Method and system for acquiring claims in a health services environment

• US 20070255591A1
• Filed: 06/09/2006
• Published: 11/01/2007
• Est. Priority Date: 04/28/2006
• Status: Active Grant

• Current Assignee: MDI Technologies, Inc. (ResMed Incorporated)
• Original Assignee: Medical Developments International Ltd., Inc.
• Inventors: Green, Jason Reinis, Wood, Raymond Michael, Snyder, Robert John
• Granted Patent: US 8,121,865 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/109 Time management, e.g. calendars, reminders, meetings or time accounting
• CPC Class Codes: G06Q 40/08 Insurance
• 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

Methods and systems for acquiring claims in health services environments are presented. An exemplary method for processing service provider claims for payment includes: scheduling appointments with the service providers, receiving claims from the service providers, analyzing the scheduled appointments to identify at least one scheduled appointment corresponding to each of the received claims, automatically detecting scheduled appointments not identified as corresponding to any of the received claims within a predetermined period of time, and notifying respective service providers that no claims have been received for the detected scheduled appointments. Optionally, the method includes analyzing appointment information associated with a scheduled appointment to determine an anticipated number of received claims corresponding to the scheduled appointment, and automatically flagging the scheduled appointment for resolution when the scheduled appointment is identified as corresponding to fewer than the anticipated number of received claims within a predetermined period of time.

Claims

1. A method for processing service provider claims for payment, comprising:

scheduling appointments with the service providers;

receiving claims from the service providers;

analyzing the scheduled appointments to identify at least one scheduled appointment corresponding to each of the received claims;

automatically detecting scheduled appointments not identified as corresponding to any of the received claims within a predetermined period of time; and

notifying respective service providers that no claims have been received for the detected scheduled appointments.

2. The method of claim 1, further comprising queuing the detected scheduled appointments for resolution by at least one trouble shooter.

3. The method of claim 2, further comprising removing a detected scheduled appointment from the queue when the detected scheduled appointment is identified as corresponding to a received claim.

4. The method of claim 1, further comprising:

analyzing appointment information associated with a scheduled appointment to determine an anticipated number of received claims corresponding to the scheduled appointment; and

automatically flagging the scheduled appointment for resolution when the scheduled appointment is identified as corresponding to fewer than the anticipated number of received claims within a predetermined period of time.

5. A recording medium on which the method for processing service provider claims for payment as claimed in claim 1 is recorded as a program code that can be executed by a computer.

6. A system for processing service provider claims for payment, comprising:

a scheduling module configured to schedule appointments with the service providers;

a claim intake module configured to receive claims from the service providers;

an adjudication module configured to identify at least one scheduled appointment corresponding to each of the received claims; and

a claims acquisition module configured to automatically detect scheduled appointments not identified by the adjudication module as corresponding to any of the received claims within a predetermined period of time and notify respective service providers that no claims have been received for the detected scheduled appointments.

7. The system of claim 6, wherein the claims acquisition module is configured to queue the detected scheduled appointments for resolution by at least one trouble shooter.

8. The system of claim 7, wherein the claims acquisition module is configured to remove a detected scheduled appointment from the queue when the detected scheduled appointment is identified as corresponding to a received claim.

9. The system of claim 6, wherein the claims acquisition module is further configured to analyze appointment information associated with a scheduled appointment to determine an anticipated number of received claims corresponding to the scheduled appointment, and automatically flag the scheduled appointment for resolution when the adjudication module identifies the scheduled appointment as corresponding to fewer than the anticipated number of received claims within a predetermined period of time.

10. A system for processing service provider claims for payment, comprising:

means for scheduling appointments with the service providers;

means for receiving claims from the service providers;

means for analyzing the scheduled appointments to identify at least one scheduled appointment corresponding to each of the received claims; and

means for automatically detecting scheduled appointments not identified by the analyzing means as corresponding to any of the received claims within a predetermined period of time and notifying respective service providers that no claims have been received for the detected scheduled appointments.