Method of increasing efficiency in a medical claim transaction, and computer program capable of executing same
First Claim
1. A method of adjudicating a medical claim, the method comprising:
- providing a medical claim processing server accessible over the Internet by a medical service provider, the server having access to a database storing a plurality of claims each claim representing medical benefits and having a set of requirements;
the medical claim processing server;
receiving over the Internet a medical claim request from the medical service provider, the request comprising components including a proposed medical procedure that is to be performed on a patient;
evaluating the components of the medical claim request against sets of requirements of at least some of the claims by setting scores to each of the at least some of the claims based on adjusting the scores according to how the components match with requirements within the sets of requirement;
identifying a manner in which the scores were adjusted;
selecting a selected claim from the scored claims based on the set scores and the manner the scores were adjusted;
adjudicating the medical claim request by determining acceptance or rejection of the medical claim request and a monetary value of the proposed medical procedure according the score of the selected claim and the manner the selected claim'"'"'s score was adjusted;
transmitting a notification over the Internet to the medical service provider, the notification comprising one of (a) a rejection of the proposed medical procedure, and (b) an acceptance the proposed medical procedure with the monetary value; and
presenting the notification via a user interface to a user associated with the medical service provider.
6 Assignments
0 Petitions
Accused Products
Abstract
A method of adjudicating a medical claim includes providing a requirements for a first claim and a second claim, receiving a medical claim for a medical procedure, setting a first score for the first claim and a second score for the second claim to an initial value, comparing components of the medical claim to the requirements of the first and second claims, changing the first and second scores for each one of the components that match one of the requirements and for each one of the requirements that is missing from the components, and selecting the first or second claim based upon predetermined criteria applied to their respective scores to determine either a monetary value of the medical procedure for a medical service provider associated with the medical procedure or a monetary value of medical coverage for a patient associated with the medical procedure.
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Citations
20 Claims
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1. A method of adjudicating a medical claim, the method comprising:
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providing a medical claim processing server accessible over the Internet by a medical service provider, the server having access to a database storing a plurality of claims each claim representing medical benefits and having a set of requirements; the medical claim processing server; receiving over the Internet a medical claim request from the medical service provider, the request comprising components including a proposed medical procedure that is to be performed on a patient; evaluating the components of the medical claim request against sets of requirements of at least some of the claims by setting scores to each of the at least some of the claims based on adjusting the scores according to how the components match with requirements within the sets of requirement; identifying a manner in which the scores were adjusted; selecting a selected claim from the scored claims based on the set scores and the manner the scores were adjusted; adjudicating the medical claim request by determining acceptance or rejection of the medical claim request and a monetary value of the proposed medical procedure according the score of the selected claim and the manner the selected claim'"'"'s score was adjusted; transmitting a notification over the Internet to the medical service provider, the notification comprising one of (a) a rejection of the proposed medical procedure, and (b) an acceptance the proposed medical procedure with the monetary value; and presenting the notification via a user interface to a user associated with the medical service provider. - View Dependent Claims (2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20)
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4. The method of claim it wherein the monetary value is an amount that the patient owes to medical service provider.
Specification