WO2002101498A2 - Method and system for processing invoice data - Google Patents

Method and system for processing invoice data Download PDF

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Publication number
WO2002101498A2
WO2002101498A2 PCT/US2002/017991 US0217991W WO02101498A2 WO 2002101498 A2 WO2002101498 A2 WO 2002101498A2 US 0217991 W US0217991 W US 0217991W WO 02101498 A2 WO02101498 A2 WO 02101498A2
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WO
WIPO (PCT)
Prior art keywords
health
data
health care
files
computers
Prior art date
Application number
PCT/US2002/017991
Other languages
French (fr)
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WO2002101498A3 (en
Inventor
Arien Andries Thijssen
Original Assignee
Medical Data Care B.V.
Id-Nl Group Inc.
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 Medical Data Care B.V., Id-Nl Group Inc. filed Critical Medical Data Care B.V.
Priority to AU2002345596A priority Critical patent/AU2002345596A1/en
Publication of WO2002101498A2 publication Critical patent/WO2002101498A2/en
Publication of WO2002101498A3 publication Critical patent/WO2002101498A3/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

Definitions

  • Health care providers include doctors, consultants, dentists, physiotherapists, etc. and the professional practices which such health care providers have and use.
  • these carers and insurers and in many cases patients or insured persons too are often required to undertake many expensive and complex transactions in order to ensure that correct payments are made in a proper manner or to check that such payments have been received by those health carers from the health care insurers. At present, this is done, for example, by the health care providers in having make patients to pay and in turn those payments are submitted as expenses by the patients to their health care insurers.
  • a carer can invoice a health care insurer for treatment given to a patient providing the health care provider knows which health care insurer insures the insured patient in question. This is done by the health care provider submitting an invoice directly to the health care insurer. For this to work, the health care provider needs to maintain communications with all health care insurers which insure those patients he treats. If health care insurers refuse to pay invoices they are returned to the carer and those costs have to be invoiced again, this time to the patient. The costs of all these administrative activities are considerable.
  • this invention offers a method for treating invoice data for a large number of health care providers who submit invoices to one or more health care insurers; it comprises the following steps:
  • sending files between the various computers will be done via computer networks or via communications networks.
  • This offers the additional advantages of being able to link up the computers at any desired moment in time, for example, by the health care providers.
  • the exchange of information can also be done very simply by giving a command to the software. It is furthermore possible to lock up the data or compress these in order to reduce transmission times required and to encrypt it for security reasons given that transmission takes place via public access data networks. It is also possible to use specialist or dedicated networks for information transmission purposes in compliance with this method.
  • a preferred form according to this invention provides for information transmission between the various computers using the physical transmission of digital data carriers.
  • a further preferred operational form offers a method comprising one or more steps : - carrying out one or more checks on the health care provider files by or with the aid of a central computer in order to determine which data needs to be returned to the health care providers, or returned to the computers used by them; - extracting said data from the health care provider files for sending back to health care providers;
  • This operational form offers the processing computer possibilities in respect of sending back incorrect data to the health care providers .
  • Such checks prevent superfluous data being sent on to health insurers, or their computers, which means it prevents superfluous work having to be carried out by the health care insurers .
  • Another preferred operational form provides one or more steps towards adding extra data with or using central processing computers for the health care insurers' files which are necessary for processing by the health care insurers' computers for which the data are specifically aimed.
  • the method preferably includes steps towards :
  • the checks might show that an insured person is not insured with the respective health care ' insurer.
  • the invoice details will not be correct and must be sent back to the health care provider as payment cannot be made on the basis of incorrect data.
  • Sending back data to the health care provider may take place at the moment that the health care provider makes contact with the processing computer via a communications network prior to sending the data. If the health care transmits data via a data carrier, it will be equally possible that incorrect data can be sent back via said data carrier. It is also possible to inform the health care providers in writing.
