Attachment integrated claims system and operating method therefor

• US 6,480,956 B1
• Filed: 01/07/2002
• Issued: 11/12/2002
• 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:
  US10/036,432
• Time in Patent Office: 309 Days
• Field of Search: 713/150, 713/153, 713/164, 713/165, 713/166, 713/168
• US Class Current: 713/150
• 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

A combination of first, second, and third storage media storing computer readable instructions permit non-networked computers to cooperate synergistically. Preferably, the first storage medium stores computer readable instructions for permitting a first computer system to receive textual data as field data, to assemble the field data and a corresponding digitized attachment into a first file and to transmit the first file to a second computer system via the Internet, while the second storage medium stores computer readable instructions for permitting the second computer system to receive the first file via the Internet, to display the first file including the digitized attachment on a first window generated by a graphics user interface (GUI) instantiated by the second computer system, to display a second file in a second window, and to transfer the field data to a third computer system operatively connected to the second computer system. Additionally, the third storage medium stores computer readable instructions for permitting the third computer system to receive the field data from the second computer system, to process the field data to thereby generate the second file including portions of the field data extracted from the first file, and to transmit the second file to the second computer system. Corresponding systems and methods are also described.

Claims

1. A combination of memories modules storing modules software for converting multiple existing computer systems into a special purpose computer system for generating, transmitting, and processing attachment integrated files, each of said files containing a plurality of data fields with at least one of said data fields containing a digital attachment, comprising:

a first memory disposed in an existing first computer system storing a first legacy software module, said first legacy software module containing first operating instructions readable by said first computer system;

a second memory disposed in an existing second computer system storing a second legacy software module, said second legacy software module;

containing second operating instructions readable by said second computer system, and

being constructed to process files of specified fields, said fields not containing digital attachments,

a third software module, accessible by said first computer system, said third software module containing third operating instructions readable by said first computer system,

a server computer, said server computer operationally connected to said second computer system via a first communications channel,

a second communications channel operationally connecting said first computer system to said server computer for the purpose of transmitting the attachment integrated file from said first computer to said server computer, wherein;

the first computer system further comprises;

a first display device for displaying a first form, said first form being instantiated by said third software module;

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 third operating instructions; and

the server computer further comprises;

a third memory storing a fourth software module, said fourth software module containing fourth operating instructions readable by said server computer system, said fourth software module operating instructions being designed to instruct said server computer to automatically transmit to said second computer system via said first communications channel those data fields, of an attachment integrated file received from said first computer, that the second legacy software module was specifically constructed to process.

2. The combination as recited in claim 1, wherein said server computer further comprises:

a second input device permitting entry of second alpha-numeric characters required to complete a second form into said second form, said second form containing a plurality of data fields;

a second display device for displaying said second form and said attachment integrated file received from said second communications channel, said second form being automatically generated when said attachment integrated file is opened, said second form and said attachment integrated file being stored in said third memory and at least a portion of said first alpha-numeric characters in said attachment integrated file are automatically transferred from said attachment integrated file to said second form; 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 third operating instructions.

3. The combination as recited in claim 1, wherein said third software module resides in the memory of said first computer system.

4. The combination as recited in claim 3, wherein said third software module residing on said first computer system is integrated with said first legacy software module.

5. The combination as recited in claim 1, wherein said first software module resides on a server computer accessible by said first computer system via the internet.

6. The combination as recited in claim 1, wherein said attachment integrated file, instantiated by said third software module, is generated by said first computer system, is transmitted to said server via said second communications channel, and the information in specified data fields is digitally entered directly into said second computer system by said fourth software module without manual re-entry of said information of the specified data fields into said second computer system.

7. The combination as recited in claim 1, wherein said specified data fields and said attachment data are labeled with the same document identification number when said attachment integrated file is received by said server.

8. The combination as recited in claim 1, wherein said third software module and said fourth software module are coordinated in that said fourth software module can identify which fields of said attachment integrated file generated by said third software module are data fields to be transmitted to said second computer system and which fields are attachment fields.

9. The combination as recited in claim 1, wherein said third software module generates said first form with format and fields as determined by said second user.

10. The combination as recited in claim 1, wherein said server computer is disposed at a facility operated by said second user.

11. The combination as recited in claim 1, wherein said fourth software module and said second legacy software module are integrated together.

12. The combination as recited in claim 1, wherein said third software module and said fourth software module can be update at the request of said second user.

13. The combination as recited in claim 1, wherein said first computer system further comprises a device for generating the digitized attachment data.

14. The combination as recited in claim 13, wherein said device for generating the digitized attachment data is a scanner.

15. The combination as recited in claim 1, wherein said first computer system further comprises a device for accepting the digitized data generated from an external source.

16. The combination as recited in claim 15, wherein said device for accepting the digitized data generated from an external source is a CD-ROM drive.

17. The combination as recited in claim 1, wherein once the attachment integrated file has been received by said server computer, said server computer or the second computer system sends an email message to said first user notifying them that the said attachment integrated file has been received.

18. The combination as recited in claim 1, wherein the attachment data includes one of pictures, graphs, sound recordings, nonstandard text, x-rays, CTs, MRIs, EKG or EEG recordings, digitized video signals, transcriptions of Operating Room Notes, estimates for services, Explanation of Benefits (EOBs), and additional ASCII text.

19. The combination as recited in claim 1, wherein said first computer system is used to submit claims for service from a healthcare service provider to a healthcare payer.

20. The combination as recited in claim 1, wherein said first legacy software module residing on said first computer system is Practice Management Software.

21. The combination as recited in claim 1, wherein said second computer system is disposed at a facility operated by a healthcare payer'"'"'s and said second legacy software module is the software used by said payer to process electronic claims submitted by healthcare providers.

22. The combination as recited in claim 1, wherein said second computer system is the legacy computer system used by a healthcare payer to process electronic claims submitted by healthcare providers.

23. The combination as recited in claim 1, wherein:

said first form is a Prior Approval Claim form;

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

said second form is a Predetermination form.

24. The combination as recited in claim 1, wherein said first form is a Final Payment Claim form.

25. The combination as recited in claim 2, wherein the second form is an Explanation of Benefits (EOB).

26. The combination as recited in claim 1, wherein said second communications channel may contain a claims clearing house.