Attachment integrated claims system and operating method therefor

• US 6,003,007 A
• Filed: 03/25/1997
• Issued: 12/14/1999
• Est. Priority Date: 03/28/1996
• Status: Expired due to Term

• Current Assignee: Integrated Claims Systems LLC
• Original Assignee: Andrew L. Dirienzo
• Inventors: DiRienzo, Andrew L.
• Primary Examiner(s): Peeso, Thomas R.
• Application Number:
  US08/824,010
• Time in Patent Office: 994 Days
• Field of Search: 705/4, 705/3, 395/200.3, 395/200.35, 395/200.48, 395/200.57, 395/200.61, 395/200.68
• US Class Current: 705/4
• CPC Class Codes: G06F 3/0481 based on specific properties of the displayed interaction object or a metaphor-based environment, e.g. interaction with desktop elements like windows or icons, or assisted by a cursor's changing behaviour or appearance
• CPC Class Codes: G06F 3/0482 Interaction with lists of selectable items, e.g. menus
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 10/02 Reservations, e.g. for tickets, services or events
• CPC Class Codes: G06Q 10/025 Coordination of plural reservations, e.g. plural trip segments, transportation combined with accommodation
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G06Q 40/12 Accounting
• CPC Class Codes: G06Q 99/00 Subject matter not provided for in other groups of this subclass
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 30/20 for handling medical images, e.g. DICOM, HL7 or PACS
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

An attachment integrated claims (AIC) system is formed by a combination of first, second and third storage media. The first storage medium stores computer readable instructions for permitting a first computer system to receive textual data as field data, where each of the field data is displayed on a predetermined portion of a first screen of the first computer system, to assemble the field data and a corresponding digitized image into a first file having an integrated file format and to transmit the first file to a second computer system via a communications channel. The second storage medium stores computer readable instructions permitting the second computer system to receive the first file via the communications channel, to display the corresponding digitized attachment on a second screen of the second computer system, and to transfer the field data to a third computer operatively connected to the second computer. In addition, the third storage medium stores computer readable instructions permitting the third computer system to receive the field data from the second computer, to display the field data on a third screen and to generate a second file including portions of the field data extracted from the first file. In other words, the AIC system permits transmission of a customizable claim form and integrated attachment to an insurance carrier via a non-clearinghouse communications channel. An AIC system including several computers connected via a communications channel, an electronic file, and an operating method therefor are also described.

Claims

1. A system for transmitting and receiving attachment integrated files each containing a plurality of field data and digitized data corresponding to at least one of the field data, said system comprising:

a first computer system including;

a first memory storing a first software module containing first operating instructions readable by said first computer system;

a first display device for displaying a predetermined first form, said first form being stored in said first memory;

a first input device permitting entry of first alpha-numeric characters into said first form; and

a first processor for converting said first alpha-numeric characters into fields to thereby generate first field data, and converting the first field data and the digitized data into one of the attachment integrated files responsive to said first operating instructions;

a communications channel receiving said one of said attachment integrated files; and

a second computer system, receiving said one of said attachment integrated files from said communications channel, including;

a second memory storing a second software module containing second operating instructions readable by said second computer system;

a second input device permitting entry of second alpha-numeric characters required to complete a second form into said second form;

a second display device for displaying said first form, said second form, said first and second forms being stored in said second memory, and said digitized data, wherein at least a portion of said first alpha-numeric characters are exhibited in said first and second forms simultaneously; and

a second processor for converting said second alpha-numeric characters into fields to thereby generate second field data, and generating an outgoing message containing said second field data responsive to said second operating instructions.

2. The system as recited in claim 1, wherein said second computer comprises a buffer computer system electrically coupled to a mainframe computer.

3. The system as recited in claim 1, wherein:

said first computer system is disposed at a facility operated by a service provider; and

said second computer system is disposed at a facility operated by an insurance company.

4. The system as recited in claim 1, wherein:

said first form is a Prior Approval Claim application;

said digitized data corresponds to a dental x-ray; and

said second form is a Predetermination form.

6. A system for transmitting and receiving attachment integrated mail messages each containing a plurality of field data and digitized data corresponding to at least one of the field data, said system comprising:

first means for generating one of the attachment integrated files including;

second means for storing first operating instructions readable by said first means;

third means for generating the digitized data;

fourth means for exhibiting a predetermined first form, said first form being stored in said second means;

fifth means for entering first alpha-numeric characters into said first form; and

sixth means for converting said first alpha-numeric characters into fields to thereby generate first field data, and for converting the first field data and the digitized data into said one of the attachment integrated files;

seventh means for transmitting said one of said attachment integrated files; and

eighth means for receiving said one of said attachment integrated files from said seventh means including;

ninth means storing second operating instructions readable by said eighth means;

tenth means for entering second alpha-numeric characters required to complete a predetermined second form into said second form;

eleventh means for exhibiting said first form, said second form, said first and second forms being stored in said ninth means, and said digitized data, wherein at least a portion of said first alpha-numeric characters are exhibited in said first and second forms simultaneously; and

twelfth means for converting said second alpha-numeric characters into fields to thereby generate second field data, and for generating an outgoing file containing said second field data.

