Managing insurance claim data across insurance policies

• US 8,103,527 B1
• Filed: 06/29/2007
• Issued: 01/24/2012
• Est. Priority Date: 06/29/2007
• Status: Active Grant

• Current Assignee: Intuit, Inc., Ingenix Incorporated (UnitedHealth Group Incorporated)
• Original Assignee: Intuit, Inc., Ingenix Incorporated (UnitedHealth Group Incorporated)
• Inventors: Rogers, Lisa H., Goldman, Beth, Costello, Maureen, Lasalle, Craig M., Linardi, Ellen, Elangovan, Lavanya, Singampalli, Srinivas, Homier, Matthew J
• Primary Examiner(s): Apple, Kirsten
• Application Number:
  US11/824,397
• Time in Patent Office: 1,670 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 across insurance policies 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 of the insured party, where the first insurance claim data is further associated with a first insurance policy, and where the second insurance claim data is further associated with a second insurance policy. The method further involves determining a financial responsibility of the insured party for the single insurance claim based on the first insurance claim data and the second insurance claim data, and presenting the financial responsibility in a graphical user interface (GUI).

Claims

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

accessing, by a software application operated by a party selected from a group consisting of a patient and a relative of the patient, a repository of a plurality of medical insurance providers, wherein the software application is executing on a hardware processor;

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

retrieving, in response to searching and by the software application operated by the party, a first entry in the repository identifying the date, a medical procedure performed on the patient, a cost of the medical procedure, and a first amount paid by a primary medical insurance policy for the medical procedure;

retrieving, in response to searching and by the software application operated by the party, a second entry in the repository identifying the date, the medical procedure, and a second amount paid by a secondary medical insurance policy for the medical procedure;

calculating, by the software application operated by the party, a financial responsibility of the party to a medical service provider for the medical procedure by subtracting the first amount paid by the primary medical insurance policy and the second amount paid by the secondary medical insurance policy from the cost of the medical procedure; and

generating, by the software application operated by the party, a graphical user interface (GUI) comprising the financial responsibility of the party.

2. The method of claim 1, further comprising:

presenting the first amount paid and the second amount paid in the GUI.

3. The method of claim 1, further comprising:

processing a GUI command associated with the financial responsibility.

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

5. The method of claim 3, wherein the GUI command comprises recording a note associated with the medical procedure, wherein the note is stored in the first entry.

6. The method of claim 3, wherein the GUI command comprises marking the financial responsibility as disputed.

7. The method of claim 3, wherein the GUI command comprises generating a dispute letter.

22. The method of claim 1, further comprising:

presenting the GUI to a third party administrator.

25. The method of claim 1, further comprising:

generating a request to the primary medical insurance provider of the plurality of medical insurance providers for a refund.

26. The method of claim 1, further comprising:

generating a request to the primary medical insurance provider of the plurality of medical insurance providers for a credit.

8. A system for determining a financial responsibility comprising:

a hardware processor;

a repository storing a plurality of medical insurance providers;

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

access the repository of the plurality of medical insurance providers;

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

retrieve, in response to searching, a first entry in the repository identifying the date, a medical procedure performed on the patient, a cost of the medical procedure, and a first amount paid by a primary medical insurance policy for the medical procedure;

retrieve, in response to searching, a second entry in the repository identifying the date, the medical procedure, and a second amount paid by a secondary medical insurance policy for the medical procedure;

calculate a financial responsibility of the insured party to a medical service provider for the medical procedure by subtracting the first amount paid by the primary medical insurance policy and the second amount paid by the secondary medical insurance policy from the cost of the medical procedure; and

generate a graphical user interface (GUI) comprising the financial responsibility of the party.

9. The system of claim 8, wherein the insurance claim data manager is further configured to:

present the first amount paid and the second amount paid in the GUI.

10. The system of claim 8, wherein the insurance claim data manager is further configured to:

process a GUI command associated with the financial responsibility.

11. The system of claim 10, wherein the GUI command comprises editing an amount of the financial responsibility of the party already paid by the party.

12. The system of claim 10, wherein the GUI command comprises recording a note associated with the medical procedure, wherein the note is stored in the first entry.

13. The system of claim 10, wherein the GUI command comprises marking the financial responsibility as disputed.

14. The system of claim 10, wherein the GUI command comprises generating a dispute letter.

23. The system of claim 8, wherein the insurance claim data manager is further configured to:

present the GUI to a third party administrator.

27. The system of claim 8, wherein the insurance claim data manager is further configured to:

generate a request to the primary medical insurance provider of the plurality of medical insurance providers for a refund.

28. The system of claim 8, wherein the insurance claim data manager is further configured to:

generate a request to the primary medical insurance provider of the plurality of medical insurance providers for a credit.

15. A non-transitory computer readable medium storing instructions for determining 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 plurality of medical insurance providers;

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

retrieving a first entry in the repository identifying the date, a medical procedure performed on the patient, a cost of the medical procedure, and a first amount paid by a primary medical insurance policy for the medical procedure;

retrieving a second entry in the repository identifying the date, the medical procedure, and a second amount paid by a secondary medical insurance policy for the medical procedure;

calculating a financial responsibility of the party to a medical service provider for the medical procedure by subtracting the first amount paid by the primary medical insurance policy and the second amount paid by the secondary medical insurance policy from the cost of the medical procedure; and

generating a graphical user interface (GUI) comprising the financial responsibility of the party.

16. The non-transitory computer readable medium of claim 15, the instructions further comprising functionality for:

presenting the first amount paid and the second amount paid in the GUI.

17. The non-transitory computer readable medium of claim 15, the instructions further comprising functionality for:

processing a GUI command associated with the financial responsibility.

18. The non-transitory computer readable medium of claim 17, wherein the GUI command comprises editing an amount of the financial responsibility of the party already paid by the party.

19. The non-transitory computer readable medium of claim 17, wherein the GUI command comprises recording a note associated with the medical procedure, wherein the note is stored in the first entry.

20. The non-transitory computer readable medium of claim 17, wherein the GUI command comprises marking the financial responsibility as disputed.

21. The non-transitory computer readable medium of claim 17, wherein the GUI command comprises generating a dispute letter.

24. The non-transitory computer readable medium of claim 15, the instructions further comprising functionality for:

presenting the GUI to a third party administrator.

29. The non-transitory computer readable medium of claim 15, the instructions further comprising functionality for:

generating a request to the primary medical insurance provider of the plurality of medical insurance providers for a refund.

30. The non-transitory computer readable medium of claim 15, the instructions further comprising functionality for:

generating a request to the primary medical insurance provider of the plurality of medical insurance providers for a credit.