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Method of Increasing Efficiency in a Medical Claim Transaction, and Computer Program Capable of Executing Same

  • US 20120109681A1
  • Filed: 01/12/2012
  • Published: 05/03/2012
  • Est. Priority Date: 01/21/2000
  • Status: Active Grant
First Claim
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1. A method of adjudicating a medical claim, the method comprising:

  • providing a medical claim processing server accessible over the Internet by a medical service provider, the server having access to a database storing a plurality of claims each claim representing medical benefits and having a set of requirements;

    the medical claim processing server;

    receiving over the Internet a medical claim request from the medical service provider, the request comprising components including a proposed medical procedure that is to be performed on a patient;

    evaluating the components of the medical claim request against sets of requirements of some of the claims by setting a score to each of the some of the claims based on comparing the components with requirements within the sets of requirements;

    selecting a selected claim from the scored claims based on the set scores;

    adjudicating the medical claim request by determining acceptance or rejection of the medical claim request and a monetary value of the proposed medical procedure according the score of the selected claim;

    transmitting a notification over the Internet to the medical service provider, the notification comprising one of (a) a rejection of the proposed medical procedure, and (b) an acceptance the proposed medical procedure with the monetary value; and

    presenting the notification via a user interface to a user associated with the medical service provider.

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