Health insurance management system
First Claim
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.
2 Assignments
0 Petitions
Accused Products
Abstract
Data processing for a health insurance management system verifies the insurance status of the claimant, identifies the appropriate insurance policy, calculates the amount to be paid to the health care provider, pays the provider, calculates the payment required by the claimant, if any, and debits the account of the claimant in the amount required. A claim may be processed under more than one policy where appropriate. The system can handle both individual and family insurance policies.
370 Citations
4 Claims
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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:
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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. - View Dependent Claims (2, 3, 4)
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Specification