Attachment integrated claims systems and operating methods therefor

• US 8,155,979 B2
• Filed: 01/05/2007
• Issued: 04/10/2012
• Est. Priority Date: 03/28/1996
• Status: Expired due to Term

• Current Assignee: Integrated Claims Systems LLC
• Original Assignee: Integrated Claims Systems LLC
• Inventors: DiRienzo, Andrew L.
• Primary Examiner(s): Morgan, Robert
• Assistant Examiner(s): KANAAN, MAROUN P
• Application Number:
  US11/650,316
• Publication Number:
  US 20070198596A1
• Time in Patent Office: 1,922 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/2
• CPC Class Codes: G06F 3/0481 based on specific properties of the displayed interaction object or a metaphor-based environment, e.g. interaction with desktop elements like windows or icons, or assisted by a cursor's changing behaviour or appearance
• CPC Class Codes: G06F 3/0482 Interaction with lists of selectable items, e.g. menus
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 10/02 Reservations, e.g. for tickets, services or events
• CPC Class Codes: G06Q 10/025 Coordination of plural reservations, e.g. plural trip segments, transportation combined with accommodation
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G06Q 40/12 Accounting
• CPC Class Codes: G06Q 99/00 Subject matter not provided for in other groups of this subclass
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 30/20 for handling medical images, e.g. DICOM, HL7 or PACS
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

Systems and methods for processing textual messages which are integrated with one or more digital attachments is described. These systems and methods are useful in the electronic filing and processing of, for example, image data, and of textual data associated with the image data. One particular application of these systems and methods would be for the electronic filing and processing of dental x-rays with patient claim forms.

Claims

1. A graphical user interface (GUI) composed of N identifiable fields instantiated by computer software stored in a memory of a computer system and configured to perform a method, the method comprising:

generating M files from data entered into selected ones of the N identifiable fields;

wherein the selected ones of the N identifiable fields that accept data are determined responsive to data entered into a first predetermined one of the N identifiable fields;

wherein each of the M files generated is composed of a subset N_J (where J is an integer that ranges from 1 to M) of filled identifiable fields N such that, for each N_J, N_J is a subset of N and members for each of the subsets N_J are determined in response to data entered into the first predetermined one of the N identifiable fields;

wherein a format of each of the M files is determined in response to the data entered into the first predetermined one of the N identifiable fields;

wherein at least two of the M files have different members or at least two of the M files have different formats; and

wherein both N and M are integers greater than 1.

2. The GUI of claim 1, wherein the number of files M created is determined responsive to text entered into the first predetermined one of the N identifiable fields.

3. The GUI of claim 1, wherein the set of fields that accept data is further amended when data is entered into a second predetermined field of the set of N identifiable fields.

4. The GUI of claim 1, wherein the M files generated are financial statements or transactions.

5. The GUI of claim 4, wherein the financial transaction is an Explanation of Benefits.

6. The GUI of claim 1, wherein at least one of the N identifiable fields which will accept data contains a digital image.

7. The GUI of claim 6, wherein the digital image is of an insurance claims attachment.

8. The GUI of claim 3, wherein the first predetermined field accepts an identifier for a payer and the second predetermined field accepts an identifier for a provider.

9. The GUI of claim 3, wherein the first predetermined field accepts an identifier for a payer and the second predetermined field accepts a medical code.

10. The GUI of claim 1, wherein a first portion of the N identifiable fields that will accept data is automatically filled in in response to data being entered into a first predetermined field.

11. The GUI of claim 4, wherein the financial transactions represent a claim for services from a healthcare provider to healthcare payers.

12. A graphical user interface (GUI) composed of N identifiable fields instantiated by computer software stored in memory of a computer system and configured to perform a method, the method comprising:

generating M files transmittable to M recipients, from data entered into selected ones of the N identifiable fields in the GUI, thereby generating filled identifiable fields;

wherein the selected ones of the N identifiable fields that accept data are determined responsive to text entered into a first predetermined one of the N identifiable fields;

wherein each of the M files is composed of a subset of the filled identifiable fields of the N identifiable fields;

wherein each of the M subsets is determined in response to data entered into the first predetermined one of the N identifiable fields;

wherein each of the M files has a format;

wherein each of the M formats is determined in response to the data entered into the first predetermined one of the N identifiable fields;

wherein at least two of the M files have subsets containing different members or at least two of the M files have different formats; and

wherein both N and M are integers greater than 1.

