WO2001027719B1 - Novel method and apparatus for repricing a reimbursement claim against a contract - Google Patents

Novel method and apparatus for repricing a reimbursement claim against a contract

Info

Publication number
WO2001027719B1
WO2001027719B1 PCT/US2000/028455 US0028455W WO0127719B1 WO 2001027719 B1 WO2001027719 B1 WO 2001027719B1 US 0028455 W US0028455 W US 0028455W WO 0127719 B1 WO0127719 B1 WO 0127719B1
Authority
WO
WIPO (PCT)
Prior art keywords
term
reimbursement
contract
code
terms
Prior art date
Application number
PCT/US2000/028455
Other languages
French (fr)
Other versions
WO2001027719A3 (en
WO2001027719A2 (en
Inventor
Dale Hoerle
Mark Lesswing
Original Assignee
Resource Information Man Syste
Dale Hoerle
Mark Lesswing
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.)
Filing date
Publication date
Application filed by Resource Information Man Syste, Dale Hoerle, Mark Lesswing filed Critical Resource Information Man Syste
Priority to AU80225/00A priority Critical patent/AU8022500A/en
Publication of WO2001027719A2 publication Critical patent/WO2001027719A2/en
Publication of WO2001027719A3 publication Critical patent/WO2001027719A3/en
Publication of WO2001027719B1 publication Critical patent/WO2001027719B1/en

Links

Classifications

    • 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
    • G06Q10/00—Administration; Management
    • G06Q10/10—Office automation; Time management
    • 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
    • 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
    • G06Q40/04—Trading; Exchange, e.g. stocks, commodities, derivatives or currency exchange
    • 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
    • G06Q40/08—Insurance

Abstract

A method for repricing a reimbursement claim under at least one contract is provided herein. The method includes converting each contract into a series of contractual terms, where each contractual term contains qualification codes, calculation codes and priority notes. The method then converts a claim into a series of claim lines, containing claim codes, unit numbers and corresponding charges for the claim codes (figure 8, items 104a, 104b) The method then begins to compare each claim code, of the claim, against each qualification code, of each contractual term, of a contract and when a qualification code, of a contractual term, is satisfied by a claim code, of a claim line, the method identifies the contractual term as a matching contractual term associated to the claim line (items 84a, 84b). Upon identifying all matching contractual terms, either to the claim line or the entire claim, the terms, and eliminate any priority conditions associated to the matching contractual terms, and eliminate any matching contractual terms that are excluded by the priority conditions. The method then calculates the reimbursement amount for the claim by determining the reimbursement charges for the non-excluded matching contractual terms. The method may then determine and make any adjustments depending upon any discount terms for the entire reimbursement amount.

