Method and system for providing evaluation data from tracked, formatted administrative data of a service provider

• US 6,915,266 B1
• Filed: 07/31/2000
• Issued: 07/05/2005
• Est. Priority Date: 07/31/2000
• Status: Expired due to Fees

• Current Assignee: Aysha Saeed, Azam Saeed
• Original Assignee: Aysha Saeed, Azam Saeed
• Inventors: Saeed, Aysha, Saeed, Azam
• Primary Examiner(s): Thomas, Joseph
• Assistant Examiner(s): KOSOWSKI, CAROLYN M
• Application Number:
  US09/630,015
• Time in Patent Office: 1,800 Days
• Field of Search: 705 2- 4, 705/7, 705/10, 705/40, 709/201, 707/10
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/0639 Performance analysis of employees; Performance analysis of enterprise or organisation operations
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

An agent-neutral computerized method for processing administrative data of a medical service provider, including defining standard administrative data formats for use by a medical service provider system, a coordinator system, and a plurality of practice management agent systems, in creating and processing administrative data. The method also includes creating neutral evaluation data for the agent-neutral coordinator system by tracking administrative data transferred between the medical service provider system and the practice management agent systems, wherein the administrative data is in the standard administrative data formats. The method further includes providing the neutral evaluation data to the medical service provider system for selection of a first practice management agent system from the plurality of practice management agent systems, wherein the agent-neutral coordinator system reduces financial and operating costs for switching from the first practice management agent system to a second practice management system.

Claims

1. A computerized method for processing administrative data of a service provider, comprising the steps of:

defining standard administrative data formats for use by service provider systems, a coordinator system, and a plurality of practice management agent systems, said practice management agent systems being independent of payer systems, in creating and processing administrative data, said administrative data formats are defined by the coordinator system through the use of software on a computer;

receiving administrative data from said medical service provider, said administrative data including billing, reimbursement, credentialing, preauthorization and collection data;

formatting said administrative data using said standard administrative data formats;

providing formatted administrative data to a practice management agent system for processing, said processing including providing the formatted administrative data to payer systems;

tracking the formatted administrative data transferred between said service provider system and said practice management agent systems, said administrative data tracked by said coordinator system through the use of software on a computer;

creating objective, historical evaluation data from the tracked formatted administrative data transferred between said service provider system and said practice management agent systems, said objective, historical evaluation data consisting of price, features, turnaround time, ancillary services, guarantees, and customer service information, said evaluation data created by said coordinator system through the use of software on a computer; and

providing said objective, historical evaluation data to said service provider system for evaluation and selection of a practice management agent system from the plurality of practice management agent systems, said evaluation data provided by the coordinator system to said service provider system over an electronic network.

2. The method of claim 1, further comprising the step of providing software modules from said coordinator system to said service provider system for generating said administrative data transactions in said standard administrative data formats.

3. The method of claim 1, further comprising the step of providing software modules from said coordinator system to said practice management agent systems for processing said administrative data transactions in said standard administrative data formats.

4. The method of claim 1, further comprising the step of registering with said coordinator system said selection of said practice management agent system by said service provider system.

5. The method of claim 1, further comprising the steps of:

evaluating security data provided to said coordinator system by said practice management agent system for accessing said administrative data of said service provider; and

authorizing said access to said administrative data for said practice management agent system by said coordinator system.

6. An agent-neutral computerized system for providing administrative services for a medical service provider, comprising:

means for defining standard administrative data formats for use by service provider systems, a coordinator system, and a plurality of practice management agent systems, said practice management agent systems being independent of payer systems, in creating and processing administrative data;

means for receiving administrative data from said service provider, said administrative data including billing, reimbursement, credentialing, preauthorization and collection data;

means for formatting said administrative data using said standard administrative data formats;

means for providing formatted administrative data to a practice management agent system for processing, said processing including providing the formatted administrative data to payer systems;

means for tracking the formatted administrative data transferred between said service provider system and said practice management agent systems;

means for creating objective, historical evaluation data from the tracked formatted administrative data transferred between said service provider system and said practice management agent systems, said objective, historical evaluation data consisting of price, features, turnaround time, ancillary services, guarantees, and customer service information; and

means for providing said objective, historical evaluation data to said service provider system for evaluation and selection of a practice management agent system from the plurality of practice management agent systems.

7. A system for providing administrative services for a medical service provider, comprising:

a coordinator system for standardizing administrative data formats for processing administrative data of a medical service provider system by a first medical practice management agent system, said medical practice management agent systems being independent of payer systems, said coordinator system providing data access authorization and security for said administrative data of said medical service provider system to said first medical practice management agent system, and for providing evaluation data from said first medical practice management agent system for evaluation by said medical service provider system;

a billing and reimbursement module located within the coordinator system, said billing and reimbursement module enabling the processing of the administrative data by providing the standardized data formats for processing by the medical practice management agent systems;

an interface module located within the coordinator system for accessing the administrative data generated in the standardized data format, said interface module transfers the administrative data to the medical practice management agent systems and transfers processed data from the medical practice management agent systems to the medical service provider system;

an evaluation module located within the coordinator system for creating historical performance data based upon administrative data processing by said medical practice agent systems;

a first communication link between said medical service provider system and said coordinator system;

a second communication link between said medical practice agent system and said coordinator system;

wherein said standardized administrative data format substantially eliminates costs incurred by said medical service provider system for switching from said first medical practice management agent system to a second medical practice management agent system; and

wherein said administrative data includes billing, reimbursement, credentialing, preauthorization and collection data.

8. The system in claim 7, wherein said standard data format includes coordinator-set operational standards and computer system interface standards.