13. The GUI of claim 12, wherein the set of M recipients is a subset of R possible recipients, wherein R is an integer greater than 1.

14. The GUI of claim 13, wherein the set of R possible recipients is a set of R independent computer applications.

15. The GUI of claim 13, wherein the number of files, M, and the particular recipients of the M files within the set of R possible recipients is determined by data entered into the first predetermined one of the N identifiable fields.

16. The GUI of claim 12, wherein the selected ones of the N identifiable fields of the GUI that accept data is the union of the M subsets.

17. The GUI of claim 12, wherein the instantiating computer software automatically populates each file of the set of M files with the associated subset of filled fields in response to the data accepting fields of N being filled with data.

18. The GUI of claim 12, wherein the members of each of the M subsets are determined by the recipient of the file containing that subset.

19. The GUI of claim 18, wherein the members of any of the M subsets can be updated at will by the recipient of the file containing that subset independently of the recipients of other files.

20. The GUI of claim 12, wherein the format of any of the M files is determined by the recipient of that file.

21. The GUI of claim 20, wherein the format of any of the M files can be updated at will by the recipient of that file independently of the recipients of other files.

22. The GUI of claim 12, wherein a first portion of the N identifiable fields which will accept data is automatically filled in when data is entered into the first predetermined field.

23. The GUI of claim 12, wherein a first portion of the N identifiable fields which will accept data is automatically filled in when a first user opens the GUI.

24. The GUI of claim 12, wherein the set of fields which will accept data is further amended when data is entered into a second predetermined field.

25. The GUI of claim 24, wherein the amendment is an annunciator further notifying a user of information which must be included.

26. The GUI of claim 12, wherein at least one file of the M files is such that, when it reaches the recipient, data in at least one of the fields of the file is automatically entered directly into a related field in another software application without manual reentry of the data.

27. The GUI of claim 12, wherein one of the fields which accepts data is automatically filled with an identification code for a user.

28. The GUI of claim 12, wherein the M files are financial statements.

29. The GUI of claim 12, wherein at least one of the N identifiable fields that will accept data accepts a digital image.

30. The GUI of claim 12, wherein at least one of the N identifiable fields that will accept data accepts a word processor document.

31. The GUI of claim 12, wherein at least one of the N identifiable fields that will accept data accepts a digital graph.

32. The GUI of claim 12, wherein at least one of the N identifiable fields that will accept data accepts a digital sound recording.

33. The GUI of claim 12, wherein at least one of the N identifiable fields that will accept data accepts a digital video signal.

34. The GUI of claim 12, wherein one of the M recipients is the one using the GUI to create the M files.

35. The GUI of claim 12, wherein the files contain information related to an insurance claim.

36. The GUI of claim 35, wherein at least one of the N identifiable fields that accepts data accepts an attachment to an insurance claim form.

37. The GUI of claim 35, wherein the file is a health insurance Explanation of Benefits.

38. The GUI of claim 35, wherein the set of fields that will accept data is further amended when a code related to a medical service is entered into a second predetermined field.

39. The GUI of claim 35, wherein the first predetermined field accepts an identifier for a payer and the second predetermined field accepts an identifier for a user of the first computer system who is a provider.

40. The GUI of claim 35, wherein M equals three, with one file going to a provider, one to a payer, and one to a Value Added Service.

41. The GUI of claim 12, wherein the instantiating software resides at an online site accessible by the first computer system.

42. The GUI of claim 41, wherein the M files are transmitted from the online site to the selected M recipients.

43. A graphical user interface (GUI) composed of N identifiable fields instantiated by computer software in memory of a computer system and configured to perform a method, the method comprising:

generating R transactions in R computer software applications from data entered into the N identifiable fields, where once the identifiable fields have been filled with data, executing R transactions by the instantiating computer software, such that;

a Jth transaction (where J is an integer that ranges from 1 to R), of the set of R transactions, comprises entering the data in a subset N_J of the filled identifiable fields N to fields in a Jth member of the set of R computer software applications;

wherein not all the subsets NJ are equal to each other;

wherein R is an integer greater than 1; and

wherein the R transactions are executed without having to manually enter data into the R computer software applications when the data was already entered into the GUI.

