Attachment integrated claims systems and operating methods therefor

• US 8,676,609 B2
• Filed: 01/12/2007
• Issued: 03/18/2014
• Est. Priority Date: 03/28/1996
• Status: Expired due to Fees

• Current Assignee: Integrated Claims Systems LLC
• Original Assignee: Integrated Claims Systems LLC
• Inventors: DiRienzo, Andrew L
• Primary Examiner(s): Kazimi, Hani M
• Assistant Examiner(s): Graham, Clement B
• Application Number:
  US11/653,104
• Publication Number:
  US 20070260493A1
• Time in Patent Office: 2,622 Days
• Field of Search: 705 35- 38
• US Class Current: 705/4
• CPC Class Codes: G06F 3/0481 based on specific properties of the displayed interaction object or a metaphor-based environment, e.g. interaction with desktop elements like windows or icons, or assisted by a cursor's changing behaviour or appearance
• CPC Class Codes: G06F 3/0482 Interaction with lists of selectable items, e.g. menus
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 10/02 Reservations, e.g. for tickets, services or events
• CPC Class Codes: G06Q 10/025 Coordination of plural reservations, e.g. plural trip segments, transportation combined with accommodation
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G06Q 40/12 Accounting
• CPC Class Codes: G06Q 99/00 Subject matter not provided for in other groups of this subclass
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 30/20 for handling medical images, e.g. DICOM, HL7 or PACS
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

Systems and methods for processing textual messages which are integrated with one or more digital attachments is described. These systems and methods are useful in the electronic filing and processing of, for example, image data, and of textual data associated with the image data. One particular application of these systems and methods would be for the electronic filing and processing of dental x-rays with patient claim forms.

Claims

1. A computer implemented method, for processing insurance transactions that require attachments, the method comprising the steps of:

receiving digital data at a first computer,

wherein the digital data comprises a first computer file and a second computer file, both of which contain information about a particular insurance encounter;

wherein at least some of the digital data in the first computer file and at least some of the digital data in the second computer file are in a first set of identifiable data fields;

wherein the first computer file and the second computer file are cross-referenced with each other;

wherein the first computer file contains at least attachment data and the second computer file contains at least insurance transaction data;

wherein at least some of the insurance transaction data and the attachment data comprise digital data in the first set of identifiable data fields;

examining via the first computer the identifiable fields of the digital data to determine which fields contain insurance transaction data and which fields contain attachment data;

storing first digital data in the first computer, wherein the first digital data comprises at least some of the attachment data;

transmitting second digital data from the first computer to a second computer, wherein the second digital data comprises at least some of the insurance transaction data;

storing the second digital data in the second computer,

wherein the insurance transaction data stored in the second computer and the attachment data stored in the first computer are cross-referenced with each other;

wherein at least some of the data included in the first digital data is excluded from the second digital data; and

processing an insurance transaction by entering data into at least one identifiable field in a second set of identifiable data fields using at least some of the data in the first set of identifiable data fields in a logic process to determine the data to be entered into the at least one identifiable field in the second set of identifiable data fields.

2. The method of claim 1, wherein the excluded data comprises at least some of the attachment data.

3. The method of claim 1, wherein the processing step comprises displaying at least some of said insurance transaction data and said attachment data on at least one computer display device.

4. The method of claim 1, wherein the processing step comprises inputting data into a form using a data inputting device.

5. The method of claim 4, wherein the inputting device comprises a keyboard.

6. The method of claim 4, wherein the form is selected from the group consisting of an explanation of benefits form, a payment form, and a predetermination form.

7. The method of claim 1, wherein the at least some of the insurance transaction data transmitted from the first computer to the second computer is data in a subset of the first set of identifiable data fields.

8. The method of claim 7, wherein the subset of the first set of identifiable data fields is specified using the identities of the fields.

9. The method of claim 1, wherein the processing step comprises using data from at least one of the identifiable data fields in the first set of identifiable data fields to complete at least one identifiable field in an electronic form.

10. The method of claim 9, wherein the form is selected from the group consisting of an explanation of benefits form, a payment form, and a predetermination form.

