System for processing unpaid healthcare claims
First Claim
1. A method for processing claim data for reimbursement of provision of healthcare to a patient in response to rejection, denial, or lack of response to a submitted claim, comprising the steps of:
- employing at least one computer system for,automatically selecting an internal activity code from a predetermined internal activity code set specific to a particular organization and including a plurality of codes identifying processing to be performed concerning rejected claim data in response to a received notification of claim denial or rejection;
automatically assigning said selected internal activity code to rejected claim data associated with said received notification;
automatically scheduling a task comprising performing processing concerning said rejected claim data to derive corrected claim data including at least one (a) claim data supplemental to said rejected claim data and (b) amended rejected claim data, in response to said assigned selected internal activity code; and
preparing said corrected claim data by including a standard activity code from a standard activity code set different to said internal activity code set and facilitating compatible communication between said particular organization and a payer organization for submission to said payer organization for payment.
1 Assignment
0 Petitions
Accused Products
Abstract
A system and method processes unpaid healthcare claims related to reimbursement of a provision of healthcare to a patient in response to a rejection, a denial, or a lack of response to a submitted claim. An activity code is selected from a predetermined activity code set including codes identifying processing to be performed concerning rejected claim data in response to a received notification of a claim denial or rejection. The selected activity code is assigned to rejected claim data associated with the received notification. A task is scheduled, including performing processing concerning the rejected claim data, to derive corrected claim data including claim data supplemental to the rejected claim data and/or amended rejected claim data, in response to the assigned selected activity code. The corrected claim data is prepared for submission to a payer organization for payment.
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Citations
17 Claims
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1. A method for processing claim data for reimbursement of provision of healthcare to a patient in response to rejection, denial, or lack of response to a submitted claim, comprising the steps of:
employing at least one computer system for, automatically selecting an internal activity code from a predetermined internal activity code set specific to a particular organization and including a plurality of codes identifying processing to be performed concerning rejected claim data in response to a received notification of claim denial or rejection; automatically assigning said selected internal activity code to rejected claim data associated with said received notification; automatically scheduling a task comprising performing processing concerning said rejected claim data to derive corrected claim data including at least one (a) claim data supplemental to said rejected claim data and (b) amended rejected claim data, in response to said assigned selected internal activity code; and preparing said corrected claim data by including a standard activity code from a standard activity code set different to said internal activity code set and facilitating compatible communication between said particular organization and a payer organization for submission to said payer organization for payment. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A method for processing claim data for reimbursement of provision of healthcare to a patient in response to rejection, denial, or lack of response to a submitted claim, comprising the steps of:
employing at least one computer system for, identifying a nonpayment code, associated with a predetermined nonpayment code set, from a received notification of claim nonpayment associated with particular claim data;
automatically selecting an internal activity code from a predetermined internal activity code set including a plurality of codes specific to a particular organization and identifying processing to be performed concerning non-paid claim data in response to said identified nonpayment reason;automatically assigning said selected internal activity code to said particular claim data associated with said received notification; automatically adding a task to a task list of a worker comprising performing processing concerning said particular claim data to derive corrected claim data including at least one (a) claim data supplemental to said rejected claim data and (b) amended rejected claim data, in response to said assigned selected internal activity code; and preparing said corrected claim data by including a standard activity code from a standard activity code set different to said internal activity code set and facilitating compatible communication between said particular organization and a payer organization for submission to said payer organization for payment. - View Dependent Claims (15, 16)
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17. A system for processing claim data for reimbursement of provision of healthcare to a patient in response to rejection, denial, or lack of response to a submitted claim, comprising:
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a workflow processor for, automatically selecting an internal activity code from a predetermined internal activity code set specific to a particular organization and including a plurality of codes identifying processing to be performed concerning rejected claim data in response to a received notification of claim denial or rejection; automatically assigning said selected internal activity code to rejected claim data associated with said received notification; automatically adding a task to a task list of a worker comprising performing processing concerning said rejected claim data to derive corrected claim data including at least one (a) claim data supplemental to said rejected claim data and (b) amended rejected claim data, in response to said assigned selected internal activity code; and an interface processor for preparing said corrected claim data by including a standard activity code from a standard activity code set different to said internal activity code set and facilitating compatible communication between said particular organization and said payer organization for submission to a payer organization for payment.
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Specification