Workers' compensation information processing system

• US 8,069,066 B2
• Filed: 06/04/2008
• Issued: 11/29/2011
• Est. Priority Date: 02/17/2000
• Status: Expired due to Term

• Current Assignee: SRPS LLC (UnitedHealth Group Incorporated)
• Original Assignee: SRPS LLC (UnitedHealth Group Incorporated)
• Inventors: Stevens, John R., Wilson, Sheryl Lee
• Primary Examiner(s): Gilligan; Luke
• Assistant Examiner(s): BURGESS, JOSEPH D
• Application Number:
  US12/132,970
• Publication Number:
  US 20080243559A1
• Time in Patent Office: 1,273 Days
• Field of Search: 705 2- 4
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof

Abstract

A workers'"'"' compensation medical reporting system including software accessed at a provider computer, the software adapted to prompt the provider to input the data concerning a workers'"'"' compensation claim, the software adapted to send an electronic workers'"'"' compensation claim, the software adapted to send an electronic workers'"'"' compensation treatment report electronically across the Internet to a payer computer; and electronic report filtering software accessed at the payer computer, the electronic report filtering software adapted to direct the electronic report as a result of predetermined criteria, electronic workers'"'"' compensation medical treatment reports that meet a human review criteria are automatically set to a case manager for review, other electronic workers'"'"' compensation medical treatment reports are automatically directed to be processed.

Claims

1. A workers'"'"' compensation system including:

an injury report system operably connected between a provider computer system and payer computer system, the injury report system configured to produce electronically, injury medical reports to the payer computer system;

a worker'"'"'s compensation claims verification system operably connected between the provider computer system and the payer computer system, the workers'"'"' compensation claims verification system configured to receive information concerning a workers'"'"' compensation claim, but not including a workers'"'"' compensation claim number for said claim, and responsive to said information, determine electronically, the presence or absence of the workers'"'"' compensation claim number in an associated database;

a bill submission system operably connected to electronically receive bills from the provider computer system, wherein on a condition that the presence of the workers'"'"' compensation claim number is determined, the workers'"'"' compensation claim number is included in the received bills; and

a payment status system operably connected between the provider computer system and the payer computer system and checking the status of the received bills.

2. The system of claim 1, wherein the bill submission system receives bills from the provider computer system.

3. The system of claim 1, wherein a server contains the software to implement the injury report system, workers'"'"' compensation claim verification system, bill submission system and payment status system.

4. The system of claim 1, wherein the bill submission system sends a bill to the payer computer system.

5. The system of claim 1, wherein the injury report system provides the injury medical reports to an employer computer system.

6. The system of claim 1, further comprising an automated reporting system operably connected between the payer computer system and an employer computer system, the automated reporting system configured to produce electronically, injury incident reports.

7. The system of claim 1, wherein the workers'"'"' compensation verification system is configured to send to the payer computer system an indication of a lack of the worker'"'"'s compensation number in response to determination of the absence of a worker'"'"'s compensation claim number for said claim in said associated database based on the received information.

8. The system of claim 7, wherein the indication of a lack of the worker'"'"'s compensation number sent to the payer computer system is an electronic mail message.

9. The system of claim 1, wherein the workers'"'"' compensation verification system is configured to send to the provider'"'"'s computer system the workers'"'"' compensation claim number determined to be present in said associated database based on the received information.

10. The system of claim 1, wherein said received information includes patient name, social security number and injury date.