SYSTEM AND METHOD FOR PROCESSING DATA RELATED TO CASE MANAGEMENT FOR INJURED INDIVIDUALS
First Claim
1. A computer system for processing data relating to medical claim management, comprising:
- a plurality of data storage devices storing;
data relating to medical claims;
data relating to system users, comprising claim handlers, clinical triage consultants and case managers, the clinical triage consultants and case managers having a greater level of clinical expertise than the claim handlers; and
rules data;
a claim management hardware server in communication with the plurality of data storage devices and with a plurality of devices accessible to the system users, the server configured to;
access from one or more of the plurality of data storage devices data relating to one of a plurality of medical claims and a claim handler assigned to the claim for long-term medical management;
determine based on the accessed data relating to the claim and rules data stored in one or more of the plurality of data storage devices whether the claim is to be assigned to a clinical triage consultant for a short-term review or to a case manager for management together with the claim handler;
responsive to determining that the claim is to be assigned to the clinical triage consultant or the case manager, assign the claim; and
notify the another one of the system users via one of the devices accessible to the system users of the assignment.
1 Assignment
0 Petitions
Accused Products
Abstract
A computer system for processing data relating to medical claim management includes data storage devices storing data relating to medical claims, system users having multiple levels of experience, and rules data; and a claim management hardware server in communication with the data storage devices and with devices accessible to the system users. The server is configured to: determine whether a claim is to be assigned from one system user to another one of the system users based on one or more of time-based and event-based triggers, responsive to determining that the claim is to be assigned to another one of the users for short-term review, assign the claim to another one of the system users at the determined level of experience; and notify the another one of the system users via one of the devices accessible to the system users of the assignment.
24 Citations
20 Claims
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1. A computer system for processing data relating to medical claim management, comprising:
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a plurality of data storage devices storing;
data relating to medical claims;
data relating to system users, comprising claim handlers, clinical triage consultants and case managers, the clinical triage consultants and case managers having a greater level of clinical expertise than the claim handlers; and
rules data;a claim management hardware server in communication with the plurality of data storage devices and with a plurality of devices accessible to the system users, the server configured to; access from one or more of the plurality of data storage devices data relating to one of a plurality of medical claims and a claim handler assigned to the claim for long-term medical management; determine based on the accessed data relating to the claim and rules data stored in one or more of the plurality of data storage devices whether the claim is to be assigned to a clinical triage consultant for a short-term review or to a case manager for management together with the claim handler; responsive to determining that the claim is to be assigned to the clinical triage consultant or the case manager, assign the claim; and notify the another one of the system users via one of the devices accessible to the system users of the assignment. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. A computer-implemented method for processing data relating to medical claim management, comprising:
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accessing by a claim management hardware server from one or more of a plurality of data storage devices data relating to one of a plurality of medical claims and a system user assigned to the claim for long-term medical management; determining by the claim management server based on the accessed data relating to the claim and rules data stored in one or more of the plurality of data storage devices whether the claim is to be assigned to another one of the system users for short-term review and a level of the another system user; responsive to determining that the claim is to be assigned to another one of the users for short-term review, assigning by the claim management hardware server the claim to another one of the system users at the determined level; and notifying by the claim management hardware server the another one of the system users of the assignment via one of a plurality of devices accessible to the system users. - View Dependent Claims (12, 13, 14, 15, 16)
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17. A non-transitory computer-readable storage medium, the computer-readable storage medium having processor-executable instructions stored thereon relating to processing of data for medical claim administration, which instructions, when executed by the processor, cause the processor to:
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access from one or more of a plurality of data storage devices data relating to one of a plurality of medical claims and a system user assigned to the claim for long-term medical management; determine based on the accessed data relating to the claim and rules data stored in one or more of the plurality of data storage devices whether the claim is to be assigned to another one of the system users for short-term review and the level of experience of the another system user; responsive to determining that the claim is to be assigned to another one of the users for short-term review, assign the claim to another one of the system users at the determined level of experience; and notify the another one of the system users of the assignment by providing data indicative of the notification over a network addressed to one of a plurality of devices accessible to the system users. - View Dependent Claims (18, 19, 20)
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Specification