11. The method of claim 9, wherein the method further comprises the step of transmitting said form to a computer operated for a provider.

12. The method of claim 11, wherein the provider is a healthcare provider.

13. The method of claim 9, wherein the method further comprises the step of archiving said form as a computer file.

14. The method of claim 9, wherein the method further comprises the step of storing at least some of the data in said form in identifiable data fields.

15. The method of claim 1, wherein the entering step comprises completing at least one identifiable data field in an explanation of benefits statement, a payment statement, a predetermination statement, or a database.

16. The method of claim 1, wherein the method further comprises the step of transmitting at least some of the completed second set of identifiable data fields to a computer operated for a provider.

17. The method of claim 16, wherein the provider is a healthcare provider.

18. The method of claim 1, wherein the method further comprises the step of accessing at least one of the first and the second digital data using the cross-referencing data.

19. The method of claim 1, wherein the first digital data comprises data in a first set of N₁ identifiable data fields, and the second digital data comprises data in a second set of N₂ identifiable data fields.

20. The method of claim 1, wherein the receiving step comprises receiving a computer file comprising the digital data.

21. The method of claim 1, wherein the receiving step comprises the steps of:

receiving the first computer file comprising at least some of the attachment data, and

receiving the second computer file comprising at least some of the insurance transaction data,

wherein at least some of the data included in the first computer file is excluded from the second computer file.

22. The method of claim 21, wherein the excluded data comprises at least some attachment data.

23. The method of claim 1, wherein the method further comprises the step of archiving at least some of the digital data as a computer file.

24. The method of claim 1, wherein the method further comprises the step of storing at least some of the digital data in identifiable data fields.

25. The method of claim 1, wherein the received digital data comprises cross-referencing data for associating the insurance transaction data with the attachment data.

26. The method of claim 1, wherein the method further comprises the step of cross-referencing the insurance transaction data and the attachment data.

27. The method of claim 1, wherein the cross-referencing data comprises at least one identification number.

28. The method of claim 1, wherein the cross-referencing data comprises at least one selected from the group consisting of at least one identification number, at least some of the insurance transaction data, healthcare provider document identification data, insurance payer document identification data, healthcare payer document identification data, healthcare transaction identification data, identification number, healthcare-insurance-claim attachment identification number, and data that identifies a healthcare encounter.

29. The method of claim 1, wherein the computer system is operated for an insurance payer.

30. The method of claim 29, wherein the insurance payer is selected from the group consisting of a dental insurance payer, a medical insurance payer, a healthcare insurance payer, a property insurance payer, a worker'"'"'s compensation insurance payer, and casualty insurance payer.

31. The method of claim 30, wherein the first computer comprises a buffer computer system and the second computer comprises a legacy computer system.

32. The method of claim 31, wherein the legacy computer system is a health-insurance-claims management computer system.

33. The method of claim 32, wherein the attachment data is health-insurance-claims attachment data and the insurance transaction data is health-insurance-claims data.

34. The method of claim 31, wherein said buffer computer system is configured by software for displaying at least some of said attachment data on a computer display device.

35. The method of claim 1, wherein the receiving step comprises receiving the digital data from a computer system operated for at least one selected from the group consisting of a value added service, a provider, an insurance provider, a healthcare provider, and a clearinghouse.

36. The method of claim 1, wherein the insurance transaction data comprises information selected from the group consisting of dental data, medical data, healthcare data, worker'"'"'s compensation data, property and casualty insurance transaction information.

37. The method of claim 1, wherein the insurance transaction data comprises at least one selected from the group consisting of an identification number, transaction identification data, beneficiary information, beneficiary name, patient data, patient name, healthcare provider data, healthcare provider name, healthcare provider identification data, healthcare provider document identification data, healthcare payer identification data, healthcare payer name, healthcare payer identification number, healthcare payer document identification data, healthcare-insurance-claim attachment identification number, description of service provided, date of service, healthcare encounter information, prior approval claim data, and worker'"'"'s compensation data.

