Claim data and document processing system

• US 20040205664A1
• Filed: 02/20/2004
• Published: 10/14/2004
• Est. Priority Date: 03/25/2003
• Status: Abandoned Application

• Current Assignee: Siemens Medical Solutions Health Services Corporation (Siemens AG)
• Original Assignee: Siemens Medical Solutions Health Services Corporation (Siemens AG)
• Inventors: Prendergast, Thomas V.
• Application Number:
  US10/783,077
• Publication Number:
  US 20040205664A1
• Time in Patent Office: Days
• US Class Current: 715/530
• CPC Class Codes: G06F 40/151 Transformation

Abstract

A system which processes claim data related to provision of healthcare to a patient includes the following. An interface processor receives claim data related to a claim for provision of a service to a particular patient. An attachment processor automatically applies predetermined claim submission requirements in processing the claim data to identify: (a) whether an attachment document is required to be submitted together with the claim to a payer for claim reimbursement; and (b) which particular document is to be provided together with the claim to said payer for claim reimbursement. A document processor retrieves the particular document from storage for provision to said payer for claim reimbursement.

Claims

1. A system for processing claim data related to provision of healthcare to a patient, comprising:

an interface processor for receiving claim data related to a claim for provision of a service to a particular patient;

an attachment processor for automatically applying predetermined claim submission requirements in processing said claim data to identify;

whether an attachment document is required to be submitted together with said claim to a payer for claim reimbursement; and

a particular document to be provided together with said claim to said payer for claim reimbursement; and

a document processor for retrieving said particular document from storage for provision to said payer for claim reimbursement.

2. A system according to claim 1, wherein said document processor automatically initiates communication of said particular document to said payer by electronic communication including at least one of, (a) Facsimile transmission, (b) Email, (c) Internet compatible communication and (d) a transaction standard compatible communication.

3. A system according to claim 2, wherein said electronic communication includes encryption of said particular document prior to communication.

4. A system according to claim 1, wherein said attachment processor automatically identifies a particular version of said particular document to be provided together with said claim to said payer for claim reimbursement.

5. A system according to claim 1, wherein said attachment processor automatically identifies a particular type of said particular document to be provided together with said claim to said payer for claim reimbursement.

6. A system according to claim 5 wherein said particular type includes one of (a) a receipt, (b) a photograph, (c) a chart, (d) an invoice, (e) a certificate, and (f) a prescription.

7. A system according to claim 1, wherein said attachment processor processes said claim data to derive information including at least one of (a) diagnosis information, (b) medical procedure information and (c) charge information, related to said claim, and employs said derived information in determining whether an attachment document is required to be submitted together with said claim to a payer for claim reimbursement.

8. A system according to claim 1, wherein said document processor determines said particular document is unavailable from storage and initiates generation of said particular document.

9. A system according to claim 8, wherein said document processor determines said particular document is unavailable from storage and initiates generation of said particular document using information derived from at least one of, (a) a clinical data repository, (b) a laboratory results repository and (c) an electronic patient record of said particular patient.

10. A system according to claim 1, wherein said attachment processor compiles a map associating a particular claim with one or more required attachments and updates said map in response to identifying said particular document is to be provided together with said claim to said payer for claim reimbursement.

11. A system according to claim 10 wherein said predetermined claim submission requirements comprise rules which associate claim data indicating provision of a service of a particular nature with an attachment and particular document.

12. A system according to claim 11 wherein said predetermined claim submission requirements comprise rules which associated one of more of:

(a) a laboratory receipt with a claim for reimbursement for a laboratory test;

(b) an X-ray with a claim for reimbursement for setting a broken bone;

(c) a prescription with a claim for reimbursement for providing medication;

a receipt with a claim for reimbursement for services provided by an outside organization.

13. A system according to claim 1, wherein;

said attachment processor automatically applies said predetermined claim submission requirements in processing said claim data to identify a plurality of documents to be provided together with said claim to said payer for claim reimbursement, and

said document processor retrieves said plurality of documents from storage for provision to said payer for claim reimbursement.

16. The method of claim 13 further comprising the step of automatically initiating communication of said particular document to said payer by electronic communication including at least one of, (a) Facsimile transmission, (b) Email, (c) Internet compatible communication and (d) a transaction standard compatible communication.

18. The method of claim 13 wherein the step of identifying a particular document comprises the step of identifying a particular version of the particular document.

19. The method of claim 13 wherein the step of identifying a particular document comprises the step of identifying a particular type of the particular document.

21. The method of claim 13 wherein the steps of:

processing said claim data comprises the step of deriving information including at least one of (a) diagnosis information, (b) medical procedure information and (c) charge information, related to said claim; and

employing said derived information to determine whether an attachment document is required to be submitted together with said claim to a payer for claim reimbursement.

22. The method of claim 13 wherein the step of retrieving said particular document comprises the steps of:

determining if said particular document is available in said storage; and

generating said particular document if said particular document is not available is said storage.

24. The method of claim 13 wherein the step of processing said claim data comprises the steps of:

compiling a map associating a particular claim with one or more required attachments; and

updating said map in response to identifying said particular document is to be provided together with said claim to said payer for claim reimbursement.

25. The method of claim 13 wherein the step of processing said claim data comprises the steps of:

automatically applying said predetermined claim submission requirements in processing said claim data for the purpose of identifying a plurality of documents to be submitted together with said claim to said payer for claim reimbursement, and

retrieving said plurality of documents from storage for provision to said payer for claim reimbursement.

14. A system for processing data related to receiving reimbursement for provision of a service to a customer, comprising:

an interface processor for receiving data related to a claim for reimbursement for provision of a service to a customer;

an attachment processor for automatically applying predetermined claim submission requirements in processing said claim data to identify;

whether an attachment document is required to be submitted together with said claim to a payer for claim reimbursement; and

a particular document to be provided together with said claim to said payer for claim reimbursement; and

a document processor for retrieving said particular document from storage for provision to said payer for claim reimbursement.

17. The method of claim 14 further comprising the step of encrypting said particular document before initiating communication.

20. The method of claim 17 wherein the step of identifying a particular type of the particular document comprises identifying the particular type as one of (a) a receipt, (b) a photograph, (c) a chart, (d) an invoice, (e) a certificate, and (f) a prescription.

23. The method of claim 20 wherein the step of generating said particular document comprises the steps of:

deriving information from at least one of (a) a clinical data repository, (b) a laboratory results repository and (c) an electronic patient record of said particular patient; and

generating said particular document using the derived information.

15. A method for processing claim data related to provision of healthcare to a patient, comprising the steps of:

receiving claim data related to a claim for provision of a service to a particular patient;

processing said claim data by automatically applying predetermined claim submission requirements for the purpose of;

identifying whether an attachment document is required to be submitted together with said claim to a payer for claim reimbursement; and

identifying a particular document to be provided together with said claim to said payer for claim reimbursement; and

retrieving said particular document from storage for provision to said payer for claim reimbursement.

26. A method for processing data related to provision of a service to a customer, comprising the steps of:

receiving data related to a claim for provision of a service to a particular customer;

processing said data by automatically applying predetermined claim submission requirements for the purpose of;

identifying whether an attachment document is required to be submitted together with said claim to a payer for claim reimbursement; and

identifying a particular document to be provided together with said claim to said payer for claim reimbursement; and

retrieving said particular document from storage for provision to said payer for claim reimbursement.