Managing insurance claim data

• US 8,086,474 B1
• Filed: 07/30/2007
• Issued: 12/27/2011
• Est. Priority Date: 07/30/2007
• Status: Active Grant

• Current Assignee: Intuit, Inc., Ingenix Incorporated (UnitedHealth Group Incorporated)
• Original Assignee: Intuit, Inc., Ingenix Incorporated (UnitedHealth Group Incorporated)
• Inventors: Lasalle, Craig M., Rogers, Lisa H., Linardi, Ellen, Goldman, Beth, Elangovan, Lavanya, Costello, Maureen, Homier, Matthew J.
• Primary Examiner(s): Apple, Kirsten
• Application Number:
  US11/830,813
• Time in Patent Office: 1,611 Days
• Field of Search: 705/4
• US Class Current: 705/4
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A method for managing insurance claim data involves identifying a first insurance claim data and a second insurance claim data using pattern recognition on multiple insurance claim data associated with an insured party, where the first insurance claim data and the second insurance claim data are associated with a single insurance claim associated with the insured party, where the second insurance claim data is later in time than the first insurance claim data, and where the second insurance claim data includes a modification of the single insurance claim relative to the first insurance claim data. The method further involves determining a financial responsibility of the insured party for the single insurance claim based on the second insurance claim data, and presenting the first insurance claim data, the second insurance claim data, and the financial responsibility in a graphical user interface (GUI).

Claims

1. A method for calculating a financial responsibility, comprising:

accessing, by a software application executing on a computer processor and operated by a party selected from a group consisting of a patient and a relative of the patient, a repository of a medical insurance provider (MIP);

searching, by the software application operated by the party, a plurality of entries in the repository of the MIP based on a date;

retrieving, in response to searching and by the software application operated by the party, an entry in the repository corresponding to the date and identifying a first medical procedure (MP) performed on the patient by a medical service provider (MSP), an amount billed to the party for the first MP, a second MP performed on the patient; and

an amount billed to the party for the second MP;

retrieving, in response to searching and by the software application operated by the party, an adjusted entry in the repository corresponding to the date and identifying the first MP and an adjusted amount billed to the party for the first medical procedure;

determining, by the software application operated by the party, that the adjusted entry is a revision of the entry based on the adjusted entry being more recent than the entry;

calculating, by the software application operated by the party, the financial responsibility of the party for the first MP and the second MP by summing the adjusted amount and the amount billed to the patient for the second MP; and

generating, by the software application operated by the party, a graphical user interface (GUI) identifying the first MP, the amount billed to the party for the first MP, an indication the amount billed to the party for the first MP is incorrect, the adjusted amount, the second medical procedure, the amount billed to the party for the second MP, and the financial responsibility of the party.

2. The method of claim 1, further comprising:

processing a GUI command associated with the first MP.

3. The method of claim 2, wherein the GUI command comprises editing an amount of the financial responsibility already paid by the party.

4. The method of claim 2, wherein the GUI command comprises accessing a diagnosis of the first MP.

5. The method of claim 2, wherein the GUI command comprises storing a note generated by the party and associated with the adjusted amount in the adjusted entry.

16. The method of claim 1, further comprising:

marking, by the software application operated by the party, the financial responsibility as a disputed amount;

populating, automatically and by the software application operated by the party, a dispute letter for the disputed amount comprising the financial responsibility of the party; and

sending, electronically and by the software application operated by the party, the dispute letter to the MIP.

17. The method of claim 1, further comprising:

identifying a medical bill transmitted to the party for the first MP and based on the entry, wherein the medical bill is transmitted after creation of the entry and before creation of the adjusted entry;

determining that the medical bill is invalid based on the adjusted entry; and

transmitting a message to the party indicating that that medical bill is invalid.

