AUTOMATED PROCESSING OF MEDICAL DATA FOR DISABILITY RATING DETERMINATIONS

• US 20100106520A1
• Filed: 10/21/2009
• Published: 04/29/2010
• Est. Priority Date: 10/24/2001
• Status: Active Grant

• Current Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Original Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Inventors: KAY, Lay K.
• Granted Patent: US 8,527,303 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06N 5/025 Extracting rules from data
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Methods and systems are described for automated processing of medical data for insurance and disability determinations. Based on medical conditions claimed by the claimant, medical evidence queries are automatically generated to provide instructions to medical providers for conducting physical exams and laboratory tests and for retrieving medical records. After medical evidence is collected according to the queries, the medical evidence and related rating codes and decisions are displayed to rating personnel in a user-friendly format to assist in making a rating decision.

Claims

1. A computer-implemented method of assisting medical evidence collection for adjudication of a medical disability request, the method comprising:

receiving, from a claimant, at least one claim of a medical condition;

selecting, from a predetermined set of medical evidence queries, a plurality of claim-type specific medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection;

receiving medical evidence data responsive to the generated medical evidence queries;

determining, by a computer, a degree of disability based on the collected medical evidence data and the disability rating rules collection; and

wherein the selected plurality of medical evidence queries excludes queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.

2. The method of claim 1, wherein the receiving medical evidence data comprises receiving medical evidence data by conducting a physical examination of the claimant.

3. The method of claim 1, wherein the receiving medical evidence data comprises receiving medical evidence data by conducting a laboratory test of the claimant.

4. The method of claim 1, wherein the receiving medical evidence data comprises receiving medical evidence data from medical records of the claimant.

5. The method of claim 1, wherein the receiving medical evidence data comprises receiving medical history data of the claimant.

6. The method of claim 1, wherein the degree of disability comprises a recommended disability percentage.

7. The method of claim 1, further comprising associating each of the selected medical evidence queries with a rating code of the disability rating rules collection.

8. The method of claim 1, further comprising displaying at least a portion of the selected queries in a medical provider'"'"'s exam protocol.

9. The method of claim 8, wherein the displaying at least a portion of the selected queries in a medical provider'"'"'s exam protocol comprises arranging the displayed queries according to modules.

10. The method of claim 8, wherein the displaying at least a portion of the selected queries in a medical provider'"'"'s exam protocol comprises arranging the displayed queries according to classifications in the disability rating rules collection.

11. The method of claim 1, further comprising displaying at least a portion of the generated selected queries in an assistant'"'"'s data collection protocol.

12. The method of claim 1, further comprising displaying at least a portion of the selected queries in a claimant questionnaire.

13. The method of claim 1, further comprising eliminating duplicate selected medical evidence queries.

14. The method of claim 1, wherein the disability rating rules collection comprises a federal law.

15. The method of claim 1, wherein the disability rating rules collection comprises a court case law.

16. The method of claim 1, wherein the disability rating rules collection comprises an administrative decision.

17. The method of claim 1, further comprising:

separating the selected medical evidence queries into at least a first set of queries and a second set of queries;

displaying the first set of queries in a medical provider'"'"'s exam protocol; and

displaying the second set of queries in an assistant'"'"'s data collection protocol.

18. The method of claim 17, wherein the first set and the second set of queries include a duplicate query, the method further comprising:

receiving medical evidence data for the duplicate query collected based on the assistant'"'"'s data collection protocol; and

removing the duplicate query from the medical provider'"'"'s exam protocol.

19. The method of claim 1, wherein the plurality of medical evidence queries is claimant-specific and claim-specific.

20. The method of claim 19, wherein the selected medical information queries vary by the claimant, vary by the claim, and vary by the claim-type.

21. A computer-implemented method of assisting adjudication of a medical disability request, the method comprising:

receiving, from a claimant, at least one claim of a medical condition;

selecting, from a predetermined set of medical evidence queries, a plurality of claim-type specific medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection;

excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type;

receiving medical evidence responsive to the generated medical evidence queries;

determining, by a computer, a degree of disability based on the collected medical evidence data and the disability rating rules collection; and

displaying, in a rating report, at least a portion of the collected medical evidence and the degree of disability.

22. The method of claim 21, wherein each of the selected queries is associated with a rating code of the disability rating rules collection, and wherein displaying in a rating report further comprises displaying in the rating report rating codes associated with the displayed medical evidence.

23. The method of claim 21, wherein the plurality of medical evidence queries is claimant-specific and claim-specific.

24. The method of claim 23, wherein the selected medical information queries vary by the claimant, vary by the claim, and vary by the claim-type.

25. A medical disability claims benefits system comprising:

a rules mapping component, embodied in a computer readable medium, that organizes a medical disability rating rules collection into at least a first plurality of general medical evidence queries;

a claimant-specific query creation component, embodied in a computer readable medium, that selects, from the first plurality of general queries a second plurality of claim-type specific medical evidence queries based on and limited by a claimed medical condition of a claimant and based on and limited by the disability rating rules collection;

a protocol creation component, embodied in a computer readable medium, that creates a query protocol based on the second plurality of queries;

a report creation component that receives medical evidence responsive to the at least one query protocol, and adapted to determine a degree of disability based on the collected medical evidence data and the medical disability rating rules collection; and

wherein the second plurality of medical evidence queries excludes queries, from the first plurality of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.

26. The system of claim 25, wherein the rules mapping component further associates each of the first plurality of queries with a rating code of the disability rating rules collection.

27. The system of claim 25, wherein the first plurality of general medical evidence queries includes a triggering query and one or more conditional queries associated with the triggering query.

28. The system of claim 25, wherein the claimant-specific query creation component eliminates duplicate queries from the second plurality of medical evidence queries.

29. The system of claim 25, wherein the plurality of medical evidence queries is claimant-specific and claim-specific.

30. The system of claim 29, wherein the selected medical information queries vary by the claimant, vary by the claim, and vary by the claim-type.