Automated processing of electronic medical data for insurance and disability determinations

• US 20070038480A1
• Filed: 06/20/2005
• Published: 02/15/2007
• Est. Priority Date: 10/24/2001
• Status: Active Grant

• Current Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Original Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Inventors: Kay, Lay
• Granted Patent: US 7,707,046 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

Methods and systems are described for automated processing of medical data for insurance and disability determinations. Based on medical conditions claimed by a claimant, medical evidence queries are automatically generated to provide instructions to medical providers for conducting physical exams and laboratory tests and for retrieving medical records. After medical evidence is collected according to the queries, the medical evidence and related rating codes and decisions are displayed to rating personnel in a user-friendly format to assist in making a rating decision.

Claims

1. A computer-implemented method of assisting medical evidence collection for adjudication of a medical disability request, the method comprising:

receiving into a storage at least one claim by a claimant of a medical condition;

automatically generating a plurality of medical evidence queries based on the at least one claim and based on a disability rules collection; and

receiving medical evidence data from a first electronic data storage into a second storage, said medical evidence data being responsive to at least one of the generated medical evidence queries.

2. The method of claim 1, wherein the medical evidence data comprises responses to the generated medical evidence queries.

3. The method of claim 1, wherein the first electronic data storage comprises electronic medical records.

4. The method of claim 1, wherein receiving medical evidence data comprises receiving medical evidence data through a local area network.

5. The method of claim 1, wherein receiving medical evidence data comprises receiving medical evidence data over the Internet.

6. The method of claim 1, wherein receiving medical evidence data comprises receiving medical evidence data over an encrypted Internet connection.

7. The method of claim 1, wherein receiving medical evidence data further comprises receiving medical evidence data collected by a medical provider.

8. The method of claim 7, wherein receiving medical evidence data collected by a medical provider further comprises reviewing and extracting data from medical records.

9. The method of claim 7, wherein receiving medical evidence data collected by a medical provider further comprises taking a medical history of the claimant.

10. The method of claim 9, wherein the medical history comprises at least one of a family history and a social history.

11. The method of claim 7, wherein receiving medical evidence data collected by a medical provider further comprises receiving data from a physical exam.

12. The method of claim 7, wherein receiving medical evidence data collected by a medical provider further comprises receiving data representative of laboratory tests.

13. The method of claim 7, wherein receiving medical evidence data collected by a medical provider further comprises receiving data from radiological study results.

14. The method of claim 7, wherein receiving medical evidence data collected by a medical provider further comprises receiving data from nuclear medicine laboratory results.

15. A computer-readable medium having computer-executable instructions stored thereon configured to perform the method of claim 1.

16. A computer-implemented method for facilitating adjudication of a medical disability request, the method comprising:

receiving medical evidence data concerning a claimant; and

automatically generating a disability rating report based on the medical evidence data;

wherein the medical evidence data is obtained by a method comprising the following steps;

receiving into a first storage at least one claim by a claimant of a medical condition;

automatically generating a plurality of medical evidence queries based on the at least one claim and based on a disability rules collection; and

receiving into a second storage answers to the generated medical evidence queries from an electronic data storage, said answers corresponding to the medical evidence data.

17. The method of claim 16, wherein the electronic data storage comprises electronic medical records.

18. The method of claim 16, further comprising:

generating a recommended rating decision based on the medical evidence data; and

displaying the recommended rating decision in the disability rating report.

19. The method of claim 16, further comprising:

generating a recommended disability percentage based on the medical evidence data; and

displaying the recommended disability percentage in the disability rating report.

20. A computer system comprising a computer-readable medium having stored thereon computer-executable instructions configured to perform the method comprising:

receiving from a claimant at least one claim of a medical condition;

generating a plurality of medical evidence queries based on the at least one claim and based on a disability rules collection; and

receiving medical evidence data corresponding to the generated medical evidence queries from an electronic data storage.

21. A computer-readable medium having stored thereon computer-executable instructions configured to perform the method comprising:

receiving from a claimant at least one claim of a medical condition;

generating a plurality of medical evidence queries based on the at least one claim and based on a disability rules collection; and

receiving medical evidence data corresponding to the generated medical evidence queries from an electronic data storage.