System for processing transaction data

• US 20050102170A1
• Filed: 09/08/2004
• Published: 05/12/2005
• Est. Priority Date: 09/09/2003
• Status: Abandoned Application

• Current Assignee: Siemens Medical Solutions Health Services Corporation (Siemens AG)
• Original Assignee: Siemens Medical Solutions Health Services Corporation (Siemens AG)
• Inventors: Smith, Douglas C., Duff, Robert C., Lefever, David L.
• Application Number:
  US10/936,295
• Publication Number:
  US 20050102170A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A system for processing data, representing a financial transaction, includes an input processor, a message generator, and a communication interface. The input processor parses data, representing a first financial transaction, and derives from the data, representing the first financial transaction, data items including a data element and an identifier identifying the first financial transaction. The message generator generates message data, representing a second financial transaction different from the first transaction, and incorporates the data items and an identifier identifying the data element. The communication interface initiates communication of the message data, representing the second financial transaction, to a remote system.

Claims

1. A system for processing data representing a financial transaction, comprising:

an input processor for parsing data, representing a first financial transaction, and for deriving, from said data, representing said first financial transaction, data items including a data element and an identifier, identifying said first financial transaction;

a message generator for generating message data, representing a second financial transaction, different from said first transaction, and incorporating said data items and an identifier identifying said data element; and

a communication interface for initiating communication of said message data, representing said second financial transaction, to a remote system.

2. A system according to claim 1, wherein

said first financial transaction comprises a remittance associated with a first claim for financial reimbursement for services provided by a healthcare provider organization to a particular patient, and

said second financial transaction comprises a second claim for an item of said first claim, including said data element.

3. A system according to claim 1, wherein

said data, representing said first financial transaction, comprises ANSI ASC X12 835 compliant transaction data.

4. A system according to claim 1, wherein

said data, representing said second financial transaction, comprises ANSI ASC X12 837 compliant transaction data.

5. A system according to claim 1, wherein

said message generator generates message data, representing said second financial transaction, using information derived from said data representing said first financial transaction to position said data element in said data, representing said second financial transaction.

6. A system according to claim 5, wherein

said message generator uses said information derived from said data, representing said first financial transaction, to map a position of said data element in said data, representing said first financial transaction, to a position in said data, representing said second financial transaction.

7. A system according to claim 1, including

said message generator generates said message data, representing said second financial transaction, using stored information including at least one of:

(a) a location identifier identifying location of said data element within said data, representing said first financial transaction, (b) a code identifying whether said data element is to be added to or deleted from said data, representing said second financial transaction, and (c) a code identifying whether said data element is to replace a corresponding data element in said data, representing said second financial transaction.

8. A system according to claim 1, wherein

said first financial transaction comprises at least one of:

(a) a claim for financial reimbursement for services provided by a service provider organization, (b) a bill for financial reimbursement for services provided by a service provider organization, (c) a remittance associated with a claim for financial reimbursement for services provided by a service provider organization, and (d) a remittance as payment for services provided by a service provider organization.

9. A system according to claim 1, wherein

said message generator generates said message data, representing said second financial transaction, using a record of predetermined format incorporating said data element in a first data field together with other data fields incorporating data items associated with said data element including,

(a) an identifier identifying said first financial transaction, and

(b) an identifier identifying said data element.

10. A system for processing data representing a financial transaction, comprising:

an input processor for receiving a data element derived from data, representing a financial transaction;

a data processor for generating a record of predetermined format incorporating said data element in a first data field together with other data fields incorporating data items associated with said data element including,

(a) an identifier identifying said financial transaction, and

(b) an identifier identifying said data element; and

a storage processor for initiating storage of said generated record in a repository in response to user command.

11. A system according to claim 10, wherein

said financial transaction comprises a remittance associated with a claim for financial reimbursement for services provided by a healthcare provider organization to a particular patient.

12. A system according to claim 10, wherein

said financial transaction comprises a remittance associated with a claim for financial reimbursement for services provided by a healthcare provider organization to a particular patient, and including

a claim processor for determining from said record whether a remittance has been received for a particular item of said claim, and for initiating generation of a second claim, incorporating said data element, for said particular item in response to a determination no remittance has been received for said particular item.

13. A system according to claim 10, wherein

said data representing a financial transaction comprises ANSI ASC X12 835 compliant transaction data.

14. A system according to claim 10, including

a message generator for using said data items in generating message data incorporating said data element.

15. A system according to claim 14, wherein

said message generator generates said message data incorporating said data element by using data in data fields in said generated record to position said data element in said generated message data.

16. A system according to claim 15, wherein

said generated message comprises ANSI ASC X12 837 compliant transaction data.

17. A system according to claim 10, wherein

said data, representing a financial transaction, comprises ANSI ASC X12 835 compliant transaction data and including

a message generator for generating a message comprising ANSI ASC X12 837 compliant transaction data incorporating said data element by using data in data fields in said generated record to map a position of said data element in said data, representing said ANSI ASC X12 835 compliant transaction data, to a position in said ANSI ASC X12 837 compliant generated message.

18. A system according to claim 10, wherein

said generated record includes at least one of:

(a) a location identifier identifying location of said data element within said data, representing a financial transaction, (b) a code identifying whether said data element is to be added to or deleted from a different second record, and (c) a code identifying whether said data element is to replace a corresponding data element in a different second record.

19. A system according to claim 10, wherein

said financial transaction comprises at least one of:

(a) a claim for financial reimbursement for services provided by a service provider organization, (b) a bill for financial reimbursement for services provided by a service provider organization, (c) a remittance associated with a claim for financial reimbursement for services provided by a service provider organization, and (d) a remittance as payment for services provided by a service provider organization.

20. A system according to claim 10, wherein

said input processor parses said data, representing said financial transaction, and derives said data element from said data, representing said financial transaction.

21. A system according to claim 10, wherein

said financial transaction comprises a remittance associated with a claim for financial reimbursement for services provided by a healthcare provider organization to a particular patient and including

a billing processor for determining from said record whether a remittance has been received for a particular item of said claim, and for initiating generation of a second claim for said particular item in response to a determination no remittance has been received.

22. A system for processing data representing a financial transaction, comprising:

a repository including at least one record incorporating a data element derived from data representing a first financial transaction, an identifier identifying said first financial transaction, and an identifier identifying said data element;

a message generator for generating message data, representing a second financial transaction, using a record derived from said repository to position said data element in said message data; and

a communication interface for initiating communication of said message data, representing said second financial transaction, to a remote system.

23. A method for processing data representing a financial transaction, comprising the activities of:

parsing data representing a first financial transaction;

deriving, from said parsed data, representing said first financial transaction, data items including, said data element, and an identifier identifying said first financial transaction;

generating message data, representing a second financial transaction, different from said first transaction;

incorporating said data items and an identifier identifying said data element in said generated message data, representing said second financial transaction; and

initiating communication of said message data, representing said second financial transaction, to a remote system.

24. A method for processing data representing a financial transaction, comprising the activities of:

receiving a data element derived from data representing a financial transaction;

generating a record of predetermined format incorporating said data element in a first data field together with other data fields incorporating data items associated with said data element including,

(a) an identifier identifying said financial transaction; and

(b) an identifier identifying said data element; and

initiating storage of said generated record in a repository in response to user command.

25. A method for processing data representing a financial transaction, comprising the activities of:

storing at least one record incorporating a data element derived from data representing a first financial transaction, an identifier identifying said first financial transaction and an identifier identifying said data element;

generating message data representing a second financial transaction using a record derived from said repository to position said data element in said message data; and

initiating communication of said data representing said second financial transaction to a remote system.