SYSTEMS TO ASSIST IN THE CREATION, TRANSMISSION, AND PROCESSING OF HEALTH INSURANCE CLAIMS

• US 20150088560A1
• Filed: 11/25/2014
• Published: 03/26/2015
• Est. Priority Date: 03/28/1996
• Status: Active Grant

• Current Assignee: Integrated Claims Systems LLC
• Original Assignee: Integrated Claims Systems LLC
• Inventors: DiRienzo, Andrew L.
• Granted Patent: US 9,619,841 B2
• 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

Abstract

Systems to assist in the creation, transmission, and processing of health insurance claims. Computer-implemented methods that enable the receiving of, storing of, and granting access to data in such systems.

Claims

1. A system designed to assist in the creation, transmission, and processing of files comprised of data in fields, the system comprising:

a first computer system for creation of files comprised of data in fields;

a second computer system for providing online storage;

a third computer system for providing a clearinghouse; and

a fourth computer system for processing files comprised of data in fields;

wherein each computer system comprises at least one computer;

wherein at least some software of the first computer system is coordinated with at least some software of the fourth computer system;

wherein the first computer system is configured to receive first data, second data, and cross-referencing data;

wherein the first computer system, in response in part to receipt of the first data, is configured

to generate a first file comprising fields containing at least some of the first data, and

to transmit the first file to the second computer system;

wherein the first computer system, in response in part to receipt of the second data, is configured

to generate a second file comprising fields containing at least some of the second data and fields containing at least some of the cross-referencing data, but not containing any of the first data, and

to transmit the second file to the third computer system;

wherein the cross-referencing data is used to correlate the first data in the first file with the second data in the second file;

wherein the fourth computer system accesses the second file at the third computer system;

wherein the fourth computer system accesses at least some of the first data comprising the first file at the second computer system by using the cross-referencing data in the second file;

wherein the fourth computer system processes the second file, at least in part, by entering data into at least one field in a third file; and

wherein the data entered is created by using the data from at least one field of the second file.

2. The system of claim 1, wherein the second file comprises a form and the first file comprises an attachment to the form.

3. The system of claim 2, further comprising:

wherein the form is one selected from a group consisting of a health-insurance claim form, a property-casualty-insurance claim form, and a law-enforcement form;

wherein the health-insurance claim form is one selected from the group consisting of a dental-insurance prior-approval claim form, a dental-insurance claim form, a medical-insurance prior-approval claim form, a medical-insurance claim form; and

wherein the attachment to the form is one selected from a group consisting of dental-insurance-claim attachment data and medical-insurance-claim attachment data, and property/casualty-insurance-claim attachment data.

4. The system of claim 1, wherein

the first data comprises health-care data;

wherein the health-care data is one selected from the group consisting of medical data and dental data;

the second data comprises health-insurance claim data;

wherein the health-insurance claim data is one selected from the group consisting of dental-insurance prior-approval claim data, dental-insurance claim data;

medical-insurance prior-approval claim data, and medical-insurance claim data; and

the health-insurance claim data and health-care data are related to a particular health care encounter between a patient and a health care provider.

5. The system of claim 1, wherein the first data comprises at least one item selected from a group consisting of a dental X-ray, an Explanation Of Benefits (EOB), an X-ray, a CT, an MRI, an EKG, an EEG, a recording, a digitized video signal, a transcription of Operating Room Notes, pictures, graphs, sound recordings, and ASCII text.

6. The system of claim 1, wherein the second data comprises at least one item selected from a group consisting of patient name, patient identification, patient social security number, provider name, provider address, provider identification number, examination and treatment record, and insurance company name.

7. The system of claim 1, wherein the fourth computer system comprises first and second computer subsystems.

8. The system of claim 7, wherein the first computer subsystem contains at least a claims management computer and the second computer subsystem contains at least a buffer computer.

9. The system of claim 7, wherein the first and second computer subsystems are networked together.

10. The system of claim 7, wherein the first and second computer subsystems are not networked together.

11. The system of claim 8, wherein the buffer computer is used to access the first file at the second computer.

12. The system of claim 1, wherein the first computer system is located at a dental health care provider'"'"'s office.

13. The system of claim 1, wherein when the second file reaches the fourth computer system, the fourth computer system is configured such that data from at least one of the fields of the second file is transferred directly into a correlated field in the software of the fourth computer system without manual reentry.

14. The system of claim 1, wherein the second computer is an online computer.

15. The system of claim 1, wherein the second computer is at least one of a value added service computer and a computer comprising a data bank.

16. The system of claim 15, wherein the value added service acts as an online archiving service for patients'"'"' health-care records.

17. The system of claim 1, wherein the third computer is an insurance claims clearinghouse.

18. The system of claim 1, wherein the third file is an Explanation Of Benefits (EOB).

19. A computer-implemented method that enables the receiving of, storing of, and granting access to data, the method comprising:

receiving, at a first computer system, first data from a second computer system;

storing, by the first computer system, at least the first data and data identifying the first data;

receiving, at the first computer system, a request to access the first data from a third computer system;

wherein the request includes at least some of the data identifying the first data; and

wherein the request complies with security measures taken to restrict access of the first data; and

granting to the third computer system, by the first computer system, access to the first data;

wherein the first data has been formatted, by the first computer system, for the third computer system; and

wherein the first, second, and third computer systems each comprise at least one computer.

20. The method of claim 19, wherein the first data comprises a patient'"'"'s health-care data.

21. The method of claim 20, wherein the patient'"'"'s health-care data is from a particular health care encounter between a patient and a health care provider.

22. The method of claim 20, wherein the patient'"'"'s health-care data comprises at least one of medical data, dental data, and health-insurance-claim attachment data.

23. The method of claim 20, wherein the patient'"'"'s health-care data comprises at least one item selected from a group consisting of a dental X-ray, an X-ray, a CT, an MRI, an EKG, an EEG, a recording, a digitized video signal, a transcription of Operating Room Notes, pictures, graphs, sound recordings and ASCII text.

24. The method of claim 19, wherein:

the first computer is one of a value added service computer and a national dental data bank computer;

the second computer is a health care provider'"'"'s computer; and

the third computer is one of a health care payer'"'"'s computer and a health care provider'"'"'s computer.

25. The method of claim 19, wherein the first computer is an online computer that is accessible online by the second and third computers.

26. The method of claim 19, wherein at least some of the first data is in fields.

27. The method of claim 19, wherein the formatting is done by the first computer to meet requirements of the third computer.