发明授权
- 专利标题: System for processing healthcare claim data
- 专利标题(中): 处理医疗保险索赔数据的系统
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申请号: US10247980申请日: 2002-09-20
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公开(公告)号: US07917378B2公开(公告)日: 2011-03-29
- 发明人: David Fitzgerald , Brian Lucas , Greg Long , David Hiebert Klassen, Sr. , John Hunter , Jon Zimmerman
- 申请人: David Fitzgerald , Brian Lucas , Greg Long , David Hiebert Klassen, Sr. , John Hunter , Jon Zimmerman
- 申请人地址: US PA Malvern
- 专利权人: Siemens Medical Solutions USA, Inc.
- 当前专利权人: Siemens Medical Solutions USA, Inc.
- 当前专利权人地址: US PA Malvern
- 代理商 Alexander J Burke
- 主分类号: G06Q40/00
- IPC分类号: G06Q40/00 ; G06Q10/00 ; G06Q50/00
摘要:
A claim pre-processing system employs trial adjudication to improve claim accuracy prior to claim submission to a healthcare payer institution or other entity. A system processes claim data related to provision of healthcare to a patient The system includes a claim data collator for collating data related to a claim for a particular patient for submission to a payer and a source of rules for use in processing collated claim data. A pre-processor submits the collated claim data for processing using the rules to validate the collated claim data is in condition for processing to initiate generation of payment. A claim processor submits the collated claim data to a payer, in response to successful validation by the pre-processor. A rules processor processes acquired claim data to identify a condition triggering application of a different set of rules for determining validity of an individual claim element. The pre-processor re-submits amended collated claim data for processing using the rules to validate the collated claim data is in condition for processing to initiate generation of payment, the amended collated claim data being received in response to unsuccessful validation using the rules.
公开/授权文献
- US20030191665A1 System for processing healthcare claim data 公开/授权日:2003-10-09