WO1995003569A3 - Method for determining primary and secondary sources of health insurance coverage - Google Patents

Method for determining primary and secondary sources of health insurance coverage Download PDF

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Publication number
WO1995003569A3
WO1995003569A3 PCT/US1994/008012 US9408012W WO9503569A3 WO 1995003569 A3 WO1995003569 A3 WO 1995003569A3 US 9408012 W US9408012 W US 9408012W WO 9503569 A3 WO9503569 A3 WO 9503569A3
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WO
WIPO (PCT)
Prior art keywords
database
coverage
coordination
rules
benefits
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PCT/US1994/008012
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French (fr)
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WO1995003569A2 (en
Inventor
Patrick M Lawlor
Original Assignee
Patrick M Lawlor
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Publication date
Application filed by Patrick M Lawlor filed Critical Patrick M Lawlor
Publication of WO1995003569A2 publication Critical patent/WO1995003569A2/en
Publication of WO1995003569A3 publication Critical patent/WO1995003569A3/en

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    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/02—Banking, e.g. interest calculation or account maintenance

Abstract

A method for operating a computer apparatus located at a hospital (8), physician's office (9), a lab (10), or a pharmacy (11) for applying the rules of coordination of benefits to claims under medical insurance (51). The computer has a first database (14) containing a grand census file identifying all individuals by social security number of personal identification number together with the plans under which they are covered. A second database (15) contains information as to the nature of the plan coverage together with the rules for coordination of benefits. When a claim is processed (figs. 2a-2c), it is first checked against the individual by identification number in the first database (step 29) to determine all plans under which coverage could be obtained (figs. 2b-2c). Thereafter, the claim is processed for coverage under the information in the second database together with the rules for coordination of benefits to determine primary and secondary coverage (steps 43, 46-49, 51, 53-55). Optionally, the claims may then be processed for payment according to such primary and secondary coverage (steps 64-68). All such determinations are then stored in a historical database for future reference (step 39).
PCT/US1994/008012 1993-07-16 1994-07-18 Method for determining primary and secondary sources of health insurance coverage WO1995003569A2 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US9309293A 1993-07-16 1993-07-16
US08/093,092 1993-07-16

Publications (2)

Publication Number Publication Date
WO1995003569A2 WO1995003569A2 (en) 1995-02-02
WO1995003569A3 true WO1995003569A3 (en) 1995-03-16

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PCT/US1994/008012 WO1995003569A2 (en) 1993-07-16 1994-07-18 Method for determining primary and secondary sources of health insurance coverage

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US8099302B2 (en) 2000-01-21 2012-01-17 The Trizetto Group, Inc. Method of increasing efficiency in a medical claim transaction, and computer program capable of executing same
US8321283B2 (en) 2005-05-27 2012-11-27 Per-Se Technologies Systems and methods for alerting pharmacies of formulary alternatives
US8321243B1 (en) 2010-02-15 2012-11-27 Mckesson Financial Holdings Limited Systems and methods for the intelligent coordination of benefits in healthcare transactions
US8386276B1 (en) 2010-02-11 2013-02-26 Mckesson Financial Holdings Limited Systems and methods for determining prescribing physician activity levels
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US8560340B1 (en) 2009-11-30 2013-10-15 Mckesson Financial Holdings Limited Systems and methods for overriding rejections of healthcare claim transactions
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Cited By (15)

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Publication number Priority date Publication date Assignee Title
US8099302B2 (en) 2000-01-21 2012-01-17 The Trizetto Group, Inc. Method of increasing efficiency in a medical claim transaction, and computer program capable of executing same
US8738402B2 (en) 2000-01-21 2014-05-27 Trizetto Corporation Medical of increasing efficiency in a medical claim transaction, and computer program capable of executing same
US8321283B2 (en) 2005-05-27 2012-11-27 Per-Se Technologies Systems and methods for alerting pharmacies of formulary alternatives
US8630873B1 (en) 2005-12-08 2014-01-14 Ndchealth Corporation Systems and methods for shifting prescription market share by presenting pricing differentials for therapeutic alternatives
US8635083B1 (en) 2008-04-02 2014-01-21 Mckesson Financial Holdings Systems and methods for facilitating the establishment of pharmaceutical rebate agreements
US8626525B2 (en) 2008-06-23 2014-01-07 Mckesson Financial Holdings Systems and methods for real-time monitoring and analysis of prescription claim rejections
US8538777B1 (en) 2008-06-30 2013-09-17 Mckesson Financial Holdings Limited Systems and methods for providing patient medication history
US8046242B1 (en) 2009-01-22 2011-10-25 Mckesson Financial Holdings Limited Systems and methods for verifying prescription dosages
US8788296B1 (en) 2010-01-29 2014-07-22 Mckesson Financial Holdings Systems and methods for providing notifications of availability of generic drugs or products
US8386276B1 (en) 2010-02-11 2013-02-26 Mckesson Financial Holdings Limited Systems and methods for determining prescribing physician activity levels
US8321243B1 (en) 2010-02-15 2012-11-27 Mckesson Financial Holdings Limited Systems and methods for the intelligent coordination of benefits in healthcare transactions
US8548824B1 (en) 2010-03-26 2013-10-01 Mckesson Financial Holdings Limited Systems and methods for notifying of duplicate product prescriptions
US8688468B1 (en) 2010-03-30 2014-04-01 Mckesson Financial Holdings Systems and methods for verifying dosages associated with healthcare transactions
US8392214B1 (en) 2010-11-30 2013-03-05 Mckesson Financial Holdings Limited Systems and methods for facilitating claim rejection resolution by providing prior authorization assistance
US8566117B1 (en) 2011-06-30 2013-10-22 Mckesson Financial Holdings Systems and methods for facilitating healthcare provider enrollment with one or more payers

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