Delivering electronic versions of supporting documents associated with an insurance claim

• US 7,263,493 B1
• Filed: 01/11/2002
• Issued: 08/28/2007
• Est. Priority Date: 01/11/2002
• Status: Expired due to Fees

• Current Assignee: PPS Data LLC (Zions Bancorporation, N.A.)
• Original Assignee: P5, Inc.
• Inventors: Provost, Wayne A., Trimble, Ryan M.
• Primary Examiner(s): Thomas; Joseph
• Assistant Examiner(s): TOMASZEWSKI, MICHAEL
• Application Number:
  US10/044,341
• Time in Patent Office: 2,055 Days
• Field of Search: 705 2- 3, 705/4
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Methods and systems for requesting and delivering supporting documents to an insurance carrier to enable the carrier to process an insurance claim for services rendered by an institutional health care provider. Hard copies of supporting documents are converted to electronic images that are accessible by the carrier through the Internet, thereby eliminating the need for communication between the provider and the carrier through regular mail. The images are indexed based upon the insurance claim, the provider, the patient, and/or the carrier to enable the carrier to access the images associated with a specific insurance claim efficiently. In addition, the insurance claim can be pre-adjudicated prior to delivering the claim to the carrier for processing and can be approved and paid before the carrier processes the claim.

Claims

1. In a client system that is associated with an institutional health care provider and communicates with a server system adapted to facilitate processing of an insurance claim, a method of providing a supporting document to the server system to enable a carrier associated with the insurance claim to process an insurance claim, the method comprising the acts of:

receiving, at the client system associated with the institutional health care provider, patient information, insurance information, and treatment information entered into a computer-displayable claim form displayed by the client system;

the client system transmitting an insurance claim that includes the patient information, insurance information, and treatment information from the client system to the remote server computer using computer-displayable the claim form;

the client system identifying a supporting document that is required to process the insurance claim while displaying the claim form;

the client system converting the supporting document into an electronic format;

the client system transmitting the supporting document in the electronic format from the client system;

the client system receiving verification that the insurance claim is in condition for advance payment; and

the client system receiving a first portion of an advance payment for the insurance claim in a first account, wherein a second portion is credited to a second account that is not accessible to the institutional health care provider until debited at least for service fees by an entity that advanced payment to the client system.

2. A method as recited in claim 1, wherein the act of identifying comprises receiving a request for the supporting document from the server system.

3. A method as recited in claim 1, further comprising the act of displaying a prompt to a medical technician using the client system, the prompt specifying the support document to be delivered to server system.

4. A method as recited in claim 1, further comprising the act of receiving data from a scanner associated with the client system, wherein the data from the scanner represents the supporting document in the electronic format and is received in response to a paper copy of the document being scanned by the scanner.

5. A method as recited in claim 1, further comprising the act of receiving notification from the server system that the insurance claim is eligible for advance payment.

6. A method as recited in claim 1, wherein the act of transmitting the supporting document is conducted such that the carrier can process the insurance claim without any supporting documents being sent by mail.

7. A method as recited in claim 6, wherein the act of transmitting the supporting document is conducted such that the server system is capable of making an electronic image of the supporting document available to the carrier.

8. In a computer system associated with a carrier that processes insurance claims, wherein the computer system is capable of communicating with a server system of a payment entity, a method of processing an insurance claim comprising the acts of:

the computer system receiving an insurance claim associated with a health care provider in an electronic format from a payment entity, wherein the payment entity made a fund distribution request to a financial entity such that a first portion of an advance payment is accessible to the health care provider and a second portion of the advance payment is not accessible to the health care provider;

the computer system receiving a notice indicating the accessibility of an electronic image of a supporting document associated with the insurance claim;

the computer system accessing the electronic image of the supporting document, the electronic image stored on a server system of the payment entity;

the computer system displaying the electronic image of the supporting document to enable the carrier to process the insurance claim; and

the computer system adjudicating the insurance claim based on information in the insurance claims and in the electronic image of the supporting document; and

the computer system making payment on the insurance claim to the payment entity that advanced payment on the insurance claim to a health care provider, wherein the payment entity debits the second portion for at least one of service fees, interest on any unpaid balances or unpaid balances and then credits a remaining part of the second portion to the health care provider.

9. A method as recited in claim 8, further comprising the act of receiving a credential from the server system that enables the computer system to access the electronic image.

10. A method as recited in claim 9, wherein the credential comprises a username and a password.

11. A method as recited in claim 10, wherein the credential is specific to at least one of a patient associated with the insurance claim, the carrier, and an institutional health care provider associated with the client system.

12. A method as recited in claim 8, further comprising the act of requesting the electronic image of the supporting document from the server system of the payment entity.

13. A method as recited in claim 12, wherein the act of requesting the electronic image comprises communicating via the Internet with a computer associated with the server system that stores the electronic image.