Medical transaction system

• US 6,453,297 B1
• Filed: 12/31/1996
• Issued: 09/17/2002
• Est. Priority Date: 11/02/1993
• Status: Expired due to Fees

• Current Assignee: Athena of North America Incorporated
• Original Assignee: Athena of North America Incorporated
• Inventors: Schweitzer, Sheila H., Schick, Robert R., Burks, James L.
• Primary Examiner(s): Poinvil, Frantzy
• Application Number:
  US08/777,805
• Time in Patent Office: 2,086 Days
• Field of Search: 705/2, 705/3, 707/4, 707/17, 707/505, 707/507, 707/522-524, 707/1, 707/10, 707/500, 395/200.15, 379/100.13, 235/375, 364/222.2, 364/224.5
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G07F 17/0014 for vending, access and use of specific services not covered anywhere else in G07F17/00 meter-controlled dispensing of liquid, gas or electricity G07F15/00

Abstract

A medical transaction system is disclosed which is capable of permitting a plurality of healthcare providers to communicate with a plurality of payors and financial institutions. The healthcare providers, payors, and financial institutions do not have to communicate in the same data message formats nor in the same communication protocols. Such a system facilitates not only the processing of medical claims submitted by the healthcare providers to the payors, but also permits the transfer of medical data records between healthcare providers. The system supports the processing of medical claims without requiring a centralized database or imposing a uniform claim format on the healthcare providers and payors. The preferred embodiment of the invention further includes a financial transactor that uses remittance information from the payors to generate the electronics funds transfer messages to credit and debit accounts. Additionally, the system supports a medical line of credit at financial institutions that may be used to pay portions of medical claims not covered by payors.

Claims

1. A medical transaction system for communicating data messages between a plurality of computer stations located at healthcare providers and payors, comprising:

a communication receiver for receiving data messages related to patient care activities performed by said healthcare providers, said messages received from said computer stations at said healthcare providers in a plurality of formats and protocols recognized by said communications receiver;

a compiler for compiling patient care information from said data messages received from said computer stations to form a plurality of patient care records having a single common format that is independent of at least one of said plurality of formats and protocols recognized by said communication receiver;

an extractor for extracting ones of said patient care records in accordance with a computer station identification code;

a formatter for formatting said extracted patient care records in a format corresponding to said computer station identification code; and

a communications transmitter for transmitting said formatted patient care records to said computer station identified by said identification code in a format and protocol recognized by said identified computer station.

2. The system of claim 1 further comprising:

a verifier for verifying data fields within said data messages received from said computer stations and generating an error record indicating at least one data field within one of said received data messages failed verification.

3. The system of claim 2 wherein said verifier generates a patient care transaction database, said patient care transaction database including all said data fields of said verified data messages and identifying information for said data messages that failed verification.

4. The system of claim 3 further comprising:

an analyzer to generate statistical data from said patient care records in said patient care transaction database.

5. The system of claim 3 further comprising:

a financial transactor for generating electronic funds transfer messages in response to remittance information in said patient care records received from said computer stations located at said payors;

said formatter formats said electronic funds transfer messages in a format corresponding to a computer station identification code for a computer station located at a financial institution; and

said communications transmitter transmits said formatted electronic funds transfer messages to said computer station identified by said computer station identification code in accordance with a protocol corresponding to said computer station identification code.

6. The system of claim 5 wherein said electronic funds transfer messages include a debit message for debiting an account at a financial institution.

7. The system of claim 6 wherein said account is a medical health credit line account.

8. The system of claim 5 wherein said formatter formats said electronic funds transfer messages in format corresponding to a financial institution computer station identification code.

9. The system of claim 1 wherein said formats for said data messages communicated by a group of said computer stations correspond to one of an ANSI 835 and ANSI 837 formats.

10. The system of claim 1 wherein said communication receiver receives data messages indicating a medical claim by a healthcare provider from said computer stations located at said healthcare providers, said data messages having a format and protocol corresponding to a computer station identification code for said healthcare provider submitting a medical claim;

said compiler compiles claim information from said received data messages, and;

said communication transmitter transmits said compiled claim information to said computer stations located at said payors in accordance with a communication protocol and format corresponding to a computer station identification code for said payor to which a medical claim is being submitted.

11. The system of claim 10 wherein said compiler formats said compiled claim information in a patient care record having a single common format that is independent of all of said plurality of formats and protocols recognized by said communication receiver.

12. The system of claim 11 further comprising:

an analyzer to generate statistical data from said patient care records.

13. A medical transaction system for communicating data messages with a plurality of computer stations comprising:

a communications receiver for receiving data messages related to patient care activities performed by healthcare providers, said messages received from a first plurality of computer stations at said healthcare providers, said data messages having a plurality of pre-defined formats and protocols recognized by said communications receiver;

a compiler for compiling patient care information from said received data messages to form a plurality of patient care records having a single common format that is independent of at least one of said plurality of formats and protocols recognized by said communications receiver;

an extractor for extracting a portion of said compiled patient care information for transmission;

a formatter for formatting said extracted patient care information in a predetermined format and protocol; and

a communications transmitter for transmitting said formatted patient care information to a second plurality of computer stations, said transmitted information having a format and protocol different than said formats and protocols of said received data messages.

14. The system of claim 13 wherein said transmitted information has a plurality of formats and protocols.

15. The system of claim 13 wherein said transmitter transmits transmitted information to said first plurality of computer stations in said formats and protocols for said data messages.

