provider information and that includes at least a portion of the voice file,

a computer system output for transmitting the output information, and

a health care organization computer system for receiving, storing and displaying at least portions of the output information from the voice enabled computer system, the health care organization computer system storing at least a portion of the voice file.

25. The information transfer system of claim of 24 wherein the voice enabled computer system is further operable to receive a voice file containing alphanumeric characters and convert the alphanumeric characters to text form and identify the patient and the provider based on the alphanumeric characters in the voice file.

26. The information transfer system of claim 24 wherein:

the voice enabled computer system is operable for;

(a) identifying a provider and producing provider identification based on the voice information,

(b) identifying persons and producing person identifications based on the voice information,

(c) storing coverage information corresponding to the eligibility of persons for benefits provided by an organization, and

(d) comparing the person information to the coverage information and determining eligibility information indicating whether a particular person is eligible for benefits, and

the computer system output for transmitting eligibility information to a provider indicating whether a person is eligible for benefits.

27. The information transfer system of claim 24 further comprising:

the provider inputs for providing voice information corresponding to at least a diagnosis of the person and a proposed action to be performed on the person,

the voice enabled computer system comparing the person information to the coverage information and producing authorization information indicating whether the proposed action can be automatically authorized by the computer system because either no authorization is required for a particular action or because the person information justifies the proposed action based on authorization criteria.

the computer system output automatically transmitting the authorization information to at least some providers for at least some proposed actions if the proposed action is justified based on the authorization criteria.

28. The information transfer system of claim 24 wherein the voice enabled computer system further comprises:

a voice storage module for storing voice signatures corresponding to the voices of providers,

a voice analysis module for comparing the voice of a provider to the voice signatures and for making a determination concerning the identity of the provider based on the voice comparison, and

an access control module for allowing further access by a provider to the voice enabled computer system to thereby receive additional information from the provider, the further access being based upon the determination that was based on the voice comparison.

29. A method of certifying whether or not a health care organization covers an action that a medical service provider desires to perform on a patient, the method comprising:

receiving a call from a medical service provider at a call processing center;

prompting the medical service provider to provide identification information that identifies the medical service provider;

prompting the medical service provider to provide identification information that identifies the patient;

prompting the medical service provider to provide identification information that identifies an action that the medical service provider desires to perform for the patient;

receiving and storing the information received from the medical service provider in memory;

examining the information received from the medical service provider in conjunction with stored information associated with the patient and an associated health care organization to determine if the medical service provider is automatically certified to perform the action for the patient and automatically informing the medical service provider that the action is certified if appropriate;

forwarding the information provided by the medical services provider to the health care organization associated with the patient if the action is not automatically certifiable;

receiving certification information from the health care organization in response to the forwarded information; and

transmitting the certification information to the medical services provider.

30. An automated system for transmitting medical information between a medical services provider and health care organization, the system comprising:

an identification memory for storing identification information that identifies a user of the automated system as an authorized user of the automated system;

a caller identifier for identifying callers based upon the identification information stored in the identification memory;

a profile memory for storing multiple profiles wherein at least a portion of the profiles are associated with selected users of the automated system;

a voice response unit for answering an incoming call to the automated system, prompting a caller to enter identification information associated with the caller and prompting the caller to enter information in accordance with a format specified by the identification information;

a voice recognition unit for receiving voice signals and converting the voice signals into digital information;

a message storage memory for storing information received from callers;

an automated response unit for examining information provided by a caller, determining if an automated response can be provided to the caller, and providing an automated response to the caller if appropriate;

a reformatting unit for altering a format of received data that is to be sent to a third party in accordance with a profile associated the third party;

a message forwarding unit for forwarding information received from a caller to a selected third party; and

a reply unit for receiving a reply from a third party in response to a forwarded message and forwarding the reply to a designated party in a format selected by the designated party.

31. A method of transferring information between two parties, the method comprising:

identifying a sending party that wants to send a message to a receiving party;

prompting the sending party to enter information in a format associated with the sending party;

saving the information provided by the sending party;

examining the information to determine if an automated response can be provided to the sending party and providing an automated response if appropriate;

reformatting the information in accordance with a format specified by a profile associated with the receiving party and forwarding the reformatted information to the receiving party specified by the sending party if an automated response is inappropriate;

receiving a response to the reformatted information from the receiving party; and

forwarding the response from the receiving party to the sending party in a format specified by the sending party.

32. An information transfer system for transferring information about a patient from a health care provider concerning health-care benefits provided by a health care organization comprising:

provider inputs enabling providers to input information including a voice file containing information about patient into the information transfer system, the information corresponding to at least the identification of a patient and the identification of a provider,

at least one voice enabled computer system including one or more computers for;

(a) receiving information from the provider including at least voice information including a voice file from the provider inputs,

(b) identifying providers and producing provider identifications in a digital non-voice format,

(c) identifying patient and producing patient identifications in a digital non-voice format,

(d) identifying a health care organization corresponding to each patient identification and producing health care organization identifications,

(e) storing voice signatures with one of the the voice signatures corresponding to each provider,

(f) identifying a particular voice signature corresponding to the provider of identification,

(g) comparing the particular voice signature to the voice file of the provider and determining whether there is a correlation between the particular voice signature and the voice file based on correlation criteria,

(h) allowing further access to the information transfer system when there is sufficient correlation between the particular voice signature and the voice file to satisfy the correlation criteria,

(i) disallowing further access to the information transfer system when there is insufficient correlation between the particular voice signature and of the voice file to satisfy the correlation criteria,

(j) storing a plurality of actions including an eligibility action and a pre-certification action,

(k) prompting the provider by voice to choose between one of a plurality of actions, receiving a choice from the provider corresponding to a chosen action and performing the chosen action,

(l) when the eligibility action is chosen, determining whether a patient is eligible for health care benefits based upon the patient identification and the health care organization identification and producing an automatic eligibility determination,

(m) when the pre-certification action is chosen, prompting the provider by voice to provide at least a diagnosis and at least an action code, determining whether a particular action may be automatically authorized for a patient based on the diagnosis code and the action code, and producing and automatic authorization determination, and

(n) based on the automatic authorization determination, generating an automatic authorization message for the provider or an authorization request for the health care organization,

a voice enabled computer system output for transmitting to the provider automatic eligibility determinations and automatic authorization messages and for transmitting to the health care organization patient identifications, provider identifications, diagnosis codes, action codes, at least a portion of the voice file, and authorization requests,

a health care organization computer system including a database for receiving information from the voice enabled computer system and for storing in the database alphanumeric characters based on at least one of the patient identification, the provider identification, the diagnosis code, and the action code, and for storing in the database at least a portion of the voice file,

a user input for providing manual inputs into the health care organization computer system,

a health care organization display for displaying at least some of the alphanumeric characters stored in the database,

a health care organization sound output for audibly playing at least a portion of the sound file; and

health care organization computer output for transmitting to the provider information concerning patients including at least some manual authorizations of actions based on the diagnosis codes, the action codes and the manual inputs.