System and method for processing transaction records suitable for healthcare and other industries

• US 20050010452A1
• Filed: 06/22/2004
• Published: 01/13/2005
• Est. Priority Date: 06/27/2003
• Status: Abandoned Application

• Current Assignee: Siemens Medical Solutions Health Services Corporation (Siemens AG)
• Original Assignee: Siemens Medical Solutions Health Services Corporation (Siemens AG)
• Inventors: Lusen, William D.
• Application Number:
  US10/873,433
• Publication Number:
  US 20050010452A1
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management

Abstract

The system of the invention includes an interface processor for receiving transaction data in a first data format identifying transactions concerning financial reimbursement claim information communicated between two entities. The system also includes a transformation processor for converting the received transaction identification data from the first data format to a different second more generic, easily processed and readable second data format thereby allowing for customization and extensibility for different users. The system further includes an indexing processor that uses predetermined information concerning the second data format to identify and extract index information from the re-formatted transaction identification data. The index information is used to locate and retrieve the archived transaction data from a data repository included as part of the system upon user request. The system also includes a storage processor for storing records representing the re-formatted transaction identification data and the associated index information in the data repository. A display processor is also included for initiating display of the re-formatted transaction identification information in the second data format in response to a user command.

Claims

1. A system for processing transaction records concerning financial reimbursement claim information communicated between two entities, comprising:

an interface processor for receiving information in a first data format identifying transactions concerning financial reimbursement claim information communicated between two entities;

a transformation processor for converting said received transaction identification information having said first data format to a different second data format;

an indexing processor using predetermined information concerning said different second data format to identify and extract index information from said re-formatted received transaction identification information; and

a display processor for initiating display of said re-formatted received transaction identification information in response to user command.

2. A system according to claim 1, including

a storage processor for storing a record representing said re-formatted received transaction identification information and associated extracted index information in at least one repository.

3. A system according to claim 1, wherein

an entity comprises at least one of (a) a hospital, (b) a physician group, (c) a clinic, (d) a healthcare reimbursement claim payer institution, (e) a healthcare provider institution, and (f) a hospital department.

4. A system according to claim 1, including

a storage processor for storing said re-formatted received transaction identification information and associated extracted index information in at least one repository.

5. A system according to claim 1, including

a storage processor for storing said re-formatted received transaction identification information in a file associated with said extracted index information.

6. A system according to claim 1, wherein

said different second data format is at least one of, (a) an Extensible Markup Language (XML) compatible format, (b) an (Standard Generalized Markup Language) SGML compatible format and (c) (American National Standards Institute Electronic Data Interchange) ANSI 272 compatible format and

said predetermined information concerning said different second data format used to identify and extract index information from said re-formatted received transaction identification information includes XML compatible tag identifiers.

7. A system according to claim 1, wherein

said first data format is at least one of, (a) an (American National Standards Institute) ANSI 837 compatible format, (b) (American National Standards Institute Electronic Data Interchange) ANSI 835 compatible format (c) (American National Standards Institute Electronic Data Interchange) ANSI 272 compatible format (d) an (American National Standards Institute Electronic Data Interchange) ANSI 272 compatible format SGML compatible format.

8. A system according to claim 1, wherein

said information in said first data format identifying transactions concerning financial reimbursement claim information comprises information identifying a data exchange between said two entities.

9. A system according to claim 1, wherein

said information in said first data format identifying transactions concerning financial reimbursement claim information comprises information identifying a data exchange between said two entities.

10. A system according to claim 1, wherein

said interface processor parses said received information in said first data format to identify records representing individual transactions;

said transformation processor converts said records representing individual received transaction information into said different second data format, and

said indexing processor uses said predetermined information concerning said different second data format to identify and extract index information from said re-formatted individual received transaction information.

11. A system according to claim 1, wherein

said display processor initiates processing said re-formatted received transaction identification information to be suitable for at least one of, (a) Fascimile transmission, (b) printing (c) export to a recipient system, in response to user command and (d) display.

12. A system according to claim 1, including

a storage processor for compressing and storing said re-formatted received transaction identification information in at least one repository, by eliminating redundant information from said re-formatted received transaction identification information.

13. A system according to claim 1, wherein

said extracted index information comprises at least one of, (a) a patient identifier, (b) a Medical Record identifier, (c) an account identifier, (d) a patient hospital registration related identifier, (e) a Healthcare payer organization identifier, (f) a healthcare provider organization identifier, (g) a visit identifier, (h) an encounter identifier and (i) a case identifier

14. A system according to claim 1, wherein

said extracted index information is identified based on XML compatible tag delimited data fields.

15. A system according to claim 1, wherein

said indexing processor adaptively applies different extraction methods based on a document type of said re-formatted received transaction identification information.

16. A system according to claim 1, including

a bursting processor for separating said re-formatted received transaction identification information into separate documents for storage in a file associated with corresponding different patients.

17. A system according to claim 1, wherein

said extracted index information is used for associating said received transaction identification information with an existing record.

18. A system according to claim 1, wherein

said re-formatted received transaction identification information identifies transactions associated with at least one of, (a) a particular patient and (b) a particular user accessing records.

19. A method for processing transaction records concerning financial reimbursement claim information communicated between two entities, comprising the activities:

receiving information in a first data format identifying transactions concerning financial reimbursement claim information communicated between two entities;

converting said received transaction identification information having said first data format to a different second data format;

indexing said re-formatted received transaction identification information of said different second data format to identify and extract index information, said extracted index information being used for associating said received transaction identification information with an existing record; and

initiating display of said re-formatted received transaction identification information in response to user command.

20. A system for processing transaction records concerning financial reimbursement claim information communicated between two entities, comprising:

an interface processor for receiving information in an ANSI 837 compatible data format identifying transactions concerning financial reimbursement claim information communicated between two entities;

an indexing processor using predetermined information concerning said ANSI 837 compatible data format to identify and extract index information from said re-formatted received transaction identification information, said extracted index information is used for associating said received transaction identification information with an existing record; and

a display processor for initiating display of said received transaction identification information in response to user command.

21. A system for processing transaction records concerning financial reimbursement claim information communicated between two entities, comprising:

an interface processor for receiving information in a first data format identifying transactions concerning financial reimbursement claim information communicated between two entities;

an indexing processor for converting said received transaction identification information having said first data format to a different second data format; and

a display processor for initiating execution of a display format procedure for processing said re-formatted received transaction identification information to provide a desired display format, in response to user command.

22. A system according to claim 21, wherein

said first data format is at least one of, (a) an (American National Standards Institute) ANSI 837 compatible format, (b) (American National Standards Institute Electronic Data Interchange) ANSI 835 compatible format (c) (American National Standards Institute Electronic Data Interchange) ANSI 272 compatible format (d) a (Standard Generalized Markup Language) SGML compatible format.

23. A system according to claim 21, wherein

said desired display format consistently displays said re-formatted transaction identification information in a predetermined display data format.

24. A system according to claim 23, wherein

said desired display format groups transaction identification information into categories including at least one of, (a) (batch) transaction identification header information, (b) provider information, (c) subscriber information and (d) financial claim information.