16. The system of claim 15 wherein said receiver receives messages from said second plurality of computer stations.

17. The system of claim 16 wherein said transmitted information has a plurality of formats and protocols.

18. A medical transaction system for communicating medical data messages comprising:

a communication layer for communicating data messages related to patient care activities performed by healthcare providers with a plurality of computer stations, said data messages being communicated in a plurality of communication protocols and being formatted in a plurality of data message formats recognized by said communication layer; and

a medical transaction processing kernel for compiling patient care information from data messages received from said computer stations at said healthcare providers in different formats and different communications protocols, generating patient care records having a single common format that is independent of at least one of said plurality of formats and protocols recognized by said communication layer, and extracting a portion of said compiled patient care information for transmission to said computer stations.

19. The system of claim 18, said communication layer including:

a transaction manager for receiving and transmitting said data messages in said plurality of communication protocols.

20. The system of claim 18, said communications layer further comprising:

a service routine for generating data messages requesting security information from one of said computer stations communicating with said communication layer and terminating communication between said communication layer and said one of said computer stations in response to determining said computer station is unauthorized to communicate with said communication layer.

21. The system of claim 18, said medical transaction processing kernel further comprising:

a compiler for compiling patient care information from said data messages received from said computer stations and for formatting said compiled information into a patient care record;

an extractor for extracting selected ones of said patient care records corresponding to a computer station identification code; and

a formatter for formatting said extracted patient care records in a format corresponding to said computer station identification code.

22. The system of claim 21, said kernel further comprising:

a financial transactor for examining remittance information contained within a patient care record generated by said compiler, said financial transactor for generating electronic funds transfer data messages in response to said remittance information, said financial transactor for formatting said electronic funds transfer data messages in a format corresponding to one of said computer station identification codes.

23. The system of claim 22 wherein at least one of said computer stations is located at one of a credit processor and financial institution, said financial institution and credit processor for managing and processing credit lines for medical services secured to individuals, and

said financial transactor generates credit authorization messages for requesting whether sufficient credit is available to cover a portion of a medical claim not paid by an insurance carrier and generating electronic funds transfer messages in response to said credit processor and financial institution transmitting a data message to said system that credit is available to pay said uncovered portion of said medical claim.

24. The system of claim 18 wherein a group of computer stations within said plurality of computer stations are located at a plurality of healthcare providers and payors, of at least two of said computer stations at said healthcare providers and at least two of said computer stations at said payors communicate with said communications layer in an ANSI 837 format.

25. The system of claim 24 wherein said two of said computer stations at said healthcare providers format said data messages within said ANSI 837 format differently.

26. The system of claim 24 wherein said two of said computer stations at said payors format said data messages within said ANSI 837 format differently.

27. The system of claim 18 wherein a group of computer stations within said plurality of computer stations are located at a plurality of financial institutions and payors, at least two of said computer stations at said payors communicate with said communications layer in an ANSI 835 format.

28. The system of claim 27 wherein said two of said computer stations at said payors format said data messages differently from one another.

29. The system of claim 27 wherein said two of said computer stations at said financial institutions format said data messages differently.

30. A method for communicating medical transactions between a plurality of computer stations, some of said computer stations being located at healthcare providers and some of the said computer stations being located at payors, said method comprising:

communicating data messages related to patient care activities performed by healthcare providers with said plurality of computer stations at said healthcare providers and said payors in a plurality of data message formats and in a plurality of communication protocols; and

processing data messages received from said computer stations at said healthcare providers in different formats and different communications protocols to compile patient care information from said received data messages and to generate patient care records having a single common format that is independent of at least one of said plurality of formats and protocols, and extracting a portion of said compiled patient care information to generate data messages for transmission to said computer stations.

31. The method of claim 30, said communicating step further comprising:

receiving data messages from said plurality of computer stations in a plurality of data message formats; and

transmitting data messages to said plurality of said computer stations in a plurality of data message formats and communication protocols.

32. The method of claim 31, said receiving step further comprising:

collecting data messages communicated from said plurality of computer stations at a first rate; and

providing said collected data messages to said compiling step at a rate less than said collecting rate.

33. The method of claim 30, said communicating step further comprising:

securing said communication with said computer stations so said communication only occurs with authorized computer stations.

34. The method of claim 33, said securing communication step further including:

generating messages requesting security information from one said plurality of said computer stations with which communication is being established;

determining whether data messages received from said one of said plurality of computer stations in response to said data messages requesting security information indicates said one of said plurality of computer stations is authorized for communication; and

terminating said communication with said one of said plurality of computer stations in response to determining said one computer station is unauthorized for communication.

35. The method of claim 34, said processing step further comprising communicating with at least two of said computer stations in a ANSI 837 format.

36. The method of claim 35, said processing step further comprising:

communicating with said at least two computer stations in said ANSI 837 format differently.

37. The method of claim 34, said processing step further comprising:

communicating with at least two of said plurality of computer stations in an ANSI 835 format.

38. The method of claim 37, said processing step further comprising:

communicating with said two of said plurality of said computer stations in said ANSI 835 format differently.

39. The method of claim 30, the processing step further comprising:

compiling information from data messages received from said plurality of computer stations;

formatting said compiled information into patient care records;

extracting ones of said patient care records that correspond to a computer station identification code; and

formatting said extracted patient care records in a data message format corresponding to a computer station identification code.