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Health insurance management system

  • US 5,235,507 A
  • Filed: 01/16/1990
  • Issued: 08/10/1993
  • Est. Priority Date: 01/16/1990
  • Status: Expired due to Term
First Claim
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1. A health insurance management system for processing claims associated with a plurality of individual accounts and a plurality of separate plans sponsored by one or more organizations for management by an employer or participant-based management group, comprising:

  • means for entering claim data corresponding to one of said plurality of individual accounts;

    means for verifying an insured status of said account;

    means for selectively determining a plan culled from a database of discrete plans corresponding to said account, and implementing a set of plan parameters defining plan attributes for processing said claim data;

    data processing means for determining the relative payment of charges associated with said claim data by said sponsoring organization, a carrier and claimant wherein relative charges are one of the parameters in said set of plan parameters and said data processing means culls from a claimant database past charges accrued during a pre-defined periodic interval;

    means for checking an authorization of a health care provider in accordance with said claim data; and

    means for paying the provider.

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