Method and system for adjudicating claims in a health service environment
First Claim
1. A method for processing service provider claims for payment, in a computer system, comprising:
- receiving, in the computer system, a claim for payment;
automatically identifying, in the computer system, candidate appointments from a plurality of scheduled appointments stored in a database based on a degree of similarity between service information associated with the received claim and appointment information associated with the scheduled appointments;
analyzing, in the computer system, the candidate appointments to determine whether to flag the received claim for resolution; and
presenting, in the computer system, the received claim for payment when at least one of the candidate appointments corresponds to the received claim.
5 Assignments
0 Petitions
Accused Products
Abstract
Methods and systems for adjudicating claims in health services environments are presented. An exemplary method for processing service provider claims for payment includes receiving a claim for payment, automatically identifying candidate appointments from a plurality of scheduled appointments based on a degree of similarity between service information associated with the received claim and appointment information associated with the scheduled appointments, analyzing the candidate appointments to determine whether to flag the received claim for resolution, and presenting the received claim for payment when at least one of the candidate appointments corresponds to the received claim. Optionally, the method includes automatically identifying already processed claims based on a degree of similarity between service information associated with the already processed claims and the service information associated with the received claim, analyzing the identified already processed claims to determine whether the received claim is a duplicate claim, and flagging potentially duplicate claims for resolution.
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Citations
24 Claims
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1. A method for processing service provider claims for payment, in a computer system, comprising:
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receiving, in the computer system, a claim for payment; automatically identifying, in the computer system, candidate appointments from a plurality of scheduled appointments stored in a database based on a degree of similarity between service information associated with the received claim and appointment information associated with the scheduled appointments; analyzing, in the computer system, the candidate appointments to determine whether to flag the received claim for resolution; and presenting, in the computer system, the received claim for payment when at least one of the candidate appointments corresponds to the received claim. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. A method for processing service provider claims for payment, in a computer system, comprising:
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receiving, in the computer system, a claim for payment; storing, in the computer system, appointment information associated with a plurality of scheduled appointments and service information associated with the received claim; automatically identifying, in the computer system, candidate appointments from the scheduled appointments based on a degree of similarity between the service information associated with the received claim and the appointment information associated with the scheduled appointments; and presenting, in the computer system, the received claim for payment when at least one of the candidate appointments corresponds to the received claim. - View Dependent Claims (13, 14)
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15. A system for processing service provider claims for payment, comprising:
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an intake module configured to receive a claim for payment; a storage module configured to store appointment information associated with a plurality of scheduled appointments and service information associated with the received claim; and an adjudication module configured to automatically identify candidate appointments from the scheduled appointments based on a degree of similarity between the service information associated with the received claim and the appointment information associated with the scheduled appointments, wherein the adjudication module is configured to present the received claim for payment when at least one of the candidate appointments corresponds to the received claim. - View Dependent Claims (16, 17, 18, 19, 20)
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21. A system for processing service provider claims for payment, comprising:
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means for receiving a claim for payment; and means for automatically identifying candidate appointments from a plurality of scheduled appointments based on a degree of similarity between service information associated with the received claim and appointment information associated with the scheduled appointments, wherein the identifying means is configured to analyze the candidate appointments to determine whether to flag the received claim for resolution and present the received claim for payment when at least one of the candidate appointments corresponds to the received claim. - View Dependent Claims (22)
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23. A system for processing service provider claims for payment, in a computer system, comprising:
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a processor; and a computer-readable medium including instructions that, when executed by the processor perform a method, the method including; receiving, in the computer system, a claim for payment; storing, in the computer system, appointment information associated with a plurality of scheduled appointments and service information associated with the received claim; automatically identifying, in the computer system, candidate appointments from the scheduled appointments based on a degree of similarity between the service information associated with the received claim and the appointment information associated with the scheduled appointments; and presenting, in the computer system, the received claim for payment when at least one of the candidate appointments corresponds to the received claim. - View Dependent Claims (24)
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Specification