SYSTEMS, METHODS, AND MEDIA FOR GENERATING CLAIM SUBMISSIONS

• US 20140200924A1
• Filed: 03/17/2014
• Published: 07/17/2014
• Est. Priority Date: 04/19/2011
• Status: Abandoned Application

• Current Assignee: Assuricare LLC
• Original Assignee: Assuricare LLC
• Inventors: Gilbert, Michael J., Kraemer, Doris E., Gibelli, Mark P.
• Application Number:
  US14/216,669
• Publication Number:
  US 20140200924A1
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Systems, methods, and media for generating claim submissions are provided. In some embodiments, the methods comprise: storing in one or more storage devices information regarding a plan of care for a care recipient and caregiver information associated with the plan of care; receiving at one or more hardware processors check-in/check-out information initiated by the caregiver regarding caregiver services for the care recipient, which check-in/check-out information includes verification data based on voice matching or face matching; and generating claim submission information based on the received check-in/check-out information.

Claims

1. A method comprising:

storing in one or more storage devices information regarding a plan of care for a care recipient and caregiver information associated with the plan of care;

receiving at one or more hardware processors check-in/check-out information initiated by the caregiver regarding caregiver services for the care recipient, which check-in/check-out information includes verification data based on voice matching or face matching; and

generating claim submission information based on the received check-in/check-out information.

2. The method of claim 1, further comprising:

repeatedly receiving location information from a global positioning system over a period of time;

determining whether the location information matches a predetermined area; and

generating an alert and/or checking out the caregiver if it is determined that the location information does not match the predetermined area.

3. The method of claim 1, wherein generating claim submission information comprises generating claim submission information in one of a coma separated values (CSV) file format, a spreadsheet, an image file format, or a page file format.

4. The method of claim 1, further comprising transmitting the claim submission information to an insurer or payer of the caregiver services.

5. The method of claim 4, further comprising transmitting the claim submission information via one of fax, secure copy (SCP) protocol, hypertext transfer protocol secure (HTTPS), file transfer protocol (FTP), or direct electronic interface.

6. The method of claim 1, wherein the storing in one or more storage devices of information regarding a plan of care comprises storing in one or more storage devices information including at least one of a care recipient identifier, a number of caregiver hours to be worked in a day, a number of caregiver days to be worked in a week, or an indication of at least one type of activity of daily living with which the care recipient is to be assisted.

7. The method of claim 1, further comprising determining a number of hours worked and comparing the number of hours worked to a planned number of hours to be worked.

8. The method of claim 1, wherein the storing in one or more storage devices of caregiver information comprises storing in one or more storage devices at least one of a caregiver identifier, a voice print of the caregiver'"'"'s voice, a previous recording of the caregiver'"'"'s voice, or an image of the caregiver'"'"'s face.

9. The method of claim 1, wherein the receiving at one or more hardware processors check-in/check-out information comprises at least one of:

receiving at the one or more hardware processors check-in time information from the caregiver regarding the caregiver services, the check-in time information including at least one of a caregiver identifier, a voice input comprising the caregiver'"'"'s spoken name, another voice input compared to the voice print, an image of the caregiver'"'"'s face;

or

receiving at the one or more hardware processors check-out time information from the caregiver regarding the caregiver services, the check-out time information including at least one of a caregiver identifier, a voice input comprising the caregiver'"'"'s spoken name, another voice input compared to the voice print, an image of the caregiver'"'"'s face, or information about services provided.

10. The method of claim 1, further comprising determining that the received check-in/check-out information is not complete or does not conform to the stored information regarding the plan of care or to the stored caregiver information and notifying a user of one or more discrepancies in the received check-in/check-out information.

11. The method of claim 10, wherein the determining that the received check-in/check-out information is not complete or does not conform to the stored information regarding the plan of care or to the stored caregiver information comprises determining whether:

a check-in event has a corresponding check-out event;

a check-out event has a corresponding check-in event;

a received voice input of a caregiver'"'"'s voice matches a voice print of the caregiver or other previously recorded voice recordings stored in the one or more storage devices;

a received image of a caregiver'"'"'s face matches an image of the caregiver stored in the one or more storage devices;

or

received location information matches location information as indicated in the information regarding the plan of care stored in the one or more storage devices or in the caregiver information stored in the one or more storage devices.

12. The method of claim 10, wherein the notifying the user comprises at least one of:

presenting on a display screen a notification of the one or more discrepancies;

emailing a notification of the one or more discrepancies;

sending a text message regarding the one or more discrepancies;

sending an instant message regarding the one or more discrepancies;

or

telephoning an automated message regarding the one or more discrepancies.

13. The method of claim 10, further comprising:

notifying the user to create updated check-in/check-out information; and

receiving information resolving the one or more discrepancies.

