Method and system for scheduling tracking, adjudicating appointments and claims in a health services environment
First Claim
1. A system for determining the appropriateness of service provider claims for payment, comprising:
- a scheduling module configured to schedule appointments for patients with service providers based on requests for services, wherein the scheduling module is further configured to generate appointment information corresponding to each of the scheduled appointments;
a claim intake module configured to receive claims from the service providers for payment of charges associated with services rendered by the service providers to the patients, wherein the claim intake module is further configured to capture service information corresponding to each of the received claims; and
an adjudication module configured to automatically identify candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments, wherein the adjudication module is further configured to present the particular received claim for payment when at least one of the candidate appointments corresponds to the particular received claim and flag the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim.
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Accused Products
Abstract
An exemplary method for determining the appropriateness of service provider claims for payment includes scheduling appointments for patients with service providers based on requests for services, generating appointment information corresponding to each of the scheduled appointments, and capturing service information corresponding to claims received from the service providers for payment of charges associated with services rendered by the service providers to the patients. The method further includes automatically identifying candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments. Additionally, the method includes flagging the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim, and presenting the particular received claim for payment when at least one of the candidate appointments corresponds to the particular received claim.
97 Citations
63 Claims
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1. A system for determining the appropriateness of service provider claims for payment, comprising:
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a scheduling module configured to schedule appointments for patients with service providers based on requests for services, wherein the scheduling module is further configured to generate appointment information corresponding to each of the scheduled appointments;
a claim intake module configured to receive claims from the service providers for payment of charges associated with services rendered by the service providers to the patients, wherein the claim intake module is further configured to capture service information corresponding to each of the received claims; and
an adjudication module configured to automatically identify candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments, wherein the adjudication module is further configured to present the particular received claim for payment when at least one of the candidate appointments corresponds to the particular received claim and flag the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22)
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23. A method for determining the appropriateness of service provider claims for payment, comprising:
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scheduling appointments for patients with service providers based on requests for services;
generating appointment information corresponding to each of the scheduled appointments;
capturing service information corresponding to claims received from the service providers for payment of charges associated with services rendered by the service providers to the patients;
automatically identifying candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments;
flagging the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim; and
presenting the particular received claim for payment when at least one of the candidate appointments corresponds to the particular received claim. - View Dependent Claims (24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62)
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63. A system for determining the appropriateness of service provider claims for payment, comprising:
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means for scheduling appointments for patients with service providers based on requests for services;
means for generating appointment information corresponding to each of the scheduled appointments;
means for capturing service information corresponding to claims received from the service providers for payment of charges associated with services rendered by the service providers to the patients;
means for automatically identifying candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments;
means for flagging the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim; and
means for presenting the particular received claim for payment when at least one of the candidate appointments corresponds to the particular received claim.
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Specification