REFERRAL COORDINATION SYSTEMS AND METHODS

• US 20080010087A1
• Filed: 01/30/2007
• Published: 01/10/2008
• Est. Priority Date: 01/30/2006
• Status: Abandoned Application

• Current Assignee: Marcus Lott, Ronnie Daniel
• Original Assignee: Marcus Lott, Ronnie Daniel
• Inventors: LOTT, MARCUS, DANIEL, RONNIE
• Application Number:
  US11/668,867
• Publication Number:
  US 20080010087A1
• Time in Patent Office: Days
• US Class Current: 705/002
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/00 ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
• CPC Class Codes: G16H 70/20 relating to practices or guidelines

Abstract

The present invention provides improved systems and methods for coordinating and processing referrals for products and/or services such as medical treatments. Embodiments of the present invention provide novel systems that allow referring entities to efficiently process and approve referrals electronically. Some embodiments allow a provider to select the reimbursement document format after the referral data has been entered and authorized to facilitate prompt reimbursement.

Claims

1. A system for processing a referral for a treatment comprising:

one or more databases configured to store data associated with a plurality of patients;

a plurality of treatments including medical data requirements for authorization;

a plurality of referring entities; and

a plurality of providers including provider profiles;

a plurality of access terminals having an input device and a graphical user interface; and

a referral coordination server configured to communicate with said one or more databases and said plurality of access terminals and further configured for;

receiving information from a user identifying a referring entity from said plurality of referring entities, a patient from said plurality of patients, a treatment from said plurality of treatments and a provider from said plurality of providers;

in response to receiving said information, prompting said user to provide medical data required to authorize said treatment; and

populating an electronic referral with said medical data and data retrieved from said one or more databases associated with said patient, said referring entity, said treatment and said provider such that said electronic referral includes information sufficient for authorization by an authorizing entity.

2. The system of claim 1, wherein said referral coordination server is further configured for providing notice to said provider after said electronic referral has been populated.

3. The system of claim 2, wherein said notice is provided by email.

4. The system of claim 1, wherein said referral coordination server is further configured for providing an option to said provider to generate a reimbursement document in one of a plurality of formats populated with data from said electronic referral.

5. The system of claim 1, wherein said referral coordination server is further configured for:

providing notice to said authorizing entity after said electronic referral has been populated;

allowing said authorizing entity to edit said electronic referral;

receiving an electronic signature from said authorizing entity;

updating said electronic referral with said electronic signature thereby creating an authorized electronic referral; and

providing a notice to said provider of said authorized electronic referral.

6. The system of claim 5, wherein said referral coordination server is further configured for:

providing access to said authorized electronic referral by said provider; and

providing an option to said provider to generate a reimbursement document in one of a plurality of formats populated with data from said authorized electronic referral.

7. The system of claim 6, wherein said plurality of formats includes a Statement of Medical Necessity format or a Certificate of Medical Necessity format.

8. The system of claim 1, wherein said referral coordination server is further configured for providing a menu comprising at least a subset of said plurality of treatments.

9. The system of claim 8, wherein said menu includes a subset of said plurality of treatments determined based on the number of times individual treatments are referred.

10. The system of claim 1, wherein said referral coordination server is further configured for providing a menu comprising a subset of said plurality of providers.

11. The system of claim 10, wherein said subset of said plurality of providers is determined based on the provider operating in a selected geographic area.

12. The system of claim 10, wherein said subset of said plurality of providers is determined based providers honoring a particular insurance.

13. The system of claim 10, wherein said subset of said plurality of providers is determined based on the providers providing said treatment.

14. The system of claim 1, wherein said referral coordination server is further configured for:

receiving a referral expiration date; and

providing an alert in advance of said referral expiration date.

15. The system of claim 1, wherein said referral coordination server is further configured for generating a Statement of Medical Necessity using said medical data.

16. The system of claim 1, wherein said referral coordination server is further configured for:

validating at least a portion of said medical data against an associated threshold; and

providing an alert if said threshold is not satisfied.

17. A method for processing a referral for treatment of a patient comprising the steps of:

providing one or more databases for storing data associated with a plurality of patients, a plurality of referring entities, a plurality of treatments including medical data requirements for authorization, and a plurality of providers;

receiving information from a user identifying a referring entity from said plurality of referring entities, a patient from said plurality of patients, a treatment from said plurality of treatments and a provider from said plurality of providers;

in response to receiving information, prompting said user to provide medical data required to authorize treatment; and

populating an electronic referral with said medical data and data retrieved from said one or more databases associated with said patient, said referring entity, said treatment and said provider such that said electronic referral contains information sufficient for authorization by an authorizing entity.

