SYSTEM AND METHOD FOR IMPROVING CLAIMS PROCESSING IN THE HEALTHCARE INDUSTRY

• US 20090070135A1
• Filed: 09/10/2007
• Published: 03/12/2009
• Est. Priority Date: 09/10/2007
• Status: Abandoned Application

• Current Assignee: General Electric Company
• Original Assignee: General Electric Company
• Inventors: Bodlapati, Trivedi, Parida, Pradip Kumar
• Application Number:
  US11/852,795
• Publication Number:
  US 20090070135A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

Certain embodiments of the present invention provide for a system and method for managing clinical documents for claims processing. In an embodiment, the method includes receiving a command to submit an invoice to a payer. The method also includes acquiring a first set of files from an electronic medical records database according to a first set of rules. The first set of rules provide for acquiring a first set of files required for submission to a payer. The method also includes displaying an identifier for the first set of files to a user for approval. The first set of files may be transmitted to the payer. In an embodiment, the method may also include receiving a request for additional information from the payer. A second set of files may be acquired according to a second set of rules. The second set of files may be transmitted to the payer.

Claims

1. A method for managing clinical documents for claims processing, said method comprising:

receiving a command to submit an invoice to a payer;

acquiring a first set of files from an electronic medical records database according to a first set of rules, wherein said first set of rules provide for acquiring a first set of files required for submission to a payer;

displaying an identifier for said first set of files to a user for approval, wherein if said user approves of the acquisition of said first set of files, electronically transmitting said first set of files to said payer.

2. The method of claim 1, further comprising receiving a request for additional information from said payer.

3. The method of claim 2, further comprising acquiring a second set of files from said electronic medical records database according to a second set of rules, wherein said second set of rules provide for acquiring a second set of files that supplement said first set of files for submission to said payer.

4. The method of claim 3, further comprising displaying an identifier for said second set of files to a user for approval, wherein if said user approves of the acquisition of said second set of files, electronically transmitting said second set of files to said payer.

5. The method of claim 2, wherein said request for additional information includes a secondary tag that is used to associate the request with other files.

6. The method of claim 5, wherein said second set of files is associated with said secondary tag of said request.

7. The method of claim 6, wherein said second set of files is acquire from said electronic medical records database according to said secondary tag.

8. The method of claim 1, wherein said invoice contains a primary tag that is used to associate the invoice with other files.

9. The method of claim 8, wherein said first set of files is associated with said primary tag of said invoice.

10. The method of claim 9, wherein said first set of files is acquired from said electronic medical records database according to said primary tag.

11. A computer readable medium including a set of instructions for execution by a computer, said set of instructions comprising:

a receiving routine for receiving a command to submit an invoice to a payer for services rendered to a patient;

an acquisition routine for acquiring a first set of files from an electronic medical records database according to a first set of rules, wherein said first set of rules provide for acquiring a first set of files required for submission to a payer;

a displaying routine for displaying an identifier for said first set of files to a user for approval, wherein if said user approves of the acquisition of said first set of files, electronically transmitting said first set of files to said payer.

12. The set of instructions of claim 11, further comprising a second receipt routine for receiving a request for additional information from said payer.

13. The set of instructions of claim 12, further comprising a second acquisition routine for acquiring a second set of files from said electronic medical records database according to a second set of rules, wherein said second set of rules provide for acquiring a second set of files that supplement said first said of files for submission to said payer.

14. The set of instructions of claim 13, further comprising a second display routine for displaying an identifier for said second set of files to a user for approval, wherein if said user approves of the acquisition of said second set of files, electronically transmitting said second set of files to said payer.

15. The set of instructions of claim 12, wherein said request for additional information includes a secondary tag that is used to associate the request with said second set of files.

16. The set of instructions of claim 15, wherein said second set of files is acquired from said electronic medical records database according to said secondary tag.

17. The set of instructions of claim 11, wherein said invoice contains a primary tag that is used to associate the invoice with said first set of files.

18. The set of instructions of claim 17, wherein said first set of files is acquired from said electronic medical records database according to said primary tag.

19. A system for managing clinical documents for claims processing, said system comprising:

a client unit having computer software for receiving a command to submit an invoice to a payer for services rendered to a patient, wherein said invoice includes a primary tag;

wherein said client unit acquires a first set of files from an electronic medical records database according to a first set of rules, wherein said first set of rules provide for acquiring a first set of files required for submission to a payer, wherein said first set of files is associated with said primary tag;

a display unit for displaying an identifier for said first set of files to a user for approval, wherein if said user approves of the acquisition of said first set of files, electronically transmitting said first set of files to said payer.

20. The system of claim 19, wherein said client unit has computer software for receiving a request for additional information from said payer, wherein said request includes a secondary tag;

wherein said client unit acquires a second set of files from said electronic medical records database according to a second set of rules, wherein said second set of rules provide for acquiring a second set of files that supplement said first said of files for submission to said payer, wherein said second set of files is associated with said secondary tag;

wherein said client unit transmits the second set of files to said payer upon user approval.