SYSTEM AND METHOD FOR MEETING PAYER PROTOCOLS
First Claim
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1. A method of processing healthcare service data to determine if additional content data is required, the method comprising:
- receiving healthcare service data;
receiving at least one protocol from at least one knowledge source comprising at least one protocol derived by automated learning from historical healthcare service data;
applying the at least one protocol to the healthcare service data to determine if additional content data is required to meet the at least one protocol;
generating a response indicative of the content data required to meet the at least one protocol, upon determining that additional content data is required; and
generating a response indicative of the next workflow step, upon determining that no additional content data is required.
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Abstract
A system and method for processing healthcare service data is herein disclosed. The system comprising a decision engine in communication with a process manager and a knowledge source. The decision engine receives at least one protocol from the knowledge source that is derived by automated learning and applies the at least one protocol to healthcare service data and transmits a response to the process manager such that the response is indicative of a next workflow step to be taken.
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Citations
23 Claims
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1. A method of processing healthcare service data to determine if additional content data is required, the method comprising:
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receiving healthcare service data; receiving at least one protocol from at least one knowledge source comprising at least one protocol derived by automated learning from historical healthcare service data; applying the at least one protocol to the healthcare service data to determine if additional content data is required to meet the at least one protocol; generating a response indicative of the content data required to meet the at least one protocol, upon determining that additional content data is required; and generating a response indicative of the next workflow step, upon determining that no additional content data is required. - View Dependent Claims (2, 3, 4, 5, 6, 7)
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8. A decision engine for use in conjunction with an automated system including a process manager for processing healthcare service data for a healthcare data transaction, the decision engine comprising:
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a knowledge source in communication with at least one database of stored historical healthcare service data, the knowledge source identifying at least one protocol derived by automated learning from historical healthcare service data, the protocol defining a content data requirement for a healthcare data transaction; and a means for applying at least one protocol to the healthcare service data, the means for applying being in communication with the knowledge source and in communication with the process manager such that healthcare service data is received from the process manager, the means for applying determining any required additional healthcare service or content data and transmitting a response indicative of the required additional content data to the process manager. - View Dependent Claims (9, 10, 11, 12, 13, 14, 15, 16, 17)
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18. A healthcare data management system for processing healthcare service data to identify required content data to be sent to a payer, the system comprising:
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an input device facilitating the entry of healthcare service data to be used in a healthcare data transaction; a process manager in communication with the input device, the process manager receiving the healthcare service data; a knowledge source in communication with at least one database of healthcare service data, the knowledge source identifying at least one protocol by automated learning from the healthcare service data, the protocol defining a content data requirement; a decision engine in communication with the process manager and in communication with the knowledge source such that the decision engine receives the healthcare service data from the process manager, receives at least one protocol from the knowledge source, applies the at least one protocol to the healthcare service data to produce a response indicative of required content data, and transmits the response to the process manager; and an output device in communication with the process manager such that the output device receives the response from the process manager and indicates a workflow step to be performed in accordance with the response. - View Dependent Claims (19, 20, 21, 22, 23)
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Specification