  • a further preferred operational method of the present invention provides one or more steps towards:
  • the method preferably provides further steps towards :
  • a further preferred operational form according to the present invention provides for steps for extracting data from health care provider files consisting of one or more steps towards :
  • a further preferred operational form according to the present invention is provided by a computer running a program to carry out the steps in the method with reference to the health care providers' computers. It furthermore provides for a processing computer running a program to carry out the steps in the method with reference to the processing computer as well as for a computer running a program to carry out the steps in the method with reference to the health care insurers' computers .
  • a preferred operational form of the present invention provides a system of networked computers as described above for carrying out a method as described above .
  • a further preferred operational form according to the present invention provides a method for the processing of invoice data of a large number of health care providers to one or more health care insurers, containing the following steps:
  • This operational form means that if health care insurers or health care providers are not or not yet equipped for using the method described under count 1, they can still make use of the benefits of a part of this method.
  • FIG. 1 is a flow-chart of a method according to an operational form of the present invention
  • - figure 2 is a flow-chart of another preferred operational -form according to the present invention
  • - figure 3 is a flow-chart of another preferred operational form according to the present invention
  • FIG. 4 is a block-graph of a preferred operational form according to the present invention.
  • a system for carrying out a preferred operational form of the method according to the invention comprises a first computer 41 for the health care provider to carry out the steps of the method on. There is also a second computer, 42, the computer which deals with the data, for carrying out the steps of the method. And finally, there is a third computer to carry out the steps of the method for the health care insurers .
  • a number of computers have been provided for to carry out the steps of the method (which computers are designated 41) for a quantity of health care provided, and indeed, a quantity of computers designated 43 are to carry out steps of the method for the health care insurers. In general, there will be more health care providers than health care insurers. More computers 42 could be deployed to carry out the steps of the method for actually processing the data.
  • Data transmission between the computers is designated by links between 44, and 45. Data transmission should preferably be carried out via data networks or communications networks.
  • a preferred operational form according to the present invention is a method in which a health care provider, being a doctor, physiotherapist, dentist or suchlike, enters data concerning invoices into a computer.
  • the health care provider will have to have software. That software should, preferably, have the following functions:
  • the health care provider can supply his invoice data in a uniform manner to all health care insurers which make use of the method in accordance with the present invention. With the aid of this method the transmission of these data can be done uniformly, simply and electronically. This offers the health care provider the advantage that he is no longer required to invoice different health care insurers differently. and do this by mail sent to those different health care insurers. ' If a health care provider makes use of this method, then his computer can supply all the invoices to the participating health care insurers and do so by one single transaction. It is also possible to enter patient data and information of treatment in which invoice data for the insurers require no additional effort when it comes to being generated alongside the foregoing data.
  • Figure 2 shows the data in step 11 concerning invoices at the stage of being entered by the health care provider.
  • the computer of the health care provider makes a file 12 on the basis of a quantity of data. If the health care provider is to supply data about invoices to a health care i,nsurer then in 13 an invoice file or health care provider file is made which is then sent by the computer of the health care provider 41 to the computer which deals with the data 42. Transmitting the files from the computers used by the health care providers to the computer which deals with that data or the central computer can be done by making use of computer networks, dial-up connections or sending physical data carriers such as a floppy disk or a CD-ROM.
  • invoice data from one single health care provider meant that different health care insurers could be automated by means of a computer which processes data and disseminates that data to the computers of the health care insurers.
  • the computer which deals with the data 42 carries out the method as shown in figure 1. That computer receives in 1 the files from the health care providers otherwise known as health care provider files. Checks are also carried out thereby. Such checks mean, for example, that the computer compares the data to ascertain with a high degree of certainty that the data supplied are actually valid.
  • step 8 invoices which are found to be invalid by the checks are returned to the health care provider.
  • the data from the files sent by the health care provider are entered into a total file in the central computer dealing with the data. That total file comprises at a given time all the data supplied up to now by the health care providers.