6. A system for determining a financial responsibility comprising:

a computer processor; and

an insurance claim data manager (ICDM) executing on the computer processor and operated by a party selected from a group consisting of a patient and a relative of the patient, the ICDM configured to;

access a repository of a medical insurance provider (MIP);

search a plurality of entries in the repository of the MIP based on a date;

retrieve, in response to searching, an entry in the repository corresponding to the date and identifying a first medical procedure (MP) performed on the patient by a medical service provider (MSP), an amount billed to the party for the first MP, a second MP performed on the patient, and an amount billed to the party for the second MP;

retrieve, in response to searching, an adjusted entry in the repository corresponding to the date and identifying the first MP and an adjusted amount billed to the party for the first MP;

determine that adjusted entry is a revision of the entry based on the adjusted entry being more recent than the entry;

calculate the financial responsibility of the party for the first MP and the second MP by summing the adjusted amount and the amount billed to the party for the second MP; and

generate, a graphical user interface (GUI) comprising the first MP, the amount billed to the party for the first MP, an indication the amount billed to the party for the first MP is incorrect, the adjusted amount, the second MP, the amount billed to the party for the second MP, and the financial responsibility of the party.

7. The system of claim 6, wherein the insurance claim data manager is further configured to:

process a GUI command associated with the first MP.

8. The system of claim 7, wherein the GUI command comprises editing an amount of the financial responsibility already paid by the party.

9. The system of claim 7, wherein the GUI command comprises accessing a diagnosis associated with the first MP.

10. The system of claim 7, wherein the GUI command comprises storing a note generated by the party and associated with the adjusted amount in the adjusted entry.

18. The system of claim 6, the ICDM further comprising functionality to:

mark the financial responsibility as a disputed amount;

automatically populate a dispute letter for the disputed amount comprising the financial responsibility of the party; and

electronically send the dispute letter to the MIP.

19. The system of claim 6, wherein the insurance claim data manager is further configured to:

identify a medical bill transmitted to the party for the first MP and based on the entry, wherein the medical bill is transmitted after creation of the entry and before creation of the adjusted entry;

determine that the medical bill is invalid based on the adjusted entry; and

transmit a message to the party indicating that that medical bill is invalid.

11. A non-transitory computer readable storage medium storing instructions for calculating a financial responsibility, the instructions executable on a processor and comprising functionality for:

accessing, for a party selected from a group consisting of a patient and a relative of the patient, a repository of a medical insurance provider (MIP);

searching a plurality of entries in the repository of the MIP based on a date;

retrieving, in response to searching, a first entry in the repository corresponding to the date and identifying a first medical procedure (MP) performed on the patient by a medical service provider (MSP), an amount billed to the party for the first MP, a second MP performed on the patient, and an amount billed to the party for the second MP;

retrieving, in response to searching, an adjusted entry in the repository corresponding to the date and identifying the first MP and an adjusted amount billed to the party for the first MP;

determining that the adjusted entry is a revision of the entry based on the adjusted entry being more recent than the entry;

calculating the financial responsibility of the party by summing the adjusted amount and the amount billed to the party for the second MP;

generating a graphical user interface (GUI) identifying the first MP, the amount billed to the party for the first MP, an indication the amount billed to the party for the first MP is incorrect, the second MP, the amount billed to the party for the second MP, and the financial responsibility of the party.

12. The non-transitory computer readable storage medium of claim 11, further comprising executable instructions to:

process a GUI command associated with the first MP.

13. The non-transitory computer readable storage medium of claim 12, wherein the GUI command comprises editing an amount of the financial responsibility already paid by the party.

14. The non-transitory computer readable storage medium of claim 12, wherein the GUI command comprises accessing a diagnosis of the first MP.

15. The non-transitory computer readable storage medium of claim 12, wherein the GUI command comprises recording a note generated by the party and associated with the adjusted amount in the adjusted entry.

20. The non-transitory computer readable storage medium of claim 11, the instructions further comprising functionality for:

marking the financial responsibility as a disputed amount;

automatically populating a dispute letter for the disputed amount comprising the financial responsibility of the party; and

electronically sending the dispute letter to the MIP.

21. The non-transitory computer readable storage medium of claim 11, the instructions further comprising functionality for:

identifying a medical bill transmitted to the party for the first MP and based on the entry, wherein the medical bill is transmitted after creation of the entry and before creation of the adjusted entry;

determining that the medical bill is invalid based on the adjusted entry; and

transmitting a message to the party indicating that that medical bill is invalid.