Interactive creation and adjudication of health care insurance claims

  • US 7,194,416 B1
  • Filed: 11/28/2000
  • Issued: 03/20/2007
  • Est. Priority Date: 12/03/1998
  • Status: Expired due to Fees
First Claim
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1. A computer program product for implementing a method of interactively preparing an insurance claim that is in condition to be paid, the insurance claim being prepared prior to a health care provider performing health care services that are the subject of the insurance claim, wherein the method is capable of being performed on a client computer that communicates with a remote server computer, the computer program product comprising:

  • a computer-readable medium carrying computer-executable instructions for implementing the method, the computer-executable instructions comprising;

    program code means for displaying a computer-displayable claim form to a health care provider;

    program code means for initiating transmission of a proposed insurance claim that includes a diagnosis code and a treatment code from the client computer to the remote server computer prior to the health care provider performing the health care services;

    program code means for receiving, from the remote server computer and prior to the health care provider performing the health care services, information indicating whether the proposed insurance claim is in condition to be paid; and

    program code means for initiating transmission of a revised proposed insurance claim, prior to the health care provider performing the health care services, if it has been determined that the proposed insurance claim is not in condition for allowance, wherein the revised proposed insurance claim includes at least one of a revised diagnosis code and a revised treatment code.

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