SYSTEM AND METHOD FOR IMPROVED PATIENT CARE AND PATIENT RECORD KEEPING
First Claim
1. A system for managing health insurance plan member medical records, the system comprising:
- a processor;
a memory; and
a management component stored in the memory, wherein said management component is executed by the processor to;
a) Identify at least one member of a health insurance plan suitable for evaluation;
b) Gather said at least one member'"'"'s medical records;
c) Analyze said at least one member'"'"'s medical records;
d) Perform a quality assurance review of said analysis;
e) Generate at least one standardized code representing the health condition of said at least one member; and
f) Prepare said at least one standardized code for submission to an insurance payor.
1 Assignment
0 Petitions
Accused Products
Abstract
The present invention relates generally to healthcare, and more specifically to a process for more completely and more accurately identifying and collecting health insurance plan members'"'"' medical diagnoses in compliance with the regulations of one or more health insurance payors such as, but not limited to, the United States Centers for Medicare and Medicaid Services'"'"' (“CMS”) Medicare Advantage regulations. In particular, the present invention provides a system, method, or computer program product whereby health insurance companies may ensure that their members are accurately diagnosed and that claims are accurately filed by reviewing existing member medical records to identify additional diagnoses which may have been treated but not specifically identified in claims filed by the members'"'"' health care provider.
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Citations
20 Claims
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1. A system for managing health insurance plan member medical records, the system comprising:
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a processor; a memory; and a management component stored in the memory, wherein said management component is executed by the processor to; a) Identify at least one member of a health insurance plan suitable for evaluation; b) Gather said at least one member'"'"'s medical records; c) Analyze said at least one member'"'"'s medical records; d) Perform a quality assurance review of said analysis; e) Generate at least one standardized code representing the health condition of said at least one member; and f) Prepare said at least one standardized code for submission to an insurance payor. - View Dependent Claims (2, 3, 4, 5, 6, 7)
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8. A method for managing health insurance plan member medical records, the method comprising:
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a) Identifying at least one member of a health insurance plan suitable for evaluation; b) Gathering said at least one member'"'"'s medical records; c) Analyzing said at least one member'"'"'s medical records; d) Performing a quality assurance review of said analysis; e) Generating at least one standardized code representing the health condition of said at least one member; and f) Preparing said at least one standardized code for submission to an insurance payor. - View Dependent Claims (9, 10, 11, 12, 13, 14)
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15. A computer program product for managing health insurance plan member medical records, the computer program product comprising:
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a computer readable storage medium storing computer executable program code that, when executed by a processor, causes said computer readable storage medium to perform a method comprising; a) Identifying at least one member of a health insurance plan suitable for evaluation; b) Gathering said at least one member'"'"'s medical records; c) Analyzing said at least one member'"'"'s medical records; d) Performing a quality assurance review of said analysis; e) Generating at least one standardized code representing the health condition of said at least one member; f) Preparing said at least one standardized code for submission to an insurance payor; and g) Identifying and quantifying any change in a level of reimbursement based on submission of said at least one standardized code to said insurance payor. - View Dependent Claims (16, 17, 18, 19, 20)
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Specification