  • the collated data of the total file is regrouped into files for each health care insurer in a health care insurer file. That could be done by copying the data from the one file to the other or by extracting data from the one file to the other. It is also possible for each component to place data for each health care insurer into a separate health care insurer file.
  • This data is the information which the computer of the health care insurer will need to assess the data concerning apportioning payment to health care providers. This could include data which is not present in the computers of the health care providers themselves .
  • one or more checks are performed on the records in the files for the health insurers .
  • the data files are also converted to a format that is suitable for the computer of the specific health insurer for which the file is intended.
  • the files pass through a conversion program.
  • This conversion program converts the health insurer files into ASCII files, for example.
  • the data may be compressed in this step.
  • records can be separated from the files in order to reduce redundancy or to adapt- the records to the data structure used by the computers of a specific health insurer.
  • the respective files are transmitted to the respective health insurers.
  • the advantage of this for the health insurer is that it receives processed data regarding declared expenses that can be automatically processed for the largest part.
  • a health insurer's computer receives the health insurer files from the processing computer.
  • this can be done through computer networks, data communication networks or, for example, by sending the actual data carrier.
  • the data are checked by the health insurer's computer. This pertains to checks of whether an insurance holder is actually insured and, for example, whether the number of treatments has been exceeded or the insured party has already paid the maximum total co-pay. In these checks, the insurer's computer can therefore fully automatically check data that have been supplied fully automatically and that therefore require no manual entry.
  • data that are rejected during the checks in 15 is either sent to the processing computer to be sent to the health care provider or sent directly to the health care provider.
  • the health care provider's invoice is paid.
  • the advantages of this automated data processing for health insurers include, for example, that fewer people will be needed in the mail room, that there will be fewer peaks in the supply of data pertaining to declared expenses, that the pressure on the ICT department is reduced, that less calls are made to the call center, that modifications in the structure of the data files can be achieved extremely quickly thanks to the simplified supply of data, and/or that fewer people will be needed for support services.
  • Health care providers can submit this information about declared expenses whenever they want, making them less dependent on the unpredictable payment habits of the patients, that the payments based on the declared expense data can be received more quickly by the health care provider (in part) as a result, that the health care provider can use a single computer program to provide expense information to all health insurers, either electronically or on paper, and/or that all electronic files can be saved in a single file.
  • This invention is not limited to the preferential implementation types for it as described above; the rights being requested are determined based on the following conclusion, within the content of which numerous modifications are imaginable.

Abstract

The present invention provides a system for performing a method for processing invoice data from a large number of health care providers to one or more health insurers. The system includes entry facilities for entering declared expense data into one or more computers of one or more health care providers (1). The system further provides entry facilities for combining the declared expense data into a health care provider file with help from the health care providers' computers (1). Transmission facilities are provided for transmitting the health care provider file to one or more processing computers (2). Data, that pertains to one or more specified health insurers, is extracted from a health care provider file to be inserted into one or more health insurere file (3). Finally, the health insurer file is transmitted to the computers of health insureres specified in advance (7).