18. The method of claim 17, further comprising the step of providing notice to said provider after said electronic referral has been populated.

19. The method of claim 17, wherein said notice is provided by email.

20. The method of claim 17 further comprising the step of providing an option to said provider to generate a reimbursement document in one of a plurality of formats populated with data from said electronic referral.

21. The method of claim 17 further comprising the steps of:

providing notice to said authorizing entity after said electronic referral has been populated;

allowing said authorizing entity to edit said electronic referral;

receiving an electronic signature from said authorizing entity;

updating said electronic referral with said electronic signature thereby creating an authorized electronic referral; and

providing a notice to said provider of said authorized electronic referral.

22. The method of claim 21, wherein said user and said authorizing entity are the same person.

23. The method of claim 21, wherein said authorizing entity is a physician.

24. The method of claim 21 further comprising the step of:

providing access to said authorized electronic referral by said provider; and

providing an option to said provider to generate a reimbursement document in one of a plurality of formats populated with data from said authorized electronic referral.

25. The method of claim 24, wherein said plurality of formats includes a Statement of Medical Necessity format or a Certificate of Medical Necessity format.

26. The method of claim 17 further comprising the step of providing a menu comprising at least a subset of said plurality of treatments.

27. The method of claim 26, wherein said menu includes a subset of said plurality of treatments determined based on the number of times individual treatments are referred.

28. The method of claim 17 further comprising the step of providing a menu comprising at least a subset of said plurality of providers.

29. The method of claim 28, wherein said subset of said plurality of providers is determined based on the provider operating in a selected geographic area.

30. The method of claim 28, said subset of said plurality of providers is determined based providers honoring a particular insurance.

31. The method of claim 28, wherein said subset of said plurality of providers is determined based on the providers providing said treatment.

32. The method of claim 17 further comprising the steps of:

receiving a referral expiration date; and

providing an alert in advance of said referral expiration date.

33. The method of claim 17 further comprising the step of generating a Statement of Medical Necessity using said medical data.

34. The method of claim 17 further comprising the steps of:

validating at least a portion of said medical data against an associated threshold; and

providing an alert if said threshold is not satisfied.

35. A method for processing a referral comprising the steps of:

providing one or more databases storing data associated with a plurality of referring entities, a plurality of products or services, and a plurality of providers;

receiving information from a user identifying a person being referred, a referring entity from said plurality of referring entities, a product or service from said plurality of products and services and a provider from said plurality of providers;

in response to receiving information, prompting said user to provide data required to authorize reimbursement for said product or service;

validating at least a portion of said data required to authorize reimbursement against a predetermined threshold; and

populating an electronic referral with said medical data and data retrieved from said one or more databases associated with said patient, said referring entity, said treatment and said provider such that said electronic referral contains information required by an authorizing entity.

36. The method of claim 35, further comprising the step of providing notice to said provider after said electronic referral has been populated.

37. The method of claim 35 further comprising the step of providing an option to said provider to generate a reimbursement document in one of a plurality of formats populated with data from said electronic referral.

38. The method of claim 35 further comprising the steps of:

providing notice to said authorizing entity after said electronic referral has been populated;

allowing said authorizing entity to edit said electronic referral;

receiving an electronic signature from said authorizing entity;

updating said electronic referral with said electronic signature thereby creating an authorized electronic referral; and

providing a notice to said provider of said authorized electronic referral.

39. The method of claim 35 further comprising the step of providing a menu comprising a subset of said plurality of products or services determined based on the number of times a product or service is referred.

40. The method of claim 35 further comprising the step of providing a menu comprising a subset of said plurality of providers determined based providers honoring a particular insurance.

43. The method of claim 35 further comprising the steps of:

providing notice to said authorizing entity after said electronic referral has been populated;

allowing said authorizing entity to edit said electronic referral;

receiving an electronic signature from said authorizing entity;

updating said electronic referral with said electronic signature thereby creating an authorized electronic referral; and

providing a notice to said provider of said authorized electronic referral.

41. A computer program product for processing a referral, the computer program product embodied on one or more computer-readable media and comprising computer-executable instructions for:

receiving information from a user identifying a referring entity from a plurality of referring entities, a patient from a plurality of patients, a treatment from a plurality of treatments and a provider from a plurality of providers stored in one or more databases;

in response to receiving said information, prompting said user to provide medical data required to authorize said treatment; and

populating an electronic referral with said medical data and data retrieved from said one or more databases associated with said patient, said referring entity, said treatment and said provider such that said electronic referral includes information sufficient for authorization by an authorizing entity.

42. The method of claim 41, further comprising the steps of:

providing notice to said provider after said electronic referral has been populated.