Method and system for adjudicating claims in a health services environment
First Claim
1. A system for determining the appropriateness of service provider claims for payment, comprising:
- a scheduling module configured to schedule appointments with service providers;
a claim intake module configured to receive claims from the service providers;
an adjudication module configured to match at least one scheduled appointment with at least one received claim and present at least one received claim for payment upon matching the at least one received claim to a scheduled appointment; and
a claims acquisition module configured to determine that at least one scheduled appointment has not been identified as corresponding to at least one received claim within a predetermined period of time.
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 scheduling appointments with service providers, receiving claims from the service providers, determining whether at least one scheduled appointment corresponds with at least one received claim and determining that at least one scheduled appointment has not been identified as corresponding to at least one received claim within a predetermined period of time. Optionally, the method includes presenting the particular received claim for payment when at least one of the scheduled appointments corresponds to the particular received claim.
66 Citations
18 Claims
-
1. A system for determining the appropriateness of service provider claims for payment, comprising:
-
a scheduling module configured to schedule appointments with service providers; a claim intake module configured to receive claims from the service providers; an adjudication module configured to match at least one scheduled appointment with at least one received claim and present at least one received claim for payment upon matching the at least one received claim to a scheduled appointment; and a claims acquisition module configured to determine that at least one scheduled appointment has not been identified as corresponding to at least one received claim within a predetermined period of time. - View Dependent Claims (2, 3, 4, 5, 6, 7)
-
-
8. A method for determining the appropriateness of service provider claims for payment, in a computer system, comprising:
-
scheduling appointments, in the computer system, with service providers; receiving claims, in the computer system, from the service providers; determining, in the computer system, whether at least one scheduled appointment can be matched with at least one received claim; determining, in the computer system, that at least one scheduled appointment has not been identified as corresponding to at least one received claim within a predetermined period of time; and presenting the particular received claim for payment when at least one of the scheduled appointments corresponds to the particular received claim. - View Dependent Claims (9, 10, 11, 12, 13, 14, 15, 16)
-
-
17. A system for determining the appropriateness of service provider claims for payment, comprising:
-
a scheduling module configured to schedule appointments with service providers; a claim intake module configured to receive claims from the service providers; an adjudication module configured to present at least one received claim for payment upon matching the at least one received claim to a scheduled appointment and present at least one received claim for payment upon matching the at least one received claim to a scheduled appointment; and a claims acquisition module configured to determine that at least one scheduled appointment has not been identified as corresponding to at least one received claim. - View Dependent Claims (18)
-
Specification