Claims

AMENDED CLAIMS
[received by
Figure imgf000002_0001
Bureau on 07 May 2001 (07.05.01); new claims 60-70 added; remaining claims unchanged (3 pages)]
60 A computer implemented sv stem of repπcmg a reimbursement claim under at least one contract comprising: means for converting each contract into a plurality of terms and a contract identifier code, each term, of the plurality of terms, containing qualification codes, calculation codes and at least two priority notes, and means for arranging the plurality of terms, of said contract, into a sequential series of terms: means for convening the reimbursement claim into a seπes of claim lines, each claim line containing a claim code, a unit number and a corresponding charge: means for sequentialh comparing each claim code, of the series of claim lines, against eacn qualification code, or the
Figure imgf000002_0002
of terms and when a claim code, or a claim line, is substantially equal to a qualification code, of a term, means for identifying said term as a matching term associated to said claim line. means for determining any priority conditions associated to all of the matching terms, and means for eliminating
Figure imgf000002_0003
matching terms that are excluded by said priority conditions: and means for determining a reimbursement amount for the claim by processing the calculation codes of the non-ehmmated matching terms.
61 The s> stem ot claim 60 w erein the
Figure imgf000002_0004
conditions include mean for categoπzing the terms, ot the sequential series ot terms, into pre-defined sections, w herein the pre-defined sections ha\ e a hιerarch\ that lists a pre-defined section ha\ mg o\ er another pre-defined section pπoi to said othei pre-defined section
62. The system of claim 61 herein the priority conditions further include means for arranging the terms, w ithin each pre-defined section, by a reverse hierarchy, which sequential lists a term, having priority
Figure imgf000002_0005
er another term, subsequent to said other term
46 63 The system of claim 62 wherein the means of sequentially comparing further includes when a claim code, of a claim line, is substantially equal to a qualification code of a term, means for identifying the pre-defined section in which the term is categorized under as a governing pre-defined section tor said claim line means for sequentially comparing the claim code of said claim line, only against the qualification codes, of each term categorized under said governing pre-defined section, and when the claim code of said claim line is substantially equal to a qualification code, of a term categorized under said governing pre-defined section, means for identifying said term as a matching term associated to said claim line
64 The system of claim 63 wherein the means of determining the reimbursement amount includes means for determining a reimbursement charge tor each claim line associated to a non-eliminated matching term and means for adding the reimbursement charges for said claim lines, whereby the reimbursement amount for the claim is the addition of the reimbursement charges
65 The s\stem of claim 64 wherein w hen a
Figure imgf000003_0001
note, ot a non-eliminated matching term, indicates that the calculation codes, of said non-eliminated matching term, apply to the entire claim, means for making the reimbursement amount for the claim equal to the reimbursement charge for the claim line associated to said non-eliminated matching term
66 The system of claim 65 wherein w hen a term, indicates that the calculation codes of said term, apply to the reimburse amount of the claim, the method further including means for determining the reimbursement amount of said claim, and when the qualifications ot said term aie satisfied, means for re-calculatmg the reimbuisement amount based upon the calculation codes of said term
67 The system of claim 66 wherein the means of converting the claim further includes the means of associating the claim to a claim identifier code
47
68. The system of claim 67 further including: means for comparing the claim identifier code, against the contract identifier code, of each contract, and when the claim identifier code is substantially equal to a contract identifier code, of a contract, means for identifying said contract as a governing contract, wherein the repricing of said claim is repriced only against said governing contract.
69. The system of claim 68 wherein the means of repricing the claim against said governing contract further includes: when at least two contracts are identified as governing contracts, means for repricing said claim against each governing contract creating a list of governing reimbursement amounts.
70. The system of claim 69 further comprising: means for determining a lowest governing reimbursement amount, of the list of governing reimbursement amounts, wherein the lowest governing reimbursement amount is the reimbursement amount of said claim.
PCT/US2000/028455 1999-10-14 2000-10-13 Novel method and apparatus for repricing a reimbursement claim against a contract WO2001027719A2 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU80225/00A AU8022500A (en) 1999-10-14 2000-10-13 Novel method and apparatus for repricing a reimbursement claim against a contract

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US15930699P 1999-10-14 1999-10-14
US60/159,306 1999-10-14
US09/577,386 US7904317B1 (en) 1999-10-14 2000-05-23 Method and apparatus for repricing a reimbursement claim against a contract
US09/577,386 2000-05-23

Publications (3)

Publication Number Publication Date
WO2001027719A2 WO2001027719A2 (en) 2001-04-19
WO2001027719A3 WO2001027719A3 (en) 2001-06-21
WO2001027719B1 true WO2001027719B1 (en) 2001-11-08

Family

ID=26855824

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2000/028455 WO2001027719A2 (en) 1999-10-14 2000-10-13 Novel method and apparatus for repricing a reimbursement claim against a contract

Country Status (3)

Country Link
US (5) US7904317B1 (en)
AU (1) AU8022500A (en)
WO (1) WO2001027719A2 (en)

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Also Published As

Publication number Publication date
AU8022500A (en) 2001-04-23
US20140067417A1 (en) 2014-03-06
US20130144648A1 (en) 2013-06-06
WO2001027719A3 (en) 2001-06-21
US20110153371A1 (en) 2011-06-23
US7904317B1 (en) 2011-03-08
WO2001027719A2 (en) 2001-04-19
US20120130754A1 (en) 2012-05-24
US8160905B2 (en) 2012-04-17
US8666787B2 (en) 2014-03-04
US8407071B2 (en) 2013-03-26

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