Description

METHOD AND SYSTEM FOR PROCESSING INVOICE DATA
Patients are often insured for the costs of treatment provided by health care providers; those costs are either covered in whole or in part. In that case, those costs of treatment are defrayed in whole or in part by insurance companies, or health care insurers. Health ■ care providers include doctors, consultants, dentists, physiotherapists, etc. and the professional practices which such health care providers have and use. However, these carers and insurers and in many cases patients or insured persons too, are often required to undertake many expensive and complex transactions in order to ensure that correct payments are made in a proper manner or to check that such payments have been received by those health carers from the health care insurers. At present, this is done, for example, by the health care providers in having make patients to pay and in turn those payments are submitted as expenses by the patients to their health care insurers. In other cases, a carer can invoice a health care insurer for treatment given to a patient providing the health care provider knows which health care insurer insures the insured patient in question. This is done by the health care provider submitting an invoice directly to the health care insurer. For this to work, the health care provider needs to maintain communications with all health care insurers which insure those patients he treats. If health care insurers refuse to pay invoices they are returned to the carer and those costs have to be invoiced again, this time to the patient. The costs of all these administrative activities are considerable. In order to deal with the aforementioned administrative routines, this invention offers a method for treating invoice data for a large number of health care providers who submit invoices to one or more health care insurers; it comprises the following steps:
- entering invoice data into one or more computers of one or more health care providers;
- collating invoice data to form a health care providers' file with the assistance of the computers used by health care providers;
- sending the health care providers' file to one or more central computer systems to be dealt with;
- extracting data about one or more pre-designated health care insurers from the central computer systems, in order to place the data collated into one or more health care providers' files for one of the health care insurers;
- sending the health care insurer files to computers of pre-designated health care insurers which are suitable to handle said health care insurer files. The advantage of this method is that a health care provider enters data about the treatment given to a patient and about the invoice for that treatment into his computer. After this, the computer can automatically .send the data about all the health care insurers to one central computer. This saves the carer a lot of time, trouble and effort when it comes to dealing with his invoice data. At the same time, the automated processing which this method allows for means that the health care insurer is able to pay the health care providers more quickly, which offers a further benefit to the providers of health care.
For the health care insurer there are also major benefits to be gained from this system. Data about invoices are no longer physically delivered separately by mail, having been forwarded either by the health care provider in question directly or sent by the patients. The health care insurer no longer needs to manually see to it that the quantity of data and the quantity of different sources of that data tally exactly. Large numbers of telephonic or written requests for information, submitted either by health care providers or patients about invoices will cease being submitted leading to a reduction of queries. At the same time, as manual data entry of invoice data will no longer be necessary, no more costly activities will need to be conducted to maintain or support the systems which are in place .
As many checks and balances can be carried out automatically on data which are supplied automatically only a very small number of invoice data which fail to fit in the automatic assessment system will still require being assessed manually.
In the preferred operational form, according to this invention, sending files between the various computers will be done via computer networks or via communications networks. This offers the additional advantages of being able to link up the computers at any desired moment in time, for example, by the health care providers. The exchange of information can also be done very simply by giving a command to the software. It is furthermore possible to lock up the data or compress these in order to reduce transmission times required and to encrypt it for security reasons given that transmission takes place via public access data networks. It is also possible to use specialist or dedicated networks for information transmission purposes in compliance with this method. A preferred form according to this invention provides for information transmission between the various computers using the physical transmission of digital data carriers. These include magnetic data carriers such as floppy disks, ZIP disks, optical data carriers such as CD- ROMs, as well as other data carriers. This operational form also offers the benefit of data transmission remaining possible even when there is no access to communications or data networks. It also offers the possibility of transmitting highly sensitive and confidential data.
A further preferred operational form, according to the invention, offers a method comprising one or more steps : - carrying out one or more checks on the health care provider files by or with the aid of a central computer in order to determine which data needs to be returned to the health care providers, or returned to the computers used by them; - extracting said data from the health care provider files for sending back to health care providers;
- using the processing computer (s) to send back the data to the health care providers.
This operational form offers the processing computer possibilities in respect of sending back incorrect data to the health care providers . Such checks prevent superfluous data being sent on to health insurers, or their computers, which means it prevents superfluous work having to be carried out by the health care insurers . Another preferred operational form provides one or more steps towards adding extra data with or using central processing computers for the health care insurers' files which are necessary for processing by the health care insurers' computers for which the data are specifically aimed.
The method preferably includes steps towards :
- using the processing computers to carry out checks on the health care provider files with the aim of determining which data need to be sent back to a given health care provider;
- extracting said data from the health care insurer files for sending back to health care providers; - sending back to the health care provider the data which, the check has shown, should be sent back.
