Methods for subrogation and reimbursement of recovery and premium reduction optimization

• US 8,566,129 B1
• Filed: 01/09/2012
• Issued: 10/22/2013
• Est. Priority Date: 01/09/2012
• Status: Active Grant

• Current Assignee: Daniel A. Schwarz
• Original Assignee: Daniel A. Schwarz
• Inventors: Schwarz, Daniel A.
• Primary Examiner(s): Lemieux, Jessica
• Application Number:
  US13/346,317
• Time in Patent Office: 652 Days
• Field of Search: 705/4
• US Class Current: 705/4
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions

Abstract

A method for subrogation recovery utilizing a computer system, including providing a database having of a plurality of records of health care claims, each record including a claim, personal data of a claimant of the claim, enrollment data of the claimant in one of a plurality of primary payers of the claim, a record of at least one of charges to the payer and payment by the primary payer to the claimant for each claim, and details of the claim. The method continues with identifying search criteria for searching the records that would likely lead to subset of potentially subrogable claims, searching the plurality of records based on the criteria, analyzing the subset of potentially subrogable claims to generate lists of potentially actionable claims for each of the plurality of primary payers, and providing at the lists of potentially actionable claims to each of the plurality of the primary payers.

Claims

1. A method for subrogation recovery utilizing a computer system, the computer system comprising a database and a processor, the method comprising:

(a) providing the database having of a plurality of records of previously paid health care claims, each record comprising;

(i) a claim;

(ii) personal data of a claimant of the claim;

(iii) enrollment data of the claimant in one of a plurality of primary payers of the claim;

(iv) a record of at least one of charges to the payer and payment by the primary payer to the claimant for each claim; and

(v) details of the claim;

(b) identifying search criteria for searching the plurality of records that would likely lead to subset of potentially subrogable claims based on the search criteria;

(c) searching, using the processor, the plurality of records based on the criteria;

(d) analyzing, using the processor, the subset of potentially subrogable claims to generate lists of potentially actionable claims for each of the plurality of primary payers;

(e) providing the lists of potentially actionable claims to each of the plurality of the primary payers; and

(f) aggregating primary payers into groups where each group has common potentially actionable claims and wherein analyzing the subset of potentially subrogable claims includes generating lists of the common potentially actionable claims for each of the plurality of primary payers in each group.