Data Restructuring for Consistent Formatting
First Claim
1. A method for providing consistently coded eligibility data, the method comprising:
- receiving eligibility data in an eligibility response;
parsing the eligibility data in the eligibility response for one or more eligibility benefit data elements;
creating one or more coded strings; and
creating a recoded eligibility response comprising the one or more coded strings.
3 Assignments
0 Petitions
Accused Products
Abstract
Consistently coded eligibility data is provided. Eligibility responses may be received from various payers comprising inconsistently coded eligibility benefit (EB) information provided in EB segments in various locations in the responses. A data restructuring engine may be operable to receive an eligibility response and restructure the response into a consistent format. Co-pay, co-insurance, benefit limitations, and benefit specific deductibles may be clarified by embedding coded strings in one or more message segments attached to EB segments. Service types, network indicators, place of service codes, and message text may be removed when a coded strings is created. Recoded eligibility responses may be provided to healthcare providers, providing coverage, eligibility, and benefit data in a consistent and standardized form, regardless of the payer sending the eligibility response.
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Citations
20 Claims
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1. A method for providing consistently coded eligibility data, the method comprising:
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receiving eligibility data in an eligibility response; parsing the eligibility data in the eligibility response for one or more eligibility benefit data elements; creating one or more coded strings; and creating a recoded eligibility response comprising the one or more coded strings. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A system for providing consistently coded eligibility data, the system comprising:
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one or more processors; and a memory coupled to the one or more processors, the one or more processors operable to; receive eligibility data in an eligibility response; parse the eligibility data in the eligibility response for one or more eligibility benefit data elements; create one or more coded strings; and create a recoded eligibility response comprising the one or more coded strings. - View Dependent Claims (14, 15, 16, 17, 18, 19)
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20. A computer readable medium containing computer executable instructions which, when executed by a computer, perform a method for providing consistently coded eligibility data, the method comprising:
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receiving eligibility data in an eligibility response; identifying a payer sending the eligibility response; looking up possible locations of eligibility benefit data elements in the eligibility response in a table; parsing the eligibility data in the eligibility response for one or more eligibility benefit data elements; creating one or more coded strings, the one or more coded strings comprising coded values for one or more of; place of service information; service type information; provider type information; relation of provider to payer information; relation of provider to patient information; reason for service information; service category information; free-form message text identifying critical benefit details;
orfree-form message text identifying benefit details identified in an eligibility benefit segment; removing eligibility benefit code values, free-form message text identifying critical benefit details, or free-form message text identifying benefit details identified in an eligibility benefit segment that has been codified in a coded string; and creating a recoded eligibility response comprising the one or more coded strings.
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Specification