Methods and systems for at-home and community-based care

• US 20050038675A1
• Filed: 06/25/2004
• Published: 02/17/2005
• Est. Priority Date: 08/12/2003
• Status: Abandoned Application

• Current Assignee: First Data Government Solutions Incorporated (Fiserv Incorporated)
• Original Assignee: First Data Government Solutions Incorporated (Fiserv Incorporated)
• Inventors: Reese, Shawn P., Siekman, Jeffrey A.
• Application Number:
  US10/877,621
• Publication Number:
  US 20050038675A1
• 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 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

Method and systems for managing services provided by providers to recipients utilizing an interactive system are described. In one embodiment, the method includes receiving, at the interactive system, a check in request from a provider and operating the system to verify an eligibility of the recipient for services. The method also includes providing to the provider, from the interactive system, a summary of services to be provided to the recipient and receiving a check out request from the provider at the interactive system.

Claims

1. A method of managing services provided by providers to recipients, the method involving the use of an interactive system, said method comprising:

receiving, at the interactive system, a check in request from a provider;

operating the interactive system to verify an eligibility of the recipient for services;

providing to the provider, from the interactive system, a summary of services to be provided to the recipient; and

receiving, at the interactive system, a check out request from the provider.

2. A method according to claim 1 further comprising processing the check in request utilizing at least one of automatic number identification, a global positioning satellite system or other location based service to verify the provider is at the location of the recipient.

3. A method according to claim 1 further comprising utilizing the interactive system to track a length of time between check in and check out.

4. A method according to claim 1 further comprising:

generating at least one of bills and insurance claims for the provided services; and

electronically submitting the bills and insurance claims to at least one third party payer with the interactive system.

5. A method according to claim 4 wherein electronically submitting the bills and insurance claims comprises:

entering one or more of a provider identifier, a personal identification number, and a client identifier;

identifying the services being provided to the client;

determining the number of units for each service remaining for the client; and

generating a provider payment list.

6. A method according to claim 4 wherein electronically submitting the bills and insurance claims comprises bulk filing bills and insurance claims.

7. A method according to claim 6 further comprising:

entering a date of service;

identifying the provider service provided to each client;

determining a number of units for each of the services provided;

determining if the provider has authorized clients; and

entering the client identifiers and the number of units of a service for the clients that received services.

8. A method according to claim 7 further comprising operating the interactive system to provide a confirmation of the submitted bulk filed services.

9. A method according to claim 1 wherein receiving the check in request comprises receiving a telephone call at the interactive system from a telephone number of the recipient.

10. A method according to claim 1 further comprising providing one or more of reporting and analysis, agency access to provider activity, client activity, and exception reporting statistics with the interactive system.

11. A method according to claim 1 further comprising managing service providers, care givers, schedules, claims, and retrieving of data relating to the provided services utilizing data and analysis tools and interfaces with the interactive system.

12. A method according to claim 1 wherein the interactive system includes one or more of an interactive voice response system, personal digital assistants, global positioning satellite systems, tablet computers, laptop computers, and bar coded devices.

13. A method according to claim 1 wherein the interactive system provides support for one or more of database lookups, automatic number identification, a dialed number identification service, a global positioning satellite system, voice recognition, text-to-speech, terminal devices for the deaf, fax back, fax-on-demand, and voice messaging.

14. A method according to claim 1 further comprising providing reports relating to one or more of client activity, case management, exception reporting, service on non-authorized day, missed visit, service for terminated client, incorrect time of day, no check in or check out, hours greater than hours authorized, hours less than hours authorized, weekly hours less than hours authorized, phone number does not match, check out number does not match, check in number does not match, incorrect service provided, no authorization for provider, and worker ID unknown with the interactive system.

15. A method according to claim 1 further comprising importing and exporting data from and to a state agency with the interactive system.

16. A method according to claim 1 wherein the provided services include one or more of personal care services, environmental equipment, pest control, home modifications, child care, child protective services, consumer directed care, adult protective services, adult day care, home preparation/delivery of meals, personal emergency response system (PERS) installation, respite care, attendant care, transportation, nutritional supplements, appliances, personal assistant services, food and clothing, personal hygiene, health care, and rehabilitation services.

17. A method according to claim 1 wherein processing the check in request comprises at least one of identifying the provider, identifying a location of the provider and identifying the recipient.

18. A method according to claim 1 wherein identifying the provider comprises receiving a worker identification number and identifying the recipient comprises receiving a client identification number.

19. A method according to claim 1 further comprising:

receiving from the provider, at the interactive system, additional services to be provided to the recipient; and

providing to the provider an eligibility of the recipient for the additional services.

20. A method according to claim 1 further comprising:

verifying whether a check-in record exits within the interactive system;

generating a check-out summary if the check-in record exists; and

entering at least one of a worker identifier and a provider selection, identifying a client by one of automatic number identification and entered client identifier, identifying the services provided, and generating a check-out summary if the check-in record did not exist.