44. The method of claim 43, wherein entering the data in a subset N_J of the filled identifiable fields N to fields in a Jth member of the set of R computer software applications comprises entering the data in a subset N_J of the filled identifiable fields N to coordinated fields in a Jth member of the set of R computer software applications.

46. The method of claim 43, wherein-executing the R transactions by the instantiating computer software is performed automatically in response to the identifiable fields having been filled with data.

45. A graphical user interface (GUI) composed of N identifiable fields instantiated by a first computer software application in memory of a first computer system and configured to perform a method, the method comprising:

generating multiple transactions in a set of second computer software applications on one or more other computer systems, the set of second computer software applications containing R computer software applications and having at least one member which is distinct from the first computer software application, in response to data being entered into selected ones of the N identifiable fields;

wherein the selected ones of the N identifiable fields that accept data are determined responsive to text entered into a first predetermined one of the N identifiable fields; and

once the fields that will accept data have been filled, executing R transactions by the instantiating first computer software application, wherein a Jth transaction, of the set of R transactions, comprises entering the data in a subset N_J (where J is an integer that ranges from 1 to R) of the filled selected ones of the N identifiable fields to fields in a Jth member of the second set of R computer software applications;

wherein each of the subsets N_J is determined by the data entered into the first predetermined field of the N identifiable fields;

wherein at least two of the subsets N_J each contain at least one filled selected ones of the N identifiable fields, but wherein one or more of the subsets N_J may contain the null set;

wherein R is an integer greater than 1; and

wherein the R transactions are executed without having to manually enter data into the R disparate computer software applications when the data was already entered into the GUI.

47. The method of claim 45, wherein-executing the R transactions by the instantiating first computer software application is performed automatically in response to the fields that will accept data having been filled with data.

48. The method of claim 45, wherein entering the data in a subset N_J of the filled selected ones of the N identifiable fields to fields in a Jth member of the second set of R computer software applications comprises entering the data in a subset N_J of the filled selected ones of the N identifiable fields to coordinated fields in a Jth member of the second set of R computer software applications.

49. A computer system configured by software to execute a method, the computer system comprising:

memory, wherein stored in the memory is information specifying, for each of M recipients, a file format, selected from a set of F file formats, to be applied to a computer file that is to be transmitted to that recipient, and wherein M is an integer equal to or greater than two and F is an integer equal to or greater than two;

wherein the method comprises;

receiving, from a source external to the computer system, an electronic communication comprising data in data fields;

generating M computer files, wherein each of the M computer files is associated with a respective one of the M recipients;

copying into each of the M computer files data from at least one of the data fields of the electronic communication;

formatting each computer file of the M computer files in accordance with the file format specified in the memory for the recipient associated with that computer file; and

transmitting the M computer files to their associated recipients.

50. The computer system of claim 49, wherein each of the M computer files contain data copied from the same data field of the electronic communication.

51. The computer system of claim 49, wherein data in the electronic communication is used to determine which ones of all possible recipients are the M recipients.

52. The computer system of claim 49, wherein each of the M recipients has associated therewith a unique portion of the computer software.

53. The computer system of claim 52, wherein the unique portion of the computer software associated with each of the M recipients contains information specifying the file format to be used for computer files generated for transmission to that recipient.

54. The computer system of claim 53, wherein the unique portion of the computer software associated with each of the M recipients is updated:

as the file requirements of that particular recipient change;

independent of the other M recipients; and

independent of a sender of the transmitted file.

55. The computer system of claim 52, wherein the unique portion of the computer software associated with each of the M recipients is accessed and updated by that recipient independently of the remaining M recipients and independently of a sender of the electronic communication.

56. The computer system of claim 49, wherein the computer system is accessible via the Internet.

57. The computer system of claim 49, wherein the method further comprises executing a transaction by transferring the data from at least one of the fields in the electronic communication into a data field in a software application.

58. The computer system of claim 49, wherein at least some of the data in the electronic communication is healthcare data of a patient.

59. The computer system of claim 49, wherein at least one of the generated M computer files is a health insurance claim form that is to be transmitted to a health insurance payer.