METHODS AND APPARATUS FOR AUTOMATED WEB PORTAL AND VOICE SYSTEM DATA AGGREGATION

• US 20140200928A1
• Filed: 03/17/2014
• Published: 07/17/2014
• Est. Priority Date: 12/15/2011
• Status: Abandoned Application

• Current Assignee: Advance Response LLC
• Original Assignee: Advance Response LLC
• Inventors: Watanabe, Timothy, Poray, Kenneth, So, Craig, Eastley, Tiffany, Uyeda, Vince, Tsutsui, Mark, Han, James
• Application Number:
  US14/216,008
• Publication Number:
  US 20140200928A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 70/20 relating to practices or guidelines

Abstract

Methods and apparatus for automating the process for researching medical claims and/or eligibility, as well as standardizing and analyzing the resulting data are. These methods include automated processes for researching an insurance claim, comprising steps of interactively and recursively querying search fields in a web portal(s) and/or phone system(s), aggregating the information from multiple sources into a standardized format in a database table(s). This data can be used to generate analytics, predictive analysis and reports for the medical provider and/or payers. This application also sets forth multiple communication standards for exchanging data over a phone or computer system. Other embodiments are described.

Claims

1. A method for processing a medical claim, comprising:

receiving claim data about medical services from an information source comprising a patient, a medical provider, or a billing service;

placing the data into a database;

searching via web portal or voice system for additional data related to the claim from the same information source or another information source;

standardizing the data into a common database schema by mapping the data from the web site into database values using a right-to-left and top-to-bottom routine;

presenting the data in an organized user interface template, in an API, or in a result file;

configuring the database to allow the information source or another information source to interactively search, filter, or sort the standardized data; and

using the standardized data to resolve the medical claim.

2. The method of claim 1, wherein the claim data comprises eligibility data.

3. The method of claim 1, wherein the claim data is used to track operational or financial metrics.

4. The method of claim 1, further comprising normalizing the claim data from any information source from which claim data has been received.

5. The method of claim 1, further comprising standardizing the data into a common database schema by parsing the data from the voice system into the database using silence recognition to determine a decision path and trigger a data entry.

6. The method of claim 5, further comprising using the standardized data mapped from the web site during the process of parsing the data from the voice system.

7. The method of claim 5, further comprising using the standardized data parsed from the voice system during the process of mapping the data from the web site.

8. A method for processing a medical claim, comprising:

receiving claim data about medical services from an information source comprising a patient, a medical provider, or a billing service;

placing the data into a database;

searching via web portal or voice system for additional data related to the claim from the same information source or another information source;

standardizing the data into a common database schema by parsing the data from the voice system into the database using silence recognition to determine a decision path and trigger a data entry;

presenting the data in an organized user interface template, in an API, or in a result file;

configuring the database to allow the information source or another information source to interactively search, filter, or sort the standardized data via a user interface; and

using the standardized data to resolve the medical claim.

9. The method of claim 8, wherein parsing the data from the voice system comprises interactively navigating the IVR system of the information source.

10. The method of claim 9, wherein parsing the data from the voice system comprises using timing sequences to determine when an input can be entered in the IVR system.

11. The method of claim 8, wherein the claim data comprises eligibility data.

12. The method of claim 8, wherein the claim data is used to track operational or financial metrics.

13. The method of claim 8, further comprising normalizing the claim data from any information source from which claim data has been received.

14. The method of claim 8, further comprising standardizing the data into a common database schema by mapping the data from the web site into database values using a right-to-left and top-to-bottom routine.

15. The method of claim 14, further comprising using the standardized data mapped from the web site during the process of parsing the data from the voice system.

16. The method of claim 14, further comprising using the standardized data parsed from the voice system during the process of mapping the data from the web site.

17. A method for processing a medical claim, comprising:

receiving claim data about medical services from an information source comprising a patient, a medical provider, or a billing service;

placing the data into a database;

searching via web portal or voice system for additional data related to the claim from the same information source or another information source;

standardizing the data into a common database schema by mapping the data from the web site into database values using a right-to-left and top-to-bottom routine and by parsing the data from the voice system into the database using silence recognition to determine a decision path and trigger a data entry;

presenting the data in an organized user interface template, in an API, or in a result file;

configuring the database to allow the information source or another information source to interactively search, filter, or sort the standardized data; and

using the standardized data to resolve the medical claim.

18. The method of claim 17, further comprising using the standardized data mapped from the web site during the process of parsing the data from the voice system.

19. The method of claim 17, further comprising using the standardized data parsed from the voice system during the process of mapping the data from the web site.