AUTHORIZATION PROCESS FOR HIGH INTENSITY MEDICAL INTERVENTIONS
First Claim
1. A process for gaining insurance authorization or other third party authorization for a prescribed mode of diagnostic testing or therapeutic medical care for a patient, the process including a dialogue between a user and a computer, the dialogue being facilitated by an algorithm contained in the computer, the process comprising the steps of:
- the user'"'"'s entry into the computer of medical information about the patient and an authorization request for a specific mode of diagnostic testing or therapeutic medical care for the patient;
the algorithm'"'"'s generation of one or more questions responsive to the information and authorization request, directed to refining an assessment of whether the specific mode of diagnostic testing or therapeutic medical care is indicated;
the user'"'"'s entry into the computer of one or more answers responsive to the one or more questions; and
the algorithm'"'"'s generation of feedback responsive to the one or more answers, the feedback instructing the user as to whether or not the specific mode of diagnostic testing or therapeutic medical care is indicated, wherein the algorithm permits the user to withdraw the authorization request throughout the process but ultimately grants the authorization request if the user does not withdraw the authorization request, irrespective of whether or not the algorithm instructs the user that the specific mode of diagnostic testing or therapeutic medical care is indicated, the computer maintaining a record of the user'"'"'s decision to withdraw or persist with the authorization request, the record factoring into a performance metric that reflects the user'"'"'s medical decision-making prowess.
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Accused Products
Abstract
A process is provided for gaining third party authorization for a medical intervention for a patient. The process includes a dialogue between a user and a computer, facilitated by an algorithm in the computer. A user enters into the computer medical information about the patient and an authorization request for a medical intervention for the patient. The algorithm generates one or more questions responsive to the information and authorization request, directed to refining an assessment of whether the medical intervention is indicated. The user enters into the computer one or more answers responsive to the one or more questions. The algorithm generates feedback responsive to the one or more answers. The feedback instructs the user as to whether or not the medical intervention is indicated. The algorithm permits the user to withdraw the request throughout the process but ultimately grants the request if the user does not withdraw the request.
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Citations
21 Claims
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1. A process for gaining insurance authorization or other third party authorization for a prescribed mode of diagnostic testing or therapeutic medical care for a patient, the process including a dialogue between a user and a computer, the dialogue being facilitated by an algorithm contained in the computer, the process comprising the steps of:
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the user'"'"'s entry into the computer of medical information about the patient and an authorization request for a specific mode of diagnostic testing or therapeutic medical care for the patient; the algorithm'"'"'s generation of one or more questions responsive to the information and authorization request, directed to refining an assessment of whether the specific mode of diagnostic testing or therapeutic medical care is indicated; the user'"'"'s entry into the computer of one or more answers responsive to the one or more questions; and the algorithm'"'"'s generation of feedback responsive to the one or more answers, the feedback instructing the user as to whether or not the specific mode of diagnostic testing or therapeutic medical care is indicated, wherein the algorithm permits the user to withdraw the authorization request throughout the process but ultimately grants the authorization request if the user does not withdraw the authorization request, irrespective of whether or not the algorithm instructs the user that the specific mode of diagnostic testing or therapeutic medical care is indicated, the computer maintaining a record of the user'"'"'s decision to withdraw or persist with the authorization request, the record factoring into a performance metric that reflects the user'"'"'s medical decision-making prowess. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
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15. A process for gaining third party payment authorization for a prescribed mode of diagnostic testing or therapeutic medical care for a patient, the process including a dialogue between a user and a computer, the dialogue being facilitated by an algorithm contained in the computer, the process comprising the steps of:
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the user'"'"'s entry into the computer of medical information about the patient and an authorization request for a specific mode of diagnostic testing or therapeutic medical care for the patient; the algorithm'"'"'s generation of one or more questions responsive to the information and authorization request, directed to refining an assessment of whether the specific mode of diagnostic testing or therapeutic medical care is indicated; the user'"'"'s entry into the computer of one or more answers responsive to the one or more questions; and the algorithm'"'"'s generation of feedback responsive to the one or more answers, the feedback instructing the user as to whether or not the specific mode of diagnostic testing or therapeutic medical care is indicated, wherein the algorithm permits the user to withdraw the authorization request throughout the process but ultimately grants the authorization request if the user does not withdraw the authorization request, irrespective of whether or not the algorithm instructs the user that the specific mode of diagnostic testing or therapeutic medical care is indicated, the computer maintaining a record of the user'"'"'s decision to withdraw or persist with the authorization request, the record factoring into a performance metric that reflects the user'"'"'s medical decision-making prowess, wherein a granting of the authorization request obligates a third party payer to pay at least a portion of costs associated with the prescribed mode of diagnostic testing or therapeutic medical care. - View Dependent Claims (16, 17, 18, 19, 20, 21)
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Specification