Systems and methods for generating payor sheets associated with payors for healthcare transactions

• US 8,244,556 B1
• Filed: 06/23/2010
• Issued: 08/14/2012
• Est. Priority Date: 06/23/2010
• Status: Active Grant

• Current Assignee: McKesson Corp.
• Original Assignee: Mckesson Financial Holdings Limited (McKesson Corp.)
• Inventors: Ringold, James Morgan
• Primary Examiner(s): Sereboff, Neal
• Application Number:
  US12/821,830
• Time in Patent Office: 783 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

Systems and methods are provided for generating payor sheets associated with payors for healthcare transactions. Information associated with one or more healthcare transactions that have been processed by a payor may be obtained. A plurality of data fields included in the one or more healthcare transactions may be identified, and a respective usage of each of the identified data fields within the one or more healthcare transactions may be calculated. Based upon the calculated usages, one or more of the plurality of data fields may be identified as required fields. A required field may be a field required by the payor during the submission of a healthcare transaction. Based at least in part upon the identified one or more required fields, a payor sheet associated with the payor may be generated.

Claims

1. A computer-implemented method, comprising:

obtaining information associated with one or more healthcare transactions that have been processed by a payor;

identifying a plurality of data fields included in the one or more healthcare transactions;

calculating a respective usage of each of the identified data fields within the one or more healthcare transactions;

identifying, based upon the calculated usages, one or more of the plurality of data fields as required fields, wherein a required field is a field required by the payor during the submission of a healthcare transaction; and

generating, based at least in part upon the identified one or more required fields, a payor sheet associated with the payor,

wherein the above operations are performed by one or more computers associated with a service provider.

2. The method of claim 1, wherein calculating a respective usage of each of the identified data fields comprises:

determining a number of transactions included in the one or more healthcare transactions;

determining a respective number of times that each of the identified data fields was populated within the one or more transactions; and

calculating, based upon the number of transactions and the respective number of times, a respective percentage usage of each of the identified data fields.

3. The method of claim 1, wherein identifying one or more of the plurality of data fields as required fields comprises:

comparing, for each of the identified data fields, the respective usage to a threshold parameter; and

determining, based upon the comparison, whether the identified data field is a required field.

4. The method of claim 1, further comprising:

identifying one or more rules associated with the generation of the payor sheet,

wherein the information associated with one or more healthcare transactions is obtained based upon the identified one or more rules.

5. The method of claim 1, further comprising:

filtering, prior to identifying the plurality of data fields, the one or more healthcare transactions to remove at least one rejected healthcare transaction.

6. The method of claim 1, wherein identifying one or more of the plurality of data fields as required fields further comprises:

identifying at least one of the one or more healthcare transactions that has been rejected by the payor;

determining that the at least one identified healthcare transaction was rejected based upon one of (i) a failure to include information in a data field or (ii) an inclusion of incorrect information in the data field; and

identifying, based upon the determination, the data field as a required field.

7. The method of claim 1, wherein obtaining information associated with one or more healthcare transactions comprises at least one of (i) accessing stored information or (ii) obtaining information from at least one external data source.

8. The method of claim 1, further comprising:

communicating the generated payor sheet to a healthcare provider.

9. A system, comprising:

at least one memory operable to store computer-executable instructions; and

at least one processor configured to access the at least one memory and execute the computer-executable instructions to;

obtain information associated with one or more healthcare transactions that have been processed by a payor;

identify a plurality of data fields included in the one or more healthcare transactions;

calculate a respective usage of each of the identified data fields within the one or more healthcare transactions;

identify, based upon the calculated usages, one or more of the plurality of data fields as required fields, wherein a required field is a field required by the payor during the submission of a healthcare transaction; and

generate, based at least in part upon the identified one or more required fields, a payor sheet associated with the payor.

10. The system of claim 9, wherein the at least one processor is configured to calculate a respective usage of each of the identified data fields by executing the computer-executable instructions to:

determine a number of transactions included in the one or more healthcare transactions;

determine a respective number of times that each of the identified data fields was populated within the one or more transactions; and

calculate, based upon the number of transactions and the respective number of times, a respective percentage usage of each of the identified data fields.

11. The system of claim 9, wherein the at least one processor is configured to identify one or more of the plurality of data fields as required fields by executing the computer-executable instructions to:

compare, for each of the identified data fields, the respective usage to a threshold parameter; and

determine, based upon the comparison, whether the identified data field is a required field.

12. The system of claim 9, wherein the at least one processor is further configured to execute the computer-executable instructions to:

identify one or more rules associated with the generation of the payor sheet,

wherein the information associated with one or more healthcare transactions is obtained based upon the identified one or more rules.

13. The system of claim 9, wherein the at least one processor is further configured to execute the computer-executable instructions to:

filter, prior to the identification of the plurality of data fields, the one or more healthcare transactions to remove at least one rejected healthcare transaction.

14. The system of claim 9, wherein the at least one processor is further configured to identify one or more of the plurality of data fields as required fields by executing the computer-executable instructions to:

identify at least one of the one or more healthcare transactions that has been rejected by the payor;

determine that the at least one identified healthcare transaction was rejected based upon one of (i) a failure to include information in a data field or (ii) an inclusion of incorrect information in the data field; and

identify, based upon the determination, the data field as a required field.

15. The system of claim 9, wherein the information associated with one or more healthcare transactions is obtained from at least one of (i) one or more data storage devices associated with the at least one processor or (ii) at least one external data source.

16. The system of claim 9, wherein the at least one processor is further configured to execute the computer-executable instructions to:

direct the communication of the generated payor sheet to a healthcare provider.

17. A computer-implemented method, comprising:

storing information associated with a plurality of healthcare transactions that are communicated between one or more healthcare providers and one or more payors by a service provider;

accessing, based upon one or more parameters associated with the generation of a payor sheet, a subset of the plurality of healthcare transactions that are associated with a payor;

identifying a plurality of data fields included in the accessed subset of healthcare transactions;

calculating a respective usage of each of the identified data fields within the subset of healthcare transactions;

identifying, based upon the calculated usages, one or more of the plurality of data fields as required fields, wherein a required field is a field required by the payor during the submission of a healthcare transaction; and

generating, based at least in part upon the identified one or more required fields, a payor sheet associated with the payor,

wherein the above operations are performed by one or more computers associated with a service provider.

18. The method of claim 17, wherein calculating a respective usage of each of the identified data fields comprises:

determining a number of transactions included in the subset of healthcare transactions;

determining a respective number of times that each of the identified data fields was populated within the subset of healthcare transactions; and

calculating, based upon the number of transactions and the respective number of times, a respective percentage usage of each of the identified data fields.

19. The method of claim 17, wherein accessing a subset of healthcare transactions based upon one or more parameters comprises accessing a subset of healthcare transactions based upon at least one of (i) a Banking Identification Number (BIN) or (ii) a Processor Control Number (PCN) associated with the payor.

20. The method of claim 17, further comprising:

communicating the generated payor sheet to a healthcare provider.