Automated processing of electronic medical data for insurance and disability determinations

• US 7,707,046 B2
• Filed: 06/20/2005
• Issued: 04/27/2010
• Est. Priority Date: 10/24/2001
• Status: Active Grant

• Current Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Original Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Inventors: Kay, Lay K.
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): Altschul; Amber L
• Application Number:
  US11/157,125
• Publication Number:
  US 20070038480A1
• Time in Patent Office: 1,772 Days
• Field of Search: 705/2, 705/3, 705/4
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

Methods and systems are described for automated processing of medical data for insurance and disability determinations. Based on medical conditions claimed by a claimant, medical evidence queries are automatically generated to provide instructions to medical providers for conducting physical exams and laboratory tests and for retrieving medical records. After medical evidence is collected according to the queries, the medical evidence and related rating codes and decisions are displayed to rating personnel in a user-friendly format to assist in making a rating decision.

Claims

1. A computer-implemented method of assisting medical evidence collection for adjudication of a medical disability request, the method comprising:

receiving from a claimant at least one claim of a medical condition;

generating a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection;

displaying the generated medical evidence queries in a data collection protocol;

receiving medical evidence data responsive to the generated medical evidence queries from an electronic data storage;

determining, by a computer, a degree of disability based on the collected medical evidence data and on the disability rating rules collection; and

generating, by a computer, a report comprising the degree of disability;

wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and

wherein the generating the plurality of medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.

2. The method of claim 1, wherein the medical evidence data comprises responses to the generated medical evidence queries.

3. The method of claim 1, wherein the electronic data storage comprises electronic medical records.

4. The method of claim 1, wherein the receiving medical evidence data comprises receiving medical evidence data through a local area network.

5. The method of claim 1, wherein the receiving medical evidence data comprises receiving medical evidence data over the Internet.

6. The method of claim 1, wherein the receiving medical evidence data comprises receiving medical evidence data over an encrypted Internet connection.

7. The method of claim 1, wherein the receiving medical evidence data further comprises receiving medical evidence data collected by a medical provider.

8. The method of claim 7, wherein the receiving medical evidence data collected by a medical provider further comprises reviewing and extracting data from medical records.

9. The method of claim 7, wherein the receiving medical evidence data collected by a medical provider further comprises taking a medical history of the claimant.

10. The method of claim 9, wherein the medical history comprises at least one of a family history and a social history.

11. The method of claim 7, wherein the receiving medical evidence data collected by a medical provider further comprises receiving data from a physical exam.

12. The method of claim 7, wherein the receiving medical evidence data collected by a medical provider further comprises receiving data representative of laboratory tests.

13. The method of claim 7, wherein the receiving medical evidence data collected by a medical provider further comprises receiving data from radiological study results.

14. The method of claim 7, wherein the receiving medical evidence data collected by a medical provider further comprises receiving data from nuclear medicine laboratory results.

15. A computer-readable medium having computer-executable instructions stored thereon for performing the method of claim 1.

16. A computer-implemented method for facilitating adjudication of a medical disability request, the method comprising:

receiving medical evidence data concerning a claimant;

determining a degree of disability based on the medical evidence data and on a disability rating rules collection; and

generating a disability rating report based on the medical evidence data;

wherein the medical evidence data is obtained by a method comprising the following steps;

receiving from the claimant at least one claim of a medical condition;

generating a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by the disability rating rules collection; and

receiving answers to the generated medical evidence queries from an electronic data storage, said answers responsive to the medical evidence data;

wherein the disability rating report comprises a degree of disability; and

wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and

wherein the generating the plurality of medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.

17. The method of claim 16, wherein the electronic data storage comprises electronic medical records.

18. The method of claim 16, wherein the degree of disability comprises:

generating a recommended disability percentage based on the medical evidence data.

19. A computer system comprising a computer-readable medium having stored thereon computer-executable instructions configured to perform the method comprising:

receiving from a claimant at least one claim of a medical condition;

generating a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection;

receiving medical evidence data responsive to the generated medical evidence queries from an electronic data storage;

determining a degree of disability based on the collected medical evidence data and on the disability rating rules collection; and

generating a report comprising the degree of disability;

wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and

wherein the generating the plurality of medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.

20. A computer-readable medium having stored thereon computer-executable instructions configured to perform the method comprising:

receiving from a claimant at least one claim of a medical condition;

generating a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection;

receiving medical evidence data responsive to the generated medical evidence queries from an electronic data storage;

determining a degree of disability based on the collected medical evidence data and on the disability rating rules collection; and

generating a report comprising the degree of disability;

wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and

wherein the generating the plurality of medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.

21. A computer-implemented method of assisting medical evidence collection for adjudication of a medical disability request, the method comprising:

receiving from a claimant at least one claim of a medical condition;

generating a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection;

receiving medical evidence data responsive to the generated medical evidence queries from an electronic data storage;

determining a degree of disability based on the collected medical evidence data and on the disability rating rules collection; and

generating a report comprising the degree of disability;

wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and

wherein the generating the plurality of medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.