Computer Implemented Method and Computer Program Product for Collecting Fees for an Insurance Network

• US 20110213624A1
• Filed: 05/09/2011
• Published: 09/01/2011
• Est. Priority Date: 03/19/2001
• Status: Abandoned Application

• Current Assignee: Jasos Intellectual Property LLC
• Original Assignee: Jasos Intellectual Property LLC
• Inventors: Moore, Terrance, Lewis, Charles
• Application Number:
  US13/103,761
• Publication Number:
  US 20110213624A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/04 Forecasting or optimisation specially adapted for administrative or management purposes, e.g. linear programming or "cutting stock problem" market predictions or forecasting for commercial activities G06Q30/0202
• CPC Class Codes: G06Q 10/0637 Strategic management or analysis, e.g. setting a goal or target of an organisation; Planning actions based on goals; Analysis or evaluation of effectiveness of goals
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/10 specially adapted for electronic funds transfer [EFT] systems; specially adapted for home banking systems
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

Computer implemented methods and computer program products for reducing the ancillary medical costs of an insurance network with a plurality of physicians participating therein. Computer implemented methods can include, for example, establishing an communication network between a healthcare consultation group and the insurance network, and accessing data associated with the plurality of physicians via the communication network. Embodiments can further include, for example, identifying, in a computer process, physicians who have engaged in ancillary medical procedures that are not preferred by the insurance network, and modifying behaviors of these physicians to reduce the ancillary medical costs of the insurance network. Embodiments can also include, for example, determining, in a computer process, whether the ancillary medical costs of the insurance network have reached at least a preselected level, and distributing a predetermined percentage of saving attributed to reducing ancillary medical costs of the insurance network to the healthcare consultation group.

Claims

1. A computer implemented method of collecting fees to manage ancillary medical costs of an insurance network having a plurality of physicians participating therein, the computer implemented method comprising the steps of:

establishing an electronic communication network between a healthcare consultation group and the insurance network to thereby facilitate communication between the healthcare consultation group and the insurance network,

accessing data, via the electronic communication network, associated with the plurality of physicians, the data including at least one of the following;

a reimbursement claim paid by the insurance network for an ancillary medical procedure used to treat one or more of a plurality of patients that participate in the insurance network, ancillary medical costs of the ancillary medical procedure, preferred ancillary medical procedures of the insurance network, and ancillary medical costs of the preferred ancillary medical procedures of the insurance network,

identifying, in a computer process, responsive to accessing the data, at least one of the plurality of physicians who has engaged in an ancillary medical procedure that is not preferred by the insurance network,

modifying behavior of the at least one physician that has engaged in the ancillary medical procedure that is not preferred by the insurance network, the modified behavior reducing the ancillary medical costs of the insurance network,

determining, in a computer process, whether the ancillary medical costs of the insurance network have reached at least a preselected level, and

distributing a predetermined percentage of saving attributed to reducing ancillary medical costs of the insurance network to the healthcare consultation group when the ancillary medical costs of the insurance network have decreased to at least the preselected level.