METHODOLOGY, SYSTEM AND COMPUTER PROGRAM PRODUCT FOR GENERATING ELECTRONIC INSURANCE CLAIMS OR BILLS, HAVING OPTIMIZED INSURANCE CLAIM ITEMS IN ORDER TO MAXIMIZE REIMBURSEMENT AND TO FACILITATE APPROVAL OF THE CLAIM(S) UPON FIRST SUBMISSION TO THE INSURANCE CARRIER
First Claim
1. A computerized method for generating electronic insurance claims or bills having optimized insurance claim items based on at least one insurance carrier of a patient, the method is comprised of:
- receiving insurance carrier data, which identifies the patient'"'"'s at least one insurance carrier;
receiving patient data which identifies the patient and the patient'"'"'s ICD diagnoses;
receiving treatment data which identifies drugs administered to the patient and procedures performed on the patient during a date of service;
processing the treatment data to obtain nurse documentation, such as treatment and flow sheets, drug inventory and reorder forms; and
automatically generating electronic insurance claims or bills having optimized reimbursable insurance claim items, including predetermined codes based on the treatment data and the insurance carrier data to facilitate approval of the claims or bills by the at least one insurance carrier.
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Abstract
A methodology, system and computer program product for generating electronic insurance claims or bills, having optimized insurance claim items based on the insurance carrier(s) of a patient are provided. The method includes receiving insurance carrier data which identifies the patient in order to facilitate payment upon first submission to the carrier. The method includes receiving carrier data, which identifies the patient'"'"'s insurance carrier(s) and patient data, which identifies the patient. The method also includes receiving treatment data, which identifies drugs administered to the patient and procedures performed on the patient on a given date of service. The treatment data is processed to generate nurse documentation, such as treatment and/or flow sheets. Electronic insurance claims or bill are automatically generated having optimized reimbursable insurance claim items, including predetermined codes based on the treatment data and the insurance carrier data to facilitate approval of the bill by the at least one insurance carrier.
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Citations
43 Claims
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1. A computerized method for generating electronic insurance claims or bills having optimized insurance claim items based on at least one insurance carrier of a patient, the method is comprised of:
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receiving insurance carrier data, which identifies the patient'"'"'s at least one insurance carrier; receiving patient data which identifies the patient and the patient'"'"'s ICD diagnoses; receiving treatment data which identifies drugs administered to the patient and procedures performed on the patient during a date of service; processing the treatment data to obtain nurse documentation, such as treatment and flow sheets, drug inventory and reorder forms; and automatically generating electronic insurance claims or bills having optimized reimbursable insurance claim items, including predetermined codes based on the treatment data and the insurance carrier data to facilitate approval of the claims or bills by the at least one insurance carrier. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 41, 42)
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21. A system for generating electronic insurance claims or bills having optimized insurance claim items based on at least one insurance carrier of a patient, the system comprising:
- a processor operable to execute computer program instructions;
a memory operable to store computer program instructions executable by the processor; and
computer program instructions stored in the memory to perform the steps of;
receiving insurance carrier data which identifies a patient'"'"'s at least one insurance carrier and patient data which identifies the patient and the patient'"'"'s ICD diagnoses;
receiving treatment data which identifies drugs administered to the patient and procedures performed on the patient during a date of service;
processing the treatment data to obtain nurse documentation, such as treatment, flow sheets, drug inventory and reorder forms; and
automatically generating electronic insurance claims or bills having optimized reimbursable insurance claim items including predetermined codes based on the treatment data and the insurance carrier data to facilitate approval of the claims or bill by the at least one insurance carrier. - View Dependent Claims (22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40)
- a processor operable to execute computer program instructions;
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43. A computer program product for generating electronic claims or bills having optimized claim items based on at least one insurance carrier of a patient, the product comprising:
- a computer readable medium; and
computer program instructions recorded on the medium and executable by a processor for performing the steps of;
receiving insurance carrier data which identifies the patient'"'"'s at least one insurance carrier and patient data which identifies the patient and the patient'"'"'s ICD diagnoses;
receiving treatment data which identifies drugs administered to the patient and procedures performed on the patient during a date of service;
processing the treatment data to obtain nurse documentation, such as treatment and flow sheets, drug inventory and reorder forms; and
automatically generating electronic insurance claims or bills having optimized reimbursable insurance claim items including predetermined codes based on the treatment data and the insurance carrier data to facilitate approval of the claims or bills by the at least one insurance carrier.
- a computer readable medium; and
Specification