14. The method of claim 1, further comprising determining that a pattern related to the received check-in/check-out information is questionable and notifying a user of one or more discrepancies in the received check-in/check-out information.

15. The method of claim 1, further comprising generating payroll, caregiver payment, or wage information based on the received check-in/check-out information.

16. The method of claim 15, wherein:

the receiving the check-in/check-out information is performed by a first processor of the one or more hardware processors; and

/or

the generating of payroll, caregiver payment, or wage information is performed by a second processor of the one or more hardware processors.

17. A system comprising:

at least one hardware processor that;

stores in one or more storage devices information regarding a plan of care for a care recipient and caregiver information associated with the plan of care;

receives check-in/check-out information initiated by the caregiver regarding caregiver services for the care recipient, which check-in/check-out information includes verification data based on voice matching or face matching; and

generates claim submission information based on the received check-in/check-out information.

18. The system of claim 17, wherein the at least one hardware processor also:

repeatedly receives location information from a global positioning system over a period of time

determines whether the location information matches a predetermined area; and

generates an alert and/or checks out the caregiver if it is determined that the location information does not match the predetermined area.

19. The system of claim 17, wherein the at least one hardware processor also generates claim submission information that comprises generating claim submission information in one of a coma separated values (CSV) file format, a spreadsheet, an image file format, or a page file format.

20. The system of claim 17, wherein the at least one hardware processor also transmits the claim submission information to an insurer or payer of the caregiver services.

21. The system of claim 20, wherein the at least one hardware processor also transmits the claim submission information via one of fax, secure copy (SCP) protocol, hypertext transfer protocol secure (HTTPS), file transfer protocol (FTP), or direct electronic interface.

22. The system of claim 17, wherein the at least one hardware processor also stores in the one or more storage devices information including at least one of a care recipient identifier, a number of caregiver hours to be worked in a day, a number of caregiver days to be worked in a week, or an indication of at least one type of activity of daily living with which the care recipient is to be assisted.

23. The system of claim 17, wherein the at least one hardware processor also determines a number of hours worked and compares the number of hours worked to a planned number of hours to be worked.

24. The system of claim 17, wherein the at least one hardware processor also stores in one or more storage devices at least one of a caregiver identifier, a voice print of the caregiver'"'"'s voice, a previous recording of the caregiver'"'"'s voice, or an image of the caregiver'"'"'s face.

25. The system of claim 17, wherein the at least one hardware processor also:

receives check-in time information from the caregiver regarding the caregiver services, the check-in time information including at least one of a caregiver identifier, a voice input comprising the caregiver'"'"'s spoken name, another voice input compared to the voice print, an image of the caregiver'"'"'s face;

or

receives check-out time information from the caregiver regarding the caregiver services, the check-out time information including at least one of a caregiver identifier, a voice input comprising the caregiver'"'"'s spoken name, another voice input compared to the voice print, an image of the caregiver'"'"'s face, or information about services provided.

26. The system of claim 17, wherein the at least one hardware processor also determines that the received check-in/check-out information is not complete or does not conform to the stored information regarding the plan of care or to the stored caregiver information and notifies a user of one or more discrepancies in the received check-in/check-out information.

27. The system of claim 26, wherein the at least one hardware processor also determines that the received check-in/check-out information is not complete or does not conform to the stored information regarding the plan of care or to the stored caregiver information comprises determining whether:

a check-in event has a corresponding check-out event;

a check-out event has a corresponding check-in event;

a received voice input of a caregiver'"'"'s voice matches a voice print of the caregiver or other previously recorded voice recordings stored in the one or more storage devices;

a received image of a caregiver'"'"'s face matches an image of the caregiver stored in the one or more storage devices;

or

received location information matches location information as indicated in the information regarding the plan of care stored in the one or more storage devices or in the caregiver information stored in the one or more storage devices.

28. The system of claim 26, wherein the at least one hardware processor, in notifying the user, also:

presents on a display screen a notification of the one or more discrepancies;

emails a notification of the one or more discrepancies;

sends a text message regarding the one or more discrepancies;

sends an instant message regarding the one or more discrepancies; and

/or

telephones an automated message regarding the one or more discrepancies.

29. The system of claim 26, wherein the at least one hardware processor also:

notifies the user to create updated check-in/check-out information; and

receives information resolving the one or more discrepancies.

30. The system of claim 17, wherein the at least one hardware processor also determines that a pattern related to the received check-in/check-out information is questionable and notifies a user of one or more discrepancies in the received check-in/check-out information.

31. The system of claim 17, wherein the at least one hardware processor also generates payroll, caregiver payment, or wage information based on the received check-in/check-out information.

32. The system of claim 31, wherein:

a first processor of the one or more hardware processors receives the check-in/check-out information; and

/or

a second processor of the one or more hardware processors generates payroll, caregiver payment, or wage information.

