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

  • US 20130151282A1
  • Filed: 02/06/2013
  • Published: 06/13/2013
  • 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:

  • storing a plurality of medical claims on a claim processing server accessible over the Internet by a medical service provider, each medical claim representing medical benefits and having a set of requirementsreceiving over the Internet a medical claim request from the medical service provider and storing the medical claim request on the claim processing server, the medical claim request comprising a plurality of components that includes a proposed medical procedure that is to be performed on a patient;

    setting an initial score for at least some of the medical claims;

    adjusting at least some of the initial scores in a direction by evaluating at least some of the components of the medical claim request against at least some of the requirements for at least some of the medical claims and determining whether a component of the medical claim request matches a requirement, thereby producing a plurality of adjusted scores for at least some of the medical claims;

    selecting a medical claim based on the plurality of adjusted scores;

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