For example, the checks might show that an insured person is not insured with the respective health care 'insurer. In that case, the invoice details will not be correct and must be sent back to the health care provider as payment cannot be made on the basis of incorrect data. Sending back data to the health care provider may take place at the moment that the health care provider makes contact with the processing computer via a communications network prior to sending the data. If the health care transmits data via a data carrier, it will be equally possible that incorrect data can be sent back via said data carrier. It is also possible to inform the health care providers in writing. A further preferred operational method of the present invention provides one or more steps towards:
- the conversion of the health care insurer files to pre-designated formats which are required for processing by the computers of a pre-designated health care insurer. This makes it possible to have the invoice data processed by the computers of the pre-designated health care insurer.
The method preferably provides further steps towards :
- using health care insurer's computers to carry out checks on the health care insurer files with the aim of determining which data should be sent back to the health care provider;
- extracting said data from the health care insurer files for sending back to the processing computers;
- sending back the data to the health care provider by means of the processing computers which, the check has shown, should be sent back;
- receiving said data on one of the health care provider' s computers .
If a health care insurer or one of the health care insurer' s computers reaches the conclusion, in respect of insured patients, that the treatment does not qualify for reimbursement on the basis of the invoice data, the data will be sent back by the health care insurer to the health care provider. This operational form provides for this in several advantageous steps . A further preferred operational form according to the present invention provides for steps for extracting data from health care provider files consisting of one or more steps towards :
- collating the health care provider files into one or more total files by or using the processing computers;
- extracting data from the total files targeted for specific health care insurers and entering said data into health care insurer files for pre-determined health care insurers . These steps can be seen as interim steps to be carried out by the processing computer. It may be beneficial for the processing computer to first read in the health care provider files. A total file is thus created, and data can be extracted from said file with the aim of inserting the data into the health care insurer files for the pre-determined health care insurers.
A further preferred operational form according to the present invention is provided by a computer running a program to carry out the steps in the method with reference to the health care providers' computers. It furthermore provides for a processing computer running a program to carry out the steps in the method with reference to the processing computer as well as for a computer running a program to carry out the steps in the method with reference to the health care insurers' computers .
A preferred operational form of the present invention provides a system of networked computers as described above for carrying out a method as described above .
A further preferred operational form according to the present invention provides a method for the processing of invoice data of a large number of health care providers to one or more health care insurers, containing the following steps:
- sending the health care provider invoices which have been received by at least one health care insurer to one or more processing computers;
- entering invoice data into the processing computers;
- collating the invoice data in health care insurer files; - transmitting the health care insurer files to the computers of health care insurers .
This operational form means that if health care insurers or health care providers are not or not yet equipped for using the method described under count 1, they can still make use of the benefits of a part of this method. On the basis of entering invoice data into the processing computer and creating health care insurer files, it is possible to apply the respective method steps of preferred operational forms as described above to the present operational form.
Further benefits, features and details of the present invention shall be explained further on the basis of the appended diagrams, in which:
- figure 1 is a flow-chart of a method according to an operational form of the present invention;
- figure 2 is a flow-chart of another preferred operational -form according to the present invention; - figure 3 is a flow-chart of another preferred operational form according to the present invention;
- figure 4 is a block-graph of a preferred operational form according to the present invention.
A system for carrying out a preferred operational form of the method according to the invention (figure 4) comprises a first computer 41 for the health care provider to carry out the steps of the method on. There is also a second computer, 42, the computer which deals with the data, for carrying out the steps of the method. And finally, there is a third computer to carry out the steps of the method for the health care insurers . A number of computers have been provided for to carry out the steps of the method (which computers are designated 41) for a quantity of health care provided, and indeed, a quantity of computers designated 43 are to carry out steps of the method for the health care insurers. In general, there will be more health care providers than health care insurers. More computers 42 could be deployed to carry out the steps of the method for actually processing the data. The reason for this is that more information will need to be processed than one single computer can process on its own. Another reason is that it is desirable that computers be available to the point of some of them being redundant with a view to continuity of computer availability and the security of operations. Data transmission between the computers is designated by links between 44, and 45. Data transmission should preferably be carried out via data networks or communications networks.
