Systems and methods for automated processing and assessment of an insurance disclosure via a network
First Claim
1. A method for processing and assessment of an insurance disclosure via a network comprising:
- receiving health care-related information from at least one data source;
comparing a portion of the health care-related information to at least one financial parameter;
comparing a portion of the health care-related information to at least clinical parameter; and
based at least in part on the comparison of the health care-related information to at least a financial parameter or clinical parameter, generating an output providing selected health care-related information.
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Accused Products
Abstract
The present invention relates to methods and systems for automated processing and assessment of an insurance disclosure. One embodiment of the invention can comprise an automated disclosure processing application engine. The automated disclosure processing application engine can be adapted to receive health care-related information. Health care-related information, also known as a “disclosure,” can include, but is not limited to, a medical claim, a precertification notice, prescription drug history, or any other information related to a medical or insurance claim for reimbursement or payment. Health care-related information can be received at any time, such as in real time, a predefined basis, daily, or on a less or more frequent basis. Health care-related information can be stored in a database, such as a AWAC® database. A portion of the health care-related information can be compared to at least one financial parameter. A portion of the health care-related information can also be compared to at least one clinical parameter. An output can be generated based in part on either the comparison with at least the financial parameter or the clinical parameter.
96 Citations
21 Claims
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1. A method for processing and assessment of an insurance disclosure via a network comprising:
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receiving health care-related information from at least one data source;
comparing a portion of the health care-related information to at least one financial parameter;
comparing a portion of the health care-related information to at least clinical parameter; and
based at least in part on the comparison of the health care-related information to at least a financial parameter or clinical parameter, generating an output providing selected health care-related information. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9)
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10. A system for providing processing and assessment of an insurance disclosure via a network comprising:
an automated disclosure processing application engine configured to receive health care-related information from at least one data source;
compare a portion of the health care-related information to at least one stop loss threshold;
compare a portion of the health care-related information to at least one code of concern; and
based at least in part on the comparison of the health care-related information to at least a financial parameter or clinical parameter, generate an output providing selected health care-related information. - View Dependent Claims (11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21)
Specification