38. The method of claim 1, wherein the attachment data comprises an attachment selected from a group consisting of a picture, a graph, a sound recording, nonstandard text, a digitized x-ray, an explanation of benefits, a CT, an MRI, a EKG, a EEG, a strip chart, a digitized video signals, a transcription of operating room notes, supplemental data to a health insurance claims, and additional ASCII text.

39. The method of claim 1, wherein the transmitting step includes transmitting the cross-referencing data from the first computer to the second computer.

40. The method of claim 1, wherein the second data comprises only a portion of the at least some of the insurance transaction data transmitted from the first computer to the second computer.

96. The method of claim 1, further comprising:

wherein the attachment data comprises at least one selected from a group consisting of a picture, a graph, a sound recording, a digitized x-ray, a CT, an MRI, a EKG, a EEG, a strip chart, an EOB, and a digitized video signal; and

wherein the insurance transaction data comprises alphanumeric data and does not comprise a picture, a graph, a sound recording, a digitized x-ray, a CT, an MRI, a EKG, a EEG, a strip chart, an EOB, or a digitized video signal.

97. The method of claim 1, wherein the attachment data comprises image data, and wherein the insurance transaction data comprises alphanumeric data and does not comprise image data.

98. The method of claim 1, further comprising:

wherein the second computer file comprises a request for payment by a medical provider; and

wherein the first computer file comprises medical evidence supporting the request for payment.

99. The method of claim 1, further comprising:

wherein the second computer file comprises a request for payment by a medical provider; and

wherein the first computer file comprises medical evidence supporting the request for payment, and wherein the medical evidence is selected in response to a medical procedure being claimed for payment in the second computer file.

100. The method of claim 1, further comprising:

wherein the attachment data which is in identifiable fields comprises at least one selected from a group consisting of a picture, a graph, a sound recording, a digitized x-ray, a CT, an MRI, a EKG, a EEG, a strip chart, an EOB, and a digitized video signal; and

wherein the insurance transaction data which is in identifiable fields consists of alphanumeric data.

41. A computer system configured to process insurance transactions that require attachments, the computer system comprising:

first and second computers;

memory; and

software in the memory configured to cause the computer system to;

receive digital data at the first computer,

wherein the digital data comprises a first computer file and a second computer file, both of which contain information about a particular insurance encounter;

wherein at least some of the digital data in the first computer file and at least some of the digital data in the second computer file are in a first set of identifiable data fields;

wherein the first computer file and the second computer file are cross-referenced with each other;

wherein the first computer file contains at least attachment data and the second computer file contains at least insurance transaction data;

wherein at least some of the insurance transaction data and the attachment data comprise digital data in the first set of identifiable data fields;

examine via the computer system the identifiable fields of the digital data to determine which fields contain insurance transaction data and which fields contain attachment data;

store first digital data in the first computer, wherein the first digital data comprises at least some of the attachment data;

transmit second digital data from the first computer to the second computer, wherein the second digital data comprises at least some of the insurance transaction data;

store the second digital data in the second computer;

wherein the insurance transaction data stored in the second computer and the attachment data stored in the first computer are cross-referenced with each other;

wherein at least some of the data included in the first digital data is excluded from the second digital data; and

process an insurance transaction by entering data into at least one identifiable field in a second set of identifiable data fields using at least some of the data in the first set of identifiable data fields in a logic process to determine the data to be entered into the at least one identifiable field in the second set of identifiable data fields.

42. The computer system of claim 41, wherein the excluded data comprises at least some of the attachment data.

43. The computer system of claim 41, wherein the processing of the insurance transaction comprises displaying at least some of said insurance transaction data and said attachment data on at least one computer display device of the computer system.

44. The computer system of claim 41, wherein the processing of the insurance transaction comprises inputting data into a form using a data inputting device.

45. The computer system of claim 44, wherein the data inputting device comprises a keyboard.

46. The computer system of claim 44, wherein the form is selected from the group consisting of an explanation of benefits form, a payment form, and a predetermination form.

47. The computer system of claim 41, wherein the at least some of the insurance transaction data transmitted from the first computer to the second computer is data in a subset of the first set of identifiable data fields.

48. The computer system of claim 47, wherein the subset of the first set of identifiable data fields is specified using the identities of the fields.

