Managing insurance claim data
First Claim
1. A method for calculating a financial responsibility, comprising:
- accessing, by a software application executing on a computer processor and operated by a party selected from a group consisting of a patient and a relative of the patient, a repository of a medical insurance provider (MIP);
searching, by the software application operated by the party, a plurality of entries in the repository of the MIP based on a date;
retrieving, in response to searching and by the software application operated by the party, an entry in the repository corresponding to the date and identifying a first medical procedure (MP) performed on the patient by a medical service provider (MSP), an amount billed to the party for the first MP, a second MP performed on the patient; and
an amount billed to the party for the second MP;
retrieving, in response to searching and by the software application operated by the party, an adjusted entry in the repository corresponding to the date and identifying the first MP and an adjusted amount billed to the party for the first medical procedure;
determining, by the software application operated by the party, that the adjusted entry is a revision of the entry based on the adjusted entry being more recent than the entry;
calculating, by the software application operated by the party, the financial responsibility of the party for the first MP and the second MP by summing the adjusted amount and the amount billed to the patient for the second MP; and
generating, by the software application operated by the party, a graphical user interface (GUI) identifying the first MP, the amount billed to the party for the first MP, an indication the amount billed to the party for the first MP is incorrect, the adjusted amount, the second medical procedure, the amount billed to the party for the second MP, and the financial responsibility of the party.
1 Assignment
0 Petitions
Accused Products
Abstract
A method for managing insurance claim data involves identifying a first insurance claim data and a second insurance claim data using pattern recognition on multiple insurance claim data associated with an insured party, where the first insurance claim data and the second insurance claim data are associated with a single insurance claim associated with the insured party, where the second insurance claim data is later in time than the first insurance claim data, and where the second insurance claim data includes a modification of the single insurance claim relative to the first insurance claim data. The method further involves determining a financial responsibility of the insured party for the single insurance claim based on the second insurance claim data, and presenting the first insurance claim data, the second insurance claim data, and the financial responsibility in a graphical user interface (GUI).
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Citations
21 Claims
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1. A method for calculating a financial responsibility, comprising:
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accessing, by a software application executing on a computer processor and operated by a party selected from a group consisting of a patient and a relative of the patient, a repository of a medical insurance provider (MIP); searching, by the software application operated by the party, a plurality of entries in the repository of the MIP based on a date; retrieving, in response to searching and by the software application operated by the party, an entry in the repository corresponding to the date and identifying a first medical procedure (MP) performed on the patient by a medical service provider (MSP), an amount billed to the party for the first MP, a second MP performed on the patient; and
an amount billed to the party for the second MP;retrieving, in response to searching and by the software application operated by the party, an adjusted entry in the repository corresponding to the date and identifying the first MP and an adjusted amount billed to the party for the first medical procedure; determining, by the software application operated by the party, that the adjusted entry is a revision of the entry based on the adjusted entry being more recent than the entry; calculating, by the software application operated by the party, the financial responsibility of the party for the first MP and the second MP by summing the adjusted amount and the amount billed to the patient for the second MP; and generating, by the software application operated by the party, a graphical user interface (GUI) identifying the first MP, the amount billed to the party for the first MP, an indication the amount billed to the party for the first MP is incorrect, the adjusted amount, the second medical procedure, the amount billed to the party for the second MP, and the financial responsibility of the party. - View Dependent Claims (2, 3, 4, 5, 16, 17)
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6. A system for determining a financial responsibility comprising:
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a computer processor; and an insurance claim data manager (ICDM) executing on the computer processor and operated by a party selected from a group consisting of a patient and a relative of the patient, the ICDM configured to; access a repository of a medical insurance provider (MIP); search a plurality of entries in the repository of the MIP based on a date; retrieve, in response to searching, an entry in the repository corresponding to the date and identifying a first medical procedure (MP) performed on the patient by a medical service provider (MSP), an amount billed to the party for the first MP, a second MP performed on the patient, and an amount billed to the party for the second MP; retrieve, in response to searching, an adjusted entry in the repository corresponding to the date and identifying the first MP and an adjusted amount billed to the party for the first MP; determine that adjusted entry is a revision of the entry based on the adjusted entry being more recent than the entry; calculate the financial responsibility of the party for the first MP and the second MP by summing the adjusted amount and the amount billed to the party for the second MP; and generate, a graphical user interface (GUI) comprising the first MP, the amount billed to the party for the first MP, an indication the amount billed to the party for the first MP is incorrect, the adjusted amount, the second MP, the amount billed to the party for the second MP, and the financial responsibility of the party. - View Dependent Claims (7, 8, 9, 10, 18, 19)
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11. A non-transitory computer readable storage medium storing instructions for calculating a financial responsibility, the instructions executable on a processor and comprising functionality for:
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accessing, for a party selected from a group consisting of a patient and a relative of the patient, a repository of a medical insurance provider (MIP); searching a plurality of entries in the repository of the MIP based on a date; retrieving, in response to searching, a first entry in the repository corresponding to the date and identifying a first medical procedure (MP) performed on the patient by a medical service provider (MSP), an amount billed to the party for the first MP, a second MP performed on the patient, and an amount billed to the party for the second MP; retrieving, in response to searching, an adjusted entry in the repository corresponding to the date and identifying the first MP and an adjusted amount billed to the party for the first MP; determining that the adjusted entry is a revision of the entry based on the adjusted entry being more recent than the entry; calculating the financial responsibility of the party by summing the adjusted amount and the amount billed to the party for the second MP; generating a graphical user interface (GUI) identifying the first MP, the amount billed to the party for the first MP, an indication the amount billed to the party for the first MP is incorrect, the second MP, the amount billed to the party for the second MP, and the financial responsibility of the party. - View Dependent Claims (12, 13, 14, 15, 20, 21)
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Specification