AUTOMATED PROCESSING OF ELECTRONIC MEDICAL DATA FOR INSURANCE AND DISABILITY DETERMINATIONS

• US 20110077981A1
• Filed: 12/07/2010
• Published: 03/31/2011
• Est. Priority Date: 10/24/2001
• Status: Abandoned Application

• Current Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Original Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Inventors: KAY, Lay K.
• Application Number:
  US12/962,616
• Publication Number:
  US 20110077981A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

Methods and systems are described for automated processing of medical data for insurance and disability determinations. Based on medical conditions claimed by a 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 method for adjudicating a medical disability request, comprising:

receiving medical evidence data responsive to a plurality of claim-type specific medical evidence queries, wherein the plurality of claim-type specific medical evidence queries is selected from a predetermined set of medical evidence queries, and are based on a disability rating rules collection and at least one claim, from a claimant, of a medical condition; and

generating, using a processor, a report comprising the received medical evidence data;

wherein the predetermined set excludes queries, from the plurality of claim-type specific medical evidence, that are not specific to the claim or claim type; and

wherein the predetermined set contains a greater number of queries than the plurality of queries.

2. The method of claim 1, further comprising displaying the selected medical evidence queries in a data collection protocol.

3. The method of claim 1, wherein the medical evidence data is received from an electronic data storage comprising electronic medical records.

4. The method of claim 1, wherein the medical evidence data comprises responses to the selected medical evidence queries.

5. The method of claim 1, wherein the receiving medical evidence data comprises receiving medical evidence data collected by a medical provider.

6. The method of claim 5, wherein the receiving medical evidence data collected by a medical provider comprises at least one of reviewing and extracting data from medical records, taking a medical history of the claimant, receiving data from a physical exam, receiving data representative of laboratory tests, receiving data from radiological study results, or receiving data from nuclear medicine laboratory results.

7. The method of claim 6, wherein the medical history comprises at least one of a family history and a social history.

8. The method of claim 1, further comprising determining a degree of disability based on the medical evidence data and on the disability rating rules collection.

9. The method of claim 8, wherein the report comprises the degree of disability.

10. A system for adjudicating a medical disability request, comprising:

a computer-readable storage comprising medical evidence data responsive to a plurality of claim-type specific medical evidence queries, wherein the plurality of claim-type specific medical evidence queries is selected from a predetermined set of medical evidence queries, and are based on a disability rating rules collection and at least one claim, from a claimant, of a medical condition; and

a computer processor configured to generate a report comprising the medical evidence data;

wherein the predetermined set excludes queries, from the plurality of claim-type specific medical evidence, that are not specific to the claim or claim type; and

wherein the predetermined set contains a greater number of queries than the plurality of queries.

11. The system of claim 10, wherein the computer processor is further configured to display the generated medical evidence queries in a data collection protocol.

12. The system of claim 10, wherein the medical evidence data is received from an electronic data storage comprising electronic medical records.

13. The system of claim 10, wherein the medical evidence data comprises responses to the selected medical evidence queries.

14. The system of claim 10, wherein the medical evidence data is collected by a medical provider.

15. The system of claim 14, wherein the medical evidence data collected by the medical provider comprises at least one of reviewing and extracting data from medical records, taking a medical history of the claimant, receiving data from a physical exam, receiving data representative of laboratory tests, receiving data from radiological study results, or receiving data from nuclear medicine laboratory results.

16. The system of claim 15, wherein the medical history comprises at least one of a family history and a social history.

17. The system of claim 10, wherein the computer processor is further configured to determine a degree of disability based on the medical evidence data and on the disability rating rules collection.

18. The system of claim 17, wherein the report comprises a degree of disability.

19. A computer-readable medium having computer-executable instructions stored thereon for performing method for adjudicating a medical disability request, comprising.

receiving medical evidence data responsive to a plurality of claim-type specific medical evidence queries, wherein the plurality of claim-type specific medical evidence queries is selected from a predetermined set of medical evidence queries, and are based on a disability rating rules collection and at least one claim, from a claimant, of a medical condition;

and

generating a report comprising the received medical evidence data;

wherein the predetermined set excludes queries, from the plurality of claim-type specific medical evidence, that are not specific to the claim or claim type; and

wherein the predetermined set contains a greater number of queries than the plurality of queries.