49. The computer system of claim 41, wherein the processing of the insurance transaction comprises the computer system using data from at least one of the identifiable data fields in the first set of identifiable data fields to complete at least one identifiable field in an electronic form.

50. The computer system of claim 49, wherein the form is selected from the group consisting of an explanation of benefits form, a payment form, and a predetermination form.

51. The computer system of claim 49, wherein the software further adapts the computer system to transmit said form to a computer operated for a provider.

52. The computer system of claim 51 wherein the provider is a healthcare provider.

53. The computer system of claim 49, wherein the software further causes the computer system to archive said form as a computer file.

54. The computer system of claim 49, wherein the software further causes the computer system to store at least some of the data in said form in identifiable fields.

55. The computer system of claim 41, wherein the at least one identifiable field in the second set of identifiable fields comprises an explanation of benefits statement, a payment statement, a predetermination statement, or a database.

56. The computer system of claim 41, wherein the software further adapts the computer system to transmit at least some of said second set of completed identifiable fields to a computer operated for a provider.

57. The computer system of claim 56, wherein the provider is a healthcare provider.

58. The computer system of claim 41, wherein the software further adapts the computer system to access at least one of the first and the second digital data using the cross-referencing data.

59. The computer system of claim 41, wherein the first digital data comprises data in a first set of N₁ identifiable data fields, and the second digital data comprises data in a second set of N₂ identifiable data fields.

60. The computer system of claim 41, wherein the digital data comprises a computer file.

61. The computer system of claim 41, wherein at least some of the data included in the first computer file is excluded from the second computer file.

62. The computer system of claim 61, wherein the excluded data comprises at least some attachment data.

63. The computer system of claim 41, wherein the software further causes the computer system to archive at least some of the digital data as a computer file.

64. The computer system of claim 41, wherein the software further causes the computer system to store at least some of the digital data in identifiable fields.

65. The computer system of claim 41, wherein the received digital data comprises cross-referencing data for associating the insurance transaction data with the attachment data.

66. The computer system of claim 41, wherein the software further adapts the computer system to cross-reference the insurance transaction data and the attachment data.

67. The computer system of claim 41, wherein the cross-referencing data comprises at least one identification number.

68. The computer system of claim 41, wherein the cross-referencing data comprises at least one selected from the group consisting of at least one identification number, at least some of the insurance transaction data, healthcare provider document identification data, insurance payer document identification data, healthcare payer document identification data, healthcare transaction identification data, identification number, healthcare-insurance-claim attachment identification number, and data that identifies a healthcare encounter.

69. The computer system of claim 41, wherein the computer system is operated for an insurance payer.

70. The computer system of claim 69, wherein the insurance payer is selected from the group consisting of dental insurance payer, medical insurance payer, healthcare insurance payer, property insurance payer, worker'"'"'s compensation insurance payer, and casualty insurance payer.

71. The computer system of claim 69, wherein the first computer comprises a buffer computer system and the second computer comprises a legacy computer system.

72. The computer system of claim 71, wherein the legacy computer system is a health-insurance-claims management computer system.

73. The computer system of claim 71, wherein the attachment data is health-insurance-claims attachment data and the insurance transaction data is health-insurance-claims data.

74. The computer system of claim 71, wherein the buffer computer system is configured by software to display at least some of said attachment data on a computer display device.

75. The computer system of claim 41, wherein the digital data is receive from a computer system operated for at least one selected from the group consisting of a value added service, a provider, an insurance provider, a healthcare provider, and a clearinghouse.

76. The computer system of claim 41, wherein the insurance transaction data comprises information selected from the group consisting of dental data, medical data, healthcare data, worker'"'"'s compensation data, property insurance transaction data, and casualty insurance transaction information.

77. The computer system of claim 41, wherein the insurance transaction data comprises at least one selected from the group consisting of identification number, transaction identification data, beneficiary information, beneficiary name, patient data, patient name, healthcare provider data, healthcare provider name, healthcare provider identification data, healthcare provider document identification data, healthcare payer identification data, healthcare payer name, healthcare payer identification number, healthcare payer document identification data, healthcare-insurance-claim attachment identification number, description of service provided, date of service, healthcare encounter information, prior approval claim data, and worker'"'"'s compensation data.