A preferred operational form according to the present invention is a method in which a health care provider, being a doctor, physiotherapist, dentist or suchlike, enters data concerning invoices into a computer. To this end, the health care provider will have to have software. That software should, preferably, have the following functions:
- entering or changing data concerning insured persons ; - entering or changing data concerning treatments; treatments are activities for which invoices may be submitted by the health care provider and which treatments were also provided by the health care provider to insured persons; - entering or changing data concerning health care insurers ;
- entering invoice data;
- printing invoices/duplicates;
- entering incoming payments received. This concerns payments effected by health care insurers and made to health care providers which have been administered via the method. With the aid of the software, once the in-coming payment has been entered, comparisons can be made between the invoice data entered and those payments which have been received;
- printing outstanding items, reminders and warnings. If invoices remain unpaid, it is possible, with the aid of these functions to create lists, reminders and final demands;
- entering and changing data concerning users;
- entering and changing own data;
- diary management ; - a help function to obtain explanations about the software .
In connection with this software to be used for the method, the health care provider can supply his invoice data in a uniform manner to all health care insurers which make use of the method in accordance with the present invention. With the aid of this method the transmission of these data can be done uniformly, simply and electronically. This offers the health care provider the advantage that he is no longer required to invoice different health care insurers differently. and do this by mail sent to those different health care insurers.' If a health care provider makes use of this method, then his computer can supply all the invoices to the participating health care insurers and do so by one single transaction. It is also possible to enter patient data and information of treatment in which invoice data for the insurers require no additional effort when it comes to being generated alongside the foregoing data.
Figure 2 shows the data in step 11 concerning invoices at the stage of being entered by the health care provider. The computer of the health care provider makes a file 12 on the basis of a quantity of data. If the health care provider is to supply data about invoices to a health care i,nsurer then in 13 an invoice file or health care provider file is made which is then sent by the computer of the health care provider 41 to the computer which deals with the data 42. Transmitting the files from the computers used by the health care providers to the computer which deals with that data or the central computer can be done by making use of computer networks, dial-up connections or sending physical data carriers such as a floppy disk or a CD-ROM. In all cases, it would be an advantage if invoice data from one single health care provider meant that different health care insurers could be automated by means of a computer which processes data and disseminates that data to the computers of the health care insurers. The computer which deals with the data 42, carries out the method as shown in figure 1. That computer receives in 1 the files from the health care providers otherwise known as health care provider files. Checks are also carried out thereby. Such checks mean, for example, that the computer compares the data to ascertain with a high degree of certainty that the data supplied are actually valid. For example, checking the combination of the ID code used by health care providers of professional practices, carrying out a per record check on ID codes) , with customer ID numbers, Per record, a check will also be made using the ID code generated from the other data in the record to see if the record is correct . In step 8 invoices which are found to be invalid by the checks are returned to the health care provider. In 2, the data from the files sent by the health care provider are entered into a total file in the central computer dealing with the data. That total file comprises at a given time all the data supplied up to now by the health care providers. After this, in 3, the collated data of the total file is regrouped into files for each health care insurer in a health care insurer file. That could be done by copying the data from the one file to the other or by extracting data from the one file to the other. It is also possible for each component to place data for each health care insurer into a separate health care insurer file.
After this method has been applied, and the data has as is shown in 3, been placed in health care insurer files, the central computer will be able to add to that data. That additional data will be stored in files in the central computer, see 4. This data is the information which the computer of the health care insurer will need to assess the data concerning apportioning payment to health care providers. This could include data which is not present in the computers of the health care providers themselves .
It is thinkable that storing data of this type in the computers of health care providers is undesirable, for example due to the quantity of work involved in saving the data, because the health care provider does not need the data or because for reasons of privacy of the patient, data of this type should not be saved by health care providers.
