Automated posting of medical insurance claims

• US 5,235,702 A
• Filed: 04/11/1990
• Issued: 08/10/1993
• Est. Priority Date: 04/11/1990
• Status: Expired due to Fees

• Current Assignee: Brent G. Miller
• Original Assignee: Brent G. Miller
• Inventors: Miller, Brent G.
• Primary Examiner(s): Heckler, Thomas M.
• Application Number:
  US07/507,401
• Time in Patent Office: 1,217 Days
• Field of Search: 371/31, 382/57, 358/405, 395/575, 395/600, 395/650, 364/401, 364/406, 364/408, 364/200 MS File, 364/900 MS File
• US Class Current: 1/1
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: Y10S 707/99942 Manipulating data structure, e.g. compression, compaction, compilation
• CPC Class Codes: Y10S 707/99943 Generating database or data structure, e.g. via user interface

Abstract

A method for inputting into a computerized data base system data disposed in a known format and comprising machine generated text is disclosed. The method comprises the steps of providing a document of known format; inputting the document into a computer system and converting the document into computer readable characters without manual typing of each characters; reconstructing within the computer the converted text which does not conform to the known format; flagging converted text which does not conform to the known format and which cannot be reconstructed; manually correcting the flagged text; and inputting the converted document to a computerized data base system.

Claims

1. A method for inputting into a computerized data base system data disposed in a desired format stored in the data base system and comprising test, the method comprising the steps of:

(a) providing a document of desired format;

(b) optically scanning the document and converting information thereon into computer readable characters and inputting the computer readable characters to a computer;

(c) automatically determining which, if any, converted information does not correspond to the desired format and reconstructing within the computer into which the optically scanned document has been input by reference to the desired format or other converted information, converted information which does not conform to the desired format;

(d) automatically flagging converted information which does not conform to the desired format and which cannot be reconstructed;

(e) manually correcting the flagged information; and

(f) transferring the converted, reconstructed and corrected document into a computerized data base system.

2. A method as in claim 1, and including the step of:

(a) utilizing ASCII code for the computer readable characters.

3. A method as in claim 1, and including the steps of:

(a) parsing the converted information into a number of data fields; and

(b) determining whether each field corresponds to a respective format model.

4. A method as in claim 1, including the steps of:

(a) providing a document having numerical data as the information;

(b) establishing a mathematical model for the numerical data; and

(c) determining whether the numerical data satisfies the mathematical model.

5. The method as in claim 1, including the steps of:

(a) providing a document having as the information a person'"'"'s name; and

(b) determining whether the name is in proper format.

6. A method as in claim 1, including the steps of:

(a) providing a document having as the information a person'"'"'s identification number; and

(b) determining whether the identification number is in a proper format.

7. A method as in claim 1, including the steps of:

(a) providing a document having as the information a currency figure; and

(b) determining whether the currency figure is in a proper format.

8. A method as in claim 1, and including the step of:

(a) repeating the determining and reconstructing step after the flagged information has been corrected.

9. A method as in claim 1, and including the steps of:

(a) separating the converted information into at least two data fields;

(b) comparing the converted information of each data field to a desired format; and

(c) flagging data which does not conform to the desired format.

10. A method as in claim 1, including the steps of:

(a) providing a document having as the information data disposed in a plurality of rows and columns;

(b) separating each row of data into fields;

(c) checking each field against a desired format; and

(d) flagging each field that does not conform to the desired format.

11. A method as in claim 1, including the steps of:

(a) providing a document having as the information numerical data disposed in a plurality of rows and columns;

(b) establishing a mathematical relationship for the numerical data of each row and each column;

(c) comparing the data for each column and row and determining whether the data satisfies the mathematical relationship for the row and for the column; and

(d) flagging all data for a row or a column that does not satisfy the associated mathematical relationship.

12. A method for automatically posting data to a provider'"'"'s medical system, the data being contained on at least a page of a returned medical insurance claim, each page having data disposed in a known format, the method comprising the steps of:

(a) providing a returned medical insurance claim of desired format having information thereon;

(b) optically scanning each page of the returned medical insurance claim and converting the information into computer readable text which is then input into a computer;

(c) automatically determining within the computer which text does not correspond to the desired format and reconstructing within the computer by reference to the desired format or the converted information the converted text that does not conform to the desired format;

(d) flagging converted test that does not conform to the desired format and which cannot be reconstructed and requesting correction and confirmation thereof;

(e) manually correcting flagged text which is not confirmed;

(f) repeating the determining and reconstructing step to thereby correct or confirm all other flagged text; and

(g) automatically posting the converted, reconstructed and corrected returned medical insurance claim to a provider'"'"'s computer system.