78. The computer system of claim 41, wherein the attachment data comprises an attachment selected from a group consisting of a picture, a graph, a sound recording, nonstandard text, a digitized x-ray, an explanation of benefits, a CT, an MRI, a EKG, a EEG, a strip chart, a digitized video signals, a transcription of operating room notes, supplemental data to a health insurance claim, and additional ASCII text.

79. The computer system of claim 41, wherein the software further adapts the computer system to transmit the cross-referencing data from the first computer to the second computer.

80. The computer system of claim 41, wherein the second data comprises only a portion of the at least some of the insurance transaction data transmitted from the first computer to the second computer.

81. A computer implemented method, for processing electronic communications, the method comprises the steps of:

receiving, from a source external to a computer system, an electronic communication comprising first digital data in N₁ identifiable data fields, wherein N₁ is an integer and wherein at least some of the N₁ identifiable data fields comprise insurance transaction data and at least one of the N₁ identifiable data fields comprises attachment data for at least one attachment stored in memory of a first computer;

storing the electronic communication in memory of a second computer;

processing the electronic communication by;

displaying at least one graphic user interface screen comprising a set of N₂ identifiable data fields, wherein N₂ is an integer, and the attachment; and

determining second digital data to be entered in at least one field in the set of N₂ identifiable data fields using at least some of the insurance transaction data in the set of N₁ identifiable data fields in a logic process;

wherein the second digital data comprises insurance transaction data and wherein the second digital data excludes the attachment.

82. The method of claim 81, wherein the attachment data comprises the attachment.

83. The method of claim 81, wherein the first digital data comprises patient healthcare data and is received from a healthcare provider.

84. The method of claim 81, wherein the first digital data comprises at least patient identification data and physician identification data.

85. The method of claim 81, further comprising the step of receiving additional digital data into at least one field in the graphic user interface.

86. The method of claim 81, further comprising the step of copying the first digital data from at least one field in the N₁ identifiable data fields into at least one field of the N₂ second identifiable data fields.

87. The method of claim 81, further comprising the step of printing at least some of the second digital data.

88. The method of claim 81, wherein the method further comprises the step of transmitting at least some of the second digital data.

89. A method, implemented by a server computer, for processing electronic communications, the computer system comprising memory and at least one display device, the method comprises the steps of:

receiving, from a source external to the computer system, an electronic communication comprising digital data in N identifiable data fields, wherein N is an integer;

displaying at least a first and a second graphic user interface screen, wherein said first graphic user interface screen comprises a first set of N₁ identifiable data fields, wherein N₁ is an integer, wherein said second graphic user interface screen comprises a second set of N₂ identifiable data fields, and wherein N₂ is an integer;

copying first digital data from at least a first field of the N identifiable fields into at least one of the N₁ identifiable fields;

copying second digital data from at least a second field of the N identifiable data fields into at least one of the N₂ identifiable data fields;

wherein digital data copied into the at least one of the N₂ identifiable fields of the second graphic user interface screen excludes at least some of the digital data copied into the at least one of the N₁ identifiable fields of the first graphic user interface screen; and

determining the digital data to be displayed in at least one identifiable data field in the sets of N₁ and N₂ identifiable data fields using at least some of the digital data in the set of N identifiable data fields in a logic process.

90. The method of claim 89, wherein the digital data comprises healthcare data of a patient.

91. The method of claim 89, wherein the digital data is received from a healthcare provider.

92. The method of claim 89, wherein the digital data comprises at least patient identification data and physician identification data.

93. The method of claim 89, further comprising the step of receiving additional digital data into at least one field of the set of N₁ identifiable data fields or the set of N₂ identifiable data fields from a keyboard or a mouse.

94. The method of claim 89, further comprising the step of printing at least some of the data in the sets of N₁ and N₂ identifiable data fields.

95. The method of claim 89, wherein the method further comprises the step of transmitting at least some of the data in the sets of N₁ and N2 identifiable data fields.