In 5 , one or more checks are performed on the records in the files for the health insurers . The data files are also converted to a format that is suitable for the computer of the specific health insurer for which the file is intended.
If it is determined during the checks in 5 that certain records are not approved, these are returned to the health care provider in 9. Reason not to approve is that the patient is not insured with the relevant health insurer. Errors of this type may occur if the health care provider does not enter the insurance data correctly. In 6, the files pass through a conversion program. This conversion program converts the health insurer files into ASCII files, for example. Moreover, the data may be compressed in this step. Furthermore, records can be separated from the files in order to reduce redundancy or to adapt- the records to the data structure used by the computers of a specific health insurer.
In 7 of figure 1, the respective files are transmitted to the respective health insurers. The advantage of this for the health insurer is that it receives processed data regarding declared expenses that can be automatically processed for the largest part.
In 14 of figure 3, a health insurer's computer receives the health insurer files from the processing computer. Here, again, this can be done through computer networks, data communication networks or, for example, by sending the actual data carrier. In 15, the data are checked by the health insurer's computer. This pertains to checks of whether an insurance holder is actually insured and, for example, whether the number of treatments has been exceeded or the insured party has already paid the maximum total co-pay. In these checks, the insurer's computer can therefore fully automatically check data that have been supplied fully automatically and that therefore require no manual entry.
In 17, data that are rejected during the checks in 15 is either sent to the processing computer to be sent to the health care provider or sent directly to the health care provider. In 16, based on the data from the checks in 15, the health care provider's invoice is paid. The advantages of this automated data processing for health insurers include, for example, that fewer people will be needed in the mail room, that there will be fewer peaks in the supply of data pertaining to declared expenses, that the pressure on the ICT department is reduced, that less calls are made to the call center, that modifications in the structure of the data files can be achieved extremely quickly thanks to the simplified supply of data, and/or that fewer people will be needed for support services.
Additional advantages for health care providers are that they can submit this information about declared expenses whenever they want, making them less dependent on the unpredictable payment habits of the patients, that the payments based on the declared expense data can be received more quickly by the health care provider (in part) as a result, that the health care provider can use a single computer program to provide expense information to all health insurers, either electronically or on paper, and/or that all electronic files can be saved in a single file.
This invention is not limited to the preferential implementation types for it as described above; the rights being requested are determined based on the following conclusion, within the content of which numerous modifications are imaginable.

Claims

1. System for performing a method for processing invoice data from a large number of health care providers to one or more health insurers, consisting of:
- entry facilities for entering declared expense data into one or more computers of one or more health care providers ;
- entry facilities for combining the declared expense data into a health care provider file with help from the health care providers' computers; - transmission facilities for transmitting the health care provider file to one or more processing computers so that it can be processed;
- extraction facilities for the processing computers to extract data from a health care provider file that pertain to one or more specified health insurers so that these extracted data can be inserted into one or more health insurer files for one of the health insurers;
- transmission facilities for transmitting the health insurer file to the computers of health insurers specified in advance, that are equipped to process the health insurer files.
2. System for performing a method in accordance with claim 1 consisting of at least one computer network or communication network for transmitting files between the various computers.
3. System for performing a method in accordance with claim 1 or 2 consisting of digital data carriers for transmitting files between the various computers by means of physical transmission. 4. System for performing the method in accordance with one or more of the previous claims consisting of: - check facilities for performing checks on the health care provider files in order to determine which data should be returned to the health care providers or to the health care providers' computers, by means of or with assistance from the processing computer;
- extraction facilities for extracting these data from the health care provider files so that these can be returned to the health care providers;
- transmission facilities for returning these data to the health care providers by means of or with assistance from the processing computers.
5. System for performing a method in accordance with one or more of the previous claims, also consisting of insertion facilities for performing one or more steps to insert additional data into the health insurer files necessary for processing by the health insurers ' computers for which the data are specifically intended, by means of or with assistance from the processing computers.
