Automated processing of electronic medical data for insurance and disability determinations
First Claim
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1. A computer-implemented method of assisting medical evidence collection for adjudication of a medical disability request, the method comprising:
- receiving from a claimant at least one claim of a medical condition;
generating a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection;
displaying the generated medical evidence queries in a data collection protocol;
receiving medical evidence data responsive to the generated medical evidence queries from an electronic data storage;
determining, by a computer, a degree of disability based on the collected medical evidence data and on the disability rating rules collection; and
generating, by a computer, a report comprising the degree of disability;
wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and
wherein the generating the plurality of medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.
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Abstract
Methods and systems are described for automated processing of medical data for insurance and disability determinations. Based on medical conditions claimed by a claimant, medical evidence queries are automatically generated to provide instructions to medical providers for conducting physical exams and laboratory tests and for retrieving medical records. After medical evidence is collected according to the queries, the medical evidence and related rating codes and decisions are displayed to rating personnel in a user-friendly format to assist in making a rating decision.
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Citations
21 Claims
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1. A computer-implemented method of assisting medical evidence collection for adjudication of a medical disability request, the method comprising:
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receiving from a claimant at least one claim of a medical condition; generating a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection; displaying the generated medical evidence queries in a data collection protocol; receiving medical evidence data responsive to the generated medical evidence queries from an electronic data storage; determining, by a computer, a degree of disability based on the collected medical evidence data and on the disability rating rules collection; and generating, by a computer, a report comprising the degree of disability; wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and wherein the generating the plurality of medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15)
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16. A computer-implemented method for facilitating adjudication of a medical disability request, the method comprising:
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receiving medical evidence data concerning a claimant; determining a degree of disability based on the medical evidence data and on a disability rating rules collection; and generating a disability rating report based on the medical evidence data; wherein the medical evidence data is obtained by a method comprising the following steps; receiving from the claimant at least one claim of a medical condition; generating a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by the disability rating rules collection; and receiving answers to the generated medical evidence queries from an electronic data storage, said answers responsive to the medical evidence data; wherein the disability rating report comprises a degree of disability; and wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and wherein the generating the plurality of medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type. - View Dependent Claims (17, 18)
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19. A computer system comprising a computer-readable medium having stored thereon computer-executable instructions configured to perform the method comprising:
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receiving from a claimant at least one claim of a medical condition; generating a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection; receiving medical evidence data responsive to the generated medical evidence queries from an electronic data storage; determining a degree of disability based on the collected medical evidence data and on the disability rating rules collection; and generating a report comprising the degree of disability; wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and wherein the generating the plurality of medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.
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20. A computer-readable medium having stored thereon computer-executable instructions configured to perform the method comprising:
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receiving from a claimant at least one claim of a medical condition; generating a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection; receiving medical evidence data responsive to the generated medical evidence queries from an electronic data storage; determining a degree of disability based on the collected medical evidence data and on the disability rating rules collection; and generating a report comprising the degree of disability; wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and wherein the generating the plurality of medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.
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21. A computer-implemented method of assisting medical evidence collection for adjudication of a medical disability request, the method comprising:
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receiving from a claimant at least one claim of a medical condition; generating a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection; receiving medical evidence data responsive to the generated medical evidence queries from an electronic data storage; determining a degree of disability based on the collected medical evidence data and on the disability rating rules collection; and generating a report comprising the degree of disability; wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and wherein the generating the plurality of medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.
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Specification