Method of automated processing of medical data for insurance and disability determinations

• US 20070038478A1
• Filed: 10/23/2002
• Published: 02/15/2007
• Est. Priority Date: 10/24/2001
• Status: Active Grant

• Current Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Original Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Inventors: Kay, Lay
• Granted Patent: US 7,630,911 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06N 5/025 Extracting rules from data
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

The present invention relates to methods and systems for automated processing of medical data for insurance and disability determinations. Based on medical conditions claimed by the claimant, medical evidence queries are automatically generated to provide instructions to medical providers for conducting physical exams and laboratory tests and for retrieving medical records. After medical evidence is collected according to the queries, the medical evidence and related rating codes are displayed to rating personnel in a user-friendly format to assist in making a rating decision.

Claims

1. A computer-implemented method of assisting medical evidence collection for adjudication of a medical disability request, the method comprising:

receiving from a claimant at least one claim of a medical condition;

generating a plurality of medical evidence queries based on the at least one claim and based on a disability rules collection; and

displaying the generated medical evidence queries in at least one data collection protocol.

2. The method of claim 1, further comprising receiving medical evidence data collected according to the generated medical evidence queries.

3. The method of claim 2, wherein receiving medical evidence data comprises receiving medical evidence data collected by conducting a physical examination of the claimant.

4. The method of claim 2, wherein receiving medical evidence data comprises receiving medical evidence data collected by conducting a laboratory test of the claimant.

5. The method of claim 2, wherein receiving medical evidence data comprises receiving medical evidence data collected from medical records of the claimant.

6. The method of claim 2, wherein receiving medical evidence data comprises receiving medical history data of the claimant.

7. The method of claim 2, further comprising generating a report based on the collected medical evidence data.

8. The method of claim 7, further comprising:

generating a recommended rating decision based on the collected medical evidence data; and

displaying the recommended rating decision in the generated report.

9. The method of claim 7, further comprising:

generating a recommended disability percentage based on the collected medical evidence data; and

displaying the recommended disability percentage in the generated report.

10. The method of claim 1, further comprising associating each of the generated medical evidence queries with a rating code of the disability rules collection.

11. The method of claim 1, wherein displaying the generated medical evidence queries comprises displaying at least a portion of the generated queries in a medical provider'"'"'s exam protocol.

12. The method of claim 11, wherein displaying at least a portion of the generated queries in a medical provider'"'"'s exam protocol comprises arranging the displayed queries according to modules.

13. The method of claim 11, wherein displaying at least a portion of the generated queries in a medical provider'"'"'s exam protocol comprises arranging the displayed queries according to classifications in the disability rules collection.

14. The method of claim 1, wherein displaying the generated medical evidence queries comprises displaying at least a portion of the generated queries in a clerk'"'"'s data collection protocol.

15. The method of claim 1, wherein displaying the generated medical evidence queries comprises displaying at least a portion of the generated queries in a claimant questionnaire.

16. The method of claim 1, further comprising eliminating duplicate generated medical evidence queries.

17. The method of claim 1, wherein the disability rules collection comprises a federal law.

18. The method of claim 1, wherein the disability rules collection comprises a court case law.

19. The method of claim 1, wherein the disability rules collection comprises an administrative decision.

20. The method of claim 1, further comprising:

separating the generated medical evidence queries into at least a first set of queries and a second set of queries;

displaying the first set of queries in a medical provider'"'"'s exam protocol; and

displaying the second set of queries in a clerk'"'"'s data collection protocol.

21. The method of claim 20, wherein the first set and the second set of queries include a duplicate query, the method further comprising:

receiving medical evidence data for the duplicate query collected based on the clerk'"'"'s data collection protocol; and

removing the duplicate query from the medical provider'"'"'s exam protocol.

22. A computer-implemented method of assisting adjudication of a medical disability request, the method comprising:

receiving from a claimant at least one claim of a medical condition;

generating a plurality of medical evidence queries based on the at least one claim and based on a disability rules collection;

receiving medical evidence collected according to the generated medical evidence queries; and

displaying in a rating report at least a portion of the collected medical evidence.

23. The method of claim 22, wherein each of the generated queries is associated with a rating code of the disability rules collection, and wherein displaying in a rating report further comprises displaying in the rating report rating codes associated with the displayed medical evidence.

24. A medical disability claims benefits system comprising:

a rules mapping component adapted to organize a medical disability rules collection into at least a first plurality of general medical evidence queries;

a knowledge library adapted to store at least the first plurality of general medical evidence queries;

a claimant-specific query creation component adapted to select from the first plurality of general queries a second plurality of claimant-specific medical evidence queries based on at least one claimed medical condition of a claimant; and

a protocol creation component adapted to create at least one data collection protocol based on the second plurality of queries.

25. The system of claim 24, wherein the rules mapping component is further adapted to associate each of the first plurality of queries with a rating code of the disability rules collection.

26. The system of claim 24, wherein the first plurality of general medical evidence queries includes a triggering query and one or more conditional queries associated with the triggering query.

27. The system of claim 24, wherein the claimant-specific query creation component is adapted to eliminate duplicate queries from the second plurality of claimant-specific medical evidence queries.

28. The system of claim 24, further comprising a report creation component adapted to receive medical evidence collected according to the at least one data collection protocol, and to display at least a portion of the received medical evidence.

29. The system of claim 24, further comprising a claimant database adapted to store medical evidence collected according to the at least one data collection protocol.