13. A method as in claim 12, and including the step of:

(a) manually confirming the accuracy of each flagged text or supplying new information in place thereof.

14. A method as in claim 12, and including the steps of:

a) parsing the returned medical insurance claim into a number of data fields; and

b) checking each field against a respective format model.

15. A method as in claim 12, including the steps of:

(a) providing a returned medical insurance claim having numerical data as the information;

(b) establishing a mathematical model for the numerical data; and

(c) determining whether the numerical data satisfies the mathematical model.

16. A method as in claim 12, including the steps of:

(a) providing a returned medical insurance claim having a person'"'"'s name as the information; and

(b) determining whether the name is in proper format.

17. A method as in claim 12, including the steps of:

(a) providing a returned medical insurance claim having a person'"'"'s identification number as the information; and

(b) determining whether the identification number is in proper format.

18. A method as in claim 12, including the steps of:

(a) providing a returned medical insurance claim having a currency figure as the information; and

(b) determining whether the currency figure is in proper format.

19. A method as in claim 12, and including the steps of:

(a) separating the computer readable text into at least two data fields;

(b) comparing the computer readable text of each data field to a desired format; and

(c) flagging data which does not conform to the desired format.

20. A method as in claim 12, including the steps of:

(a) providing a returned medical insurance claim having as the information data disposed in a plurality of rows and columns;

(b) separating the rows of data into a plurality of fields;

(c) checking each field against a desired format; and

(d) flagging each field that does not conform to the desired format.

21. A method as in claim 12, including the steps of:

(a) providing the returned medical insurance claim having as the information numerical data disposed in a plurality of rows and columns;

(b) establishing a mathematical relationship between the numerical data for each row and for each column;

(c) checking whether the data for each column and row satisfies the associated mathematical relationship for the associated row and column; and

(d) flagging all data of a row or column that does not satisfy the associated mathematical relationship.

22. A method for inputting data disposed in a plurality of rows and columns of known format on a document having machine generated text into a computer system, the method comprising the steps of:

(a) scanning the document text and thereby converting the text into computer readable characters and inputting the computer readable characters into a computer;

(b) automatically reconstructing by reference to a desired format or other computer readable characters within the computer converted text that does not conform to a desired format;

(c) automatically flagging within the computer converted text that does not conform to the desired format;

(d) interactively correcting the flagged text; and

(e) automatically transferring the corrected text into another computer system.

23. A method as in claim 22, including the steps of:

(a) providing a document having text in rows of data;

(b) separating each row of data into a number of groups;

(c) separating each group of data of each row into a number of fields of data;

(d) verifying and checking each field of data; and

(e) flagging each field of data that does not correspond to a desired format.

24. A method as in claim 23, and including the steps of:

a) manually confirming or supplying new data to each flagged data.

25. A method as in claim 24, and including the step of:

(a) determining whether correction of flagged data causes a corresponding correction to other flagged data and causing the other flagged data to be corrected in response thereto.

26. A method as in claim 22, and including the step of:

a) scanning the document with an electronic scanner.

27. A method as in claim 22, and including the step of:

(a) utilizing ASCII code for the computer readable characters.

28. A method for computer processing documents, comprising the steps of:

(a) providing a document having information thereon;

(b) optically scanning the document and converting the information into computer usable text;

(c) inputting the computer usable text into a computer;

(d) comparing within the computer the computer usable text with a predetermined format and determining which, if any, of the computer usable text does not correspond to the predetermined format; and

(e) requesting correction or confirmation of the accuracy of the computer usable text determined not to correspond to the predetermined format.

29. The method of claim 28, including the step of:

(a) posting the computer usable text to a data base after data determined not to correspond to the predetermined format has been corrected or confirmed.

30. A system for inputting into a computer data from a document having a known format and having machine generated text, comprising:

(a) a computer system;

(b) means for optically scanning the document and converting the document text into computer readable characters so that the converted text may be input into the said system;

(c) first program means within said system for automatically reconstructing converted text that does not conform to a predetermined format stored in said system;

(d) second program means within said system for permitting converted text that does not conform to the predetermined format to be manually corrected; and

(e) third program means within said system for automatically posting the correct text to another computer system.