METHOD AND SYSTEM FOR PROCESSING MEDICAL PROVIDER CLAIM DATA

• US 20110179048A1
• Filed: 04/04/2011
• Published: 07/21/2011
• Est. Priority Date: 02/20/2001
• Status: Active Grant

• Current Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Original Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Inventors: Satlow, Marcia
• Granted Patent: US 8,799,313 B2
• Time in Patent Office: Days
• US Class Current: 707/754
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A computer system for processing data related to medical insurance has a communications device in communication with a network; a data storage device in communication with the communications device; and a processor in communication with the communications device and the data storage device. The processor is configured to receive, via the communications device, from a first source data indicative of medical provider claims, from a second source data indicative of insurance payments, and from a third source data indicative of medical provider data; identify common information items in said data from said first, second and third sources; and store the received data, in a data storage device, in a database, wherein said data from said first, second and third sources is cross-referenced with regard to said common information items.

Claims

1. A computer-implemented method for processing data related to medical insurance, comprising:

receiving by a processor from a first source data indicative of medical provider claims, from a second source data indicative of insurance payments, and from a third source data indicative of medical provider data;

identifying by the processor common information items in said data from said first, second and third sources; and

storing by the processor the received data in a data storage device in a database, wherein said data from said first, second and third sources is cross-referenced with regard to said common information items.

2. The computer-implemented method of claim 1, further comprising filtering the data stored in said database using at least one selected information item to create output data containing cross-referenced data items relating to said at least one selected filtering information item;

and

storing the created output data containing the cross-referenced data items in the database in the data storage device.

3. The computer-implemented method of claim 2, further comprising preparing a report containing the cross-referenced data items, and printing the report.

4. The computer-implemented method of claim 2, further comprising filtering the cross-referenced data items to create output data containing an additional cross-referenced data item relating to at least one additional information item, and preparing a report containing the additional cross-referenced data.

5. The computer-implemented method of claim 1, wherein the receiving comprises receiving the data via a communications network in communication with the processor.

6. The computer-implemented method of claim 1, wherein the data indicative of medical provider claims comprises date of loss data, injury type data and total cost data.

7. The computer-implemented method of claim 6, wherein the data indicative of insurance payments comprises procedure code data, total paid amount data and provider code data, and the data indicative of medical provider data comprises provider type data and provider specialty data.

8. A computer system for processing data related to medical insurance, comprising:

a communications device in communication with a network;

a data storage device in communication with the communications device; and

a processor in communication with the communications device and the data storage device, and configured to;

receive, via the communications device, from a first source data indicative of medical provider claims, from a second source data indicative of insurance payments, and from a third source data indicative of medical provider data;

identify common information items in said data from said first, second and third sources; and

store the received data, in a database stored in the data storage device, wherein said data from said first, second and third sources is cross-referenced with regard to said common information items.

9. The computer system of claim 8, wherein the processor is further configured to:

filter the stored data using at least one selected information item contained in said database to provide output data indicative of cross-referenced data items relating to said at least one selected information item; and

store the data indicative of the cross-referenced data items in the database stored in the data storage device.

10. The computer system of claim 9, further comprising a display in communication with the processor, the processor further configured to provide the data indicative of the cross-referenced data items to the display for display to a user.

11. The computer system of claim 8, wherein the data indicative of medical provider claims comprises, for each of a plurality of claims, claim number, patient data, insurance provider data, medical provider data, diagnosis data, treatment data and amount of claim data;

and the data indicative of insurance payments comprises a procedure code, a provider code and a total paid amount; and

the data indicative of medical providers comprises provider identification data, provider type and patient data.

12. The computer system of claim 10, wherein the data indicative of medical providers further comprises data relating to treatment schedules.

13. The computer system of claim 10, wherein the selected information item comprises claim number criteria.

14. The computer system of claim 10, wherein the processor is further configured to compare data items from one of said sources with data items from another one of said sources to create composite information items.

15. The computer system of claim 14, wherein the processor is further configured to compare medical provider data associated with one of said plurality of claims from said first source, with data indicative of medical provider participation in a plan from said third source, determine whether the medical provider participates in the plan, and store in the data storage device a composite information item in the form of an indication of whether the medical provider participates in the plan.

16. A non-transitory computer-readable medium having processor-executable instructions stored thereon, which instructions, when executed by a processor, cause the processor to:

receive, via a communications device, from a first source data indicative of medical provider claims, from a second source data indicative of insurance payments, and from a third source data indicative of medical provider data;

identify common information items in said data from said first, second and third sources; and

store the received data, in a data storage device, in a database, wherein said data from said first, second and third sources is cross-referenced with regard to said common information items.

17. The non-transitory computer-readable medium of claim 16, wherein the instructions, when executed by the processor, further cause the processor to:

filter the stored data using at least one selected information item contained in said database to provide output data indicative of cross-referenced data items relating to said at least one selected information item; and

store in the database the data indicative of the cross-referenced data items.

18. The non-transitory computer-readable medium of claim 17, wherein the data indicative of medical provider claims comprises, for each of a plurality of claims, claim number, patient data, insurance provider data, medical provider data, diagnosis data, treatment data and amount of claim data;

and the data indicative of insurance payments comprises a procedure code, a provider code and a total paid amount; and

the data indicative of medical providers comprises provider identification data, provider type and patient data.

19. The non-transitory computer-readable medium of claim 18, wherein the selected information items comprise claim number and invoice number.

20. The non-transitory computer-readable medium of claim 17, wherein the instructions further cause the processor to prepare a report including the data indicative of the cross-referenced data items, and to permit the report to be downloaded over a network.