6. System for performing a method in accordance with one or more of the previous claims furthermore for performing one or more steps, consisting of:
- check facilities for performing checks on the health insurer files in order to determine which data is to be returned to the health care provider, by means of or with assistance from the processing computers;
- extraction facilities for extracting these data from the health insurer files so that these can be returned to the health care providers;
- collection facilities for returning to the health care provider the data identified to be returned in the check.
7. System for performing a method in accordance with one or more of the previous claims furthermore consisting of conversion facilities for performing one or more steps to convert the health insurer files into predetermined formats that are required for processing by the computers of a pre-determined health insurer. 8. System for performing a method in accordance with one or more of the previous claims furthermore for performing one or more steps, consisting of:
- check facilities for performing checks on the health insurer files in order to determine which data should be returned to the health care provider, by means of or with assistance from a health insurer's computers;
- extraction facilities for extracting these data from the health insurer files so that these can be returned to the processing computers, - transmission facilities so that the processing computer can return to the health care provider the data identified in the check to be returned;
- reception facilities so that the health care provider's computer can receive these data. 9. System for performing a method in accordance with one or more of the previous claims furthermore for performing steps for extracting data from health care provider files, consisting of one or more steps, consisting of: - combination facilities to combine the health care provider files into one or more total files, by means of or with assistance from the processing computer;
- extraction facilities for extracting the data intended for specific health insurers from the total files and inserting this data into health insurer files for the pre-determined health insurers.
10. Method for processing invoice data from a large number of health care providers for one or more health insurers, consisting of the following steps:
- entering declared expense data in one or more of the computers of one or more health care providers ;
- combining the declared expense data into a health care provider file with assistance from the health care providers' computers;
- transmitting the health care provider file to one or more processing computers so that it can be processed;
- extracting the data from the health care provider file that pertain to one or more pre-determined health insurers by the processing computers so that these extracted data can be inserted into one or more health insurer files for one of the health insurers;
- transmitting the health insurer files to the computers of pre-determined health insurers, which are equipped to process these health insurer files.
11. Method in accordance with claim 10 by which transmission of the files between the various computers is performed by computer network or communication network. 12. Method in accordance with claim 10 by which the transmission of files between the various computers is performed by means of physically transmitting digital data carriers .
13. Method in accordance with one or more of the claims 10 - 12 furthermore consisting of one or more steps for:
- performing one or more checks on the health care provider files by means of or with assistance from a processing computer so that it can be determined which data are to be returned to the health care providers or to the health care providers' computers;
- extracting this data from the health care provider files so that these can be returned to the health care providers;
- returning these data to the health care providers by means of or with assistance from the processing computers . 1 . Method in accordance with one or more of the claims 10 - 13 furthermore consisting of one or more steps for adding additional data to the health insurer files, by means of or with assistance from the processing computers, that is needed so that the computers of the health insurers for which the data are specifically intended can process them.
15. Method in accordance with one or more of claims 10 - 14 furthermore consisting of one or more steps for:
- performing one or more checks on the health insurer files by means of or with assistance from a processing computer so that it can be determined which data are to be returned to a health care provider;
- extracting these data from the health insurer files so that these can be returned to the health care providers;
- returning to the health care providers by means of or with assistance from the processing computers the data identified to be returned during the check.
16. Method in accordance with one or more of the claims 10 - 15 furthermore consisting of one or more steps for converting the health insurer files into predetermined formats required so that the computers of a pre-determined health insurer can process them.
17. Method in accordance with one or more of the claims 10 - 16 furthermore consisting of one or more steps for:
- performing one or more checks on the health insurer files by means of or with assistance from the health insurer's computers so that it can be determined which data are to be returned to the health care providers ;
- extracting these data from the health insurer files so that these can be returned to the processing computer;
- returning by means of the processing computers the data identified during the checks to be returned;
- reception by the health care provider's computer of this