System and method for processing and managing claim forms
First Claim
1. A system for preparing and tracking an insurance claim for an insurance provider identified from a plurality of insurance providers for a pharmaceutical product for a patient from a plurality of patients, said system comprising:
- a database for storing patient information relating to said patient, claim information relating to said insurance claim, form information relating to said plurality of insurance providers, provider information relating to said plurality of insurance providers and product information relating to said pharmaceutical product;
a software system operating on a computer for entering and processing said patient information, claim information, provider information and product information, said software system adapted to receive said patient information from a user, to identify said claim information utilizing in part said patient information and to track a status of said insurance claim as it is processed by said insurance provider.
1 Assignment
0 Petitions
Accused Products
Abstract
The invention provides a system and method for processing and managing medical insurance claim forms. A computer software system is provided for implementing the system and method. A user of the computer software system may use it to retrieve data about patient, physicians, and insurance providers from data bases provided by the computer software system and enter retrieved data automatically into claim forms for submission to an insurance provider. Documentation for seeking pre-approval of a treatment, making insurance claims, or appeal rejection of claims by an insurance provider may be generated using the software system. Claim processing status, whether a claim is submitted and still pending, rejected, appealed, or approved, may be tracked and managed using the computer software system. The computer software system also provides access to both legal and medical reference information to justify or support an insurance claim.
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Citations
13 Claims
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1. A system for preparing and tracking an insurance claim for an insurance provider identified from a plurality of insurance providers for a pharmaceutical product for a patient from a plurality of patients, said system comprising:
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a database for storing patient information relating to said patient, claim information relating to said insurance claim, form information relating to said plurality of insurance providers, provider information relating to said plurality of insurance providers and product information relating to said pharmaceutical product;
a software system operating on a computer for entering and processing said patient information, claim information, provider information and product information, said software system adapted to receive said patient information from a user, to identify said claim information utilizing in part said patient information and to track a status of said insurance claim as it is processed by said insurance provider. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. A method of preparing and tracking an insurance claim for an insurance provider identified from a plurality of insurance providers for a pharmaceutical product for a patient from a plurality of patients, a status of said insurance claim being stored in a database accessible by a software system operating on a computer, said software system adapted to receive data relating to said insurance claim and to generate a claim package relating to said insurance claim, said method comprising the steps of:
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receiving said patient information from a user by said software system;
providing product information relating to said pharmaceutical product for inclusion in said claim package for selection by said user;
generating said claim package utilizing said received patient information and product information;
tracking a status of said insurance claim; and
updating said status upon a user being notified of approval or rejection of the insurance claim. - View Dependent Claims (12)
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13. A method of assessing a patient, and preparing and tracking an insurance claim for an insurance provider identified from a plurality of insurance providers for a pharmaceutical product identified by said assessment for treatment of said patient from a plurality of patients, a status of said insurance claim being stored in a database accessible by a software system operating on a computer, said software system adapted to receive data relating to said insurance claim and to generate a claim package relating to said patient assessment and said insurance claim, said method comprising the steps of:
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receiving patient assessment information from a user by said software system;
providing diagnosis information based on said patient assessment information;
providing treatment information based on said diagnosis; and
when said treatment information identifies a pharmaceutical product;
receiving said patient information from a user by said software system;
providing product information relating to said pharmaceutical product for inclusion in said claim package for selection by said user;
generating said claim package utilizing said received patient information and product information;
tracking a status of said insurance claim; and
updating said status upon a user being notified of approval or rejection of the insurance claim.
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Specification