21. A method according to claim 4 wherein generating at least one of bills and insurance claims for the provided services further comprises generating Medicaid claims in a HIPAA compliant electronic data interchange transaction.

22. A method according to claim 1 wherein for consumer directed care, said method comprising preparing the summary of services to be provided to the recipient from a plan of care for the recipient.

23. A computer-based system for managing transactions associated with remote site care services, comprising:

an interactive system;

a web server; and

a database server comprising a database, said system configured for access by providers through at least one of said web server and said interactive system, said computer-based system configured to receive check in requests from providers, verify an eligibility of recipients for services, provide a summary of services to be provided to the recipients, and receive check out requests from the providers.

24. A system according to claim 23 wherein said interactive system comprises one or more of automatic number identification, a global positioning satellite system, location based services, an interactive voice response system, personal digital assistants, tablet computers, laptop computers, and bar coded devices.

25. A system according to claim 23 wherein to verify provider check in, said system receives one or more of a provider identification, a client identification, and a service identification from a telephone of a service recipient.

26. A system according to claim 23 wherein to verify an eligibility of a recipient, said interactive system accesses said database to retrieve eligibility data for the recipient.

27. A system according to claim 23, said system configured to export data relating to provided services to a state agency system.

28. A system according to claim 23 configured with an administrative function accessible by a user, said administrative function allowing a user to edit, delete, and view claims, add claims, edit and delete missed service provider visits, and perform client claim validation.

29. A system according to claim 23 wherein to facilitate the providing of like services to multiple recipients, said system is configured to allow a provider to enter a number of such services provided during a single check in.

30. A system according to claim 29 wherein said system is configured to:

receive at least one of a provider identifier, a provider personal identification number, a worker identifier, and a plurality of client identifiers;

allow a provider to select a number of services to be provided for each client;

prompt a provider to enter a number of units for each service provided to each client; and

generate a confirmation file that includes service and unit information for each serviced client.

31. A system according to claim 23 configured with a time card function, said time card function allowing a user to track the service types provided to clients over specified periods.

32. A system according to claim 23 wherein said system is configured to administer one or more plans of care for one or more participants in a consumer directed care program.

33. A method for using an interactive voice response (IVR) system to manage services provided by a provider to one or more recipients at a recipient location, said method comprising:

accessing the IVR system to check in the provider;

retrieving the services to be provided to each recipient using the IVR system;

verifying an eligibility of each recipient to receive the retrieved services using the IVR system; and

accessing the IVR system to check out the provider once the eligible services have been rendered by the provider.

34. A method according to claim 33 further comprising:

selecting additional services to be provided to the recipient using the IVR system; and

verifying an eligibility of the recipient to receive the additional services using the IVR system.

35. A method according to claim 33 further comprising providing a check in summary to the provider using the IVR system.

36. A method according to claim 33 wherein verifying an eligibility of the recipient comprises identifying the recipient utilizing automatic number identification of the telephone accessing the IVR system.

37. A method according to claim 33 verifying an eligibility of the recipient comprises retrieving a plan of care for a consumer directed care recipient.

38. A method according to claim 33 wherein accessing the IVR system to check in the provider comprises one or more of:

entering a worker identification number;

selecting a service provider; and

entering a client identification number.

39. A method according to claim 33 wherein accessing the IVR system to check out the provider care giver comprises:

verifying a check in record exists using the IVR system; and

providing a check out summary to the provider, based on the check in summary, using the IVR system.

40. A method according to claim 33 wherein accessing the IVR system to check out the provider comprises:

determining a check in record does not exist using the IVR system;

entering a worker identification number;

selecting a service provider;

identifying the recipient; and

providing a check out without check in summary to the care giver.

41. A method according to claim 33 wherein identifying the recipient comprises one or more of attempting to identify the recipient using automatic number identification and entering a client identification number.

42. A method according to claim 33 further comprising providing payments to the provider.

43. A method according to claim 42 wherein providing payments to the provider comprises:

entering a provider identification number and a valid PIN;

determining if payments are to be made; and

providing a payment list.

44. A method according to claim 33 further comprising causing the IVR system to generate a file summarizing all services and units of services provided to clients.

45. An interactive voice response (IVR) system to manage services provided by a provider to one or more recipients at a recipient location, said IVR system configured to:

receive a telephone call from a recipient location to check in the provider;

provide the provider with services to be provided to the recipient;

verify an eligibility of the recipient to receive the services; and

receive a telephone call from a recipient location to check out the provider.

46. An interactive voice response system according to claim 45 further configured to:

receive a selection of additional services to be provided to the recipient from the provider; and

verifying an eligibility of the recipient to receive the additional services.

47. An interactive voice response system according to claim 45 wherein the services provided are one of Medicare and Medicaid services.

48. An interactive voice response system according to claim 45 wherein said system is configured to verify an availability of funds for services provided within a consumer directed care plan of care.