33. A non-transitory computer-readable medium containing computer-executable instructions that, when executed by a processor, cause the processor to perform a method comprising:

storing in one or more storage devices information regarding a plan of care for a care recipient and caregiver information associated with the plan of care;

receiving at one or more hardware processors check-in/check-out information initiated by the caregiver regarding caregiver services for the care recipient, which check-in/check-out information includes verification data based on voice matching or face matching; and

generating claim submission information based on the received check-in/check-out information.

34. The non-transitory computer-readable medium of claim 33, wherein the method further comprises:

repeatedly receiving location information from a global positioning system over a period of time;

determining whether the location information matches a predetermined area; and

generating an alert and/or checking out the caregiver if it is determined that the location information does not match the predetermined area.

35. The non-transitory computer-readable medium of claim 33, wherein generating claim submission information comprises generating claim submission information in one of a coma separated values (CSV) file format, a spreadsheet, an image file format, or a page file format.

36. The non-transitory computer-readable medium of claim 33, wherein the method further comprises transmitting the claim submission information to an insurer or payer of the caregiver services.

37. The non-transitory computer-readable medium of claim 36, wherein the method further comprises transmitting the claim submission information via one of fax, secure copy (SCP) protocol, hypertext transfer protocol secure (HTTPS), file transfer protocol (FTP), or direct electronic interface.

38. The non-transitory computer-readable medium of claim 33, wherein the storing in one or more storage devices of information regarding a plan of care comprises storing in one or more storage devices information including at least one of a care recipient identifier, a number of caregiver hours to be worked in a day, a number of caregiver days to be worked in a week, or an indication of at least one type of activity of daily living with which the care recipient is to be assisted.

39. The non-transitory computer-readable medium of claim 33, wherein the method further comprises determining a number of hours worked and comparing the numbers of hours worked to a planned number of hours to be worked.

40. The non-transitory computer-readable medium of claim 33, wherein the storing in one or more storage devices of caregiver information comprises storing in one or more storage devices at least one of a caregiver identifier, a voice print of the caregiver'"'"'s voice, a previous recording of the caregiver'"'"'s voice, or an image of the caregiver'"'"'s face.

41. The non-transitory computer-readable medium of claim 33, wherein the receiving at one or more hardware processors check-in/check-out information comprises at least one of:

receiving at the one or more hardware processors check-in time information from the caregiver regarding the caregiver services, the check-in time information including at least one of a caregiver identifier, a voice input comprising the caregiver'"'"'s spoken name, another voice input compared to the voice print, an image of the caregiver'"'"'s face;

or

receiving at the one or more hardware processors check-out time information from the caregiver regarding the caregiver services, the check-out time information including at least one of a caregiver identifier, a voice input comprising the caregiver'"'"'s spoken name, another voice input compared to the voice print, an image of the caregiver'"'"'s face, or information about services provided.

42. The non-transitory computer-readable medium of claim 33, wherein the method further comprises determining that the received check-in/check-out information is not complete or does not conform to the stored information regarding the plan of care or to the stored caregiver information and notifying a user of one or more discrepancies in the received check-in/check-out information.

43. The non-transitory computer-readable medium of claim 42, wherein the determining that the received check-in/check-out information is not complete or does not conform to the stored information regarding the plan of care or to the stored caregiver information comprises determining whether:

a check-in event has a corresponding check-out event;

a check-out event has a corresponding check-in event;

a received voice input of a caregiver'"'"'s voice matches a voice print of the caregiver or other previously recorded voice recordings stored in the one or more storage devices;

a received image of a caregiver'"'"'s face matches an image of the caregiver stored in the one or more storage devices;

or

received location information matches location information as indicated in the information regarding the plan of care stored in the one or more storage devices or in the caregiver information stored in the one or more storage devices.

44. The non-transitory computer-readable medium of claim 42, wherein the notifying the user comprises at least one of:

presenting on a display screen a notification of the one or more discrepancies;

emailing a notification of the one or more discrepancies;

sending a text message regarding the one or more discrepancies;

sending an instant message regarding the one or more discrepancies;

or

telephoning an automated message regarding the one or more discrepancies.

45. The non-transitory computer-readable medium of claim 42, wherein the method further comprises:

notifying the user to create updated check-in/check-out information; and

receiving information resolving the one or more discrepancies.

46. The non-transitory computer-readable medium of claim 33, wherein the method further comprises determining that a pattern related to the received check-in/check-out information is questionable and notifying a user of one or more discrepancies in the received check-in/check-out information.

47. The non-transitory computer-readable medium of claim 33, wherein the method further comprises generating payroll, caregiver payment, or wage information based on the received check-in/check-out information.

48. The non-transitory computer-readable medium of claim 47, wherein:

the receiving the check-in/check-out information is performed by a first processor of the one or more hardware processors; and

/or

the generating of payroll, caregiver payment, or wage information is performed by a second processor of the one or more hardware processors.