5. The system as recited in claim 7, wherein:

said first form is a Final Payment Claim form;

said digitized data corresponds to explanation of Medicare benefits (EOMB) information; and

said second form is an explanation of benefits (EOB) form.

7. The system as recited in claim 6, wherein said eighth means comprises a buffer computer system operatively connected to a mainframe computer.

8. The system as recited in claim 6, wherein:

said first means is disposed as to be operated by a service provider;

said eighth means is disposed so as to be operated by an insurance company;

said first form is a Prior Approval Claim application;

said digitized data corresponds to a dental x-ray; and

said second form is a Predetermination form.

9. A method for operating a computer system including first, second and third computers, each of said first, second and third computers including a memory, an input device, and a display, respectively, said first and said second computers being connected to one another by modems and a common communication line, and said first computer including a digitizing device, said method comprising the steps of:

(a) retrieving a first form from storage in the first computer'"'"'s memory and displaying said first form on the first computer'"'"'s display;

(b) writing first field data to said first form using the first computer'"'"'s input device;

(c) digitizing a patient'"'"'s x-ray to thereby generate a digitized x-ray;

(d) combining said digitized x-ray and said first form so as to generate an attachment integrated file;

(e) transmitting said attachment integrated file to the second computer;

(f) transmitting said first field data from said second computer to said third computer;

(g) generating a second form upon receipt of said attachment integrated file, said first and second forms containing at least a portion of said first field data;

(h) displaying said first form, said second form and an image corresponding to said digitized x-ray on respective displays of said third computer and said second computer;

(i) writing second field data to said second form using said third computer'"'"'s input device;

(j) transmitting said first and second field data corresponding to second form back to the first computer.

10. The method as recited in claim 9, further comprising the steps of:

(k) receiving said first and second field data corresponding to said second form on the first computer;

(l) reconstructing and displaying said second form on the first computer'"'"'s display;

(m) adding completion data to said second form using the first computer'"'"'s input device to thereby convent said second form into a third form; and

(n) transmitting said first and second field data and said completion data corresponding to said third form from the first computer to a selected one of said second and third computers.

11. The method as recited in claim 9, further comprising the steps of:

(o) receiving said first and second field data corresponding to said second form on the first computer;

(p) generating a third form responsive to receipt of said first and second field data corresponding to said second form;

(q) automatically transferring selected portions of said first and second filed data to said third form;

(r) entering completion data into said third form using the first computer'"'"'s input device; and

(s) transmitting said selected portions of said first and second field data and said completion data corresponding to said third form from the first computer to a selected one of said second and third computers.

12. The method as recited in claim 9, wherein said step (d) comprises the step of combining said digitized x-ray and said first form by inserting said digitized x-ray into a predetermined field portion of said first form so as to generate an attachment integrated file.

13. The method as recited in claim 9, wherein said step (d) comprises the step of combining said digitized x-ray and said first form by specifying that said digitized x-ray is an attachment to said first form and by inserting into said first form and said digitized x-ray a common identification code so as to generate an attachment integrated file.

14. The method as recited in claim 9, wherein said step (e) comprises the steps of:

(e)(i) transmitting said attachment integrated claim application to an on-line service; and

(e)(ii) transmitting said attachment integrated claim application from said on-line service to the second computer.

15. The method as recited in claim 9, wherein said step (i) comprises the steps of:

(i)(i) transmitting said second form to an on-line service; and

(j)(ii) transmitting said second form from said on-line service to the first computer.

16. The method as recited in claim 9, wherein:

said attachment integrated claim application is a Prior Approval Claim application;

said digitized x-ray comprises one field of said attachment integrated claim application; and

said second form is a Predetermination form.

17. A method for operating a computer network including first and second computer systems connected by a communications channel, each of said first and second computers including a memory, an input device, and a display, respectively, said method comprising the steps of:

(a) retrieving a first form from storage in the first computer system'"'"'s memory and displaying said first form on the first computer system'"'"'s display;

(b) writing first field data to said first form using the first computer system'"'"'s input device;

(c) combining a digital attachment and said first form so as to generate an attachment integrated file;

(d) transmitting said attachment integrated file to the second computer system;

(e) generating a second form upon receipt of said attachment integrated file, said first and second forms containing at least a portion of said first field data;

(f) displaying said second form and an image corresponding to said digital attachment on the second computer system'"'"'s display; and

(g) writing second field data to said second form using the second computer system'"'"'s input device.

18. The method as recited in claim 17, wherein said second computer system comprises a buffer computer system and a mainframe computer and further comprising the step of (h) transmitting selected portions of said first field data and said second field data back from said mainframe computers to the first computer system.

19. The method as recited in claim 17, wherein said computer network includes a third computer system and wherein said method further comprises the step of (i) transmitting selected portions of said first field data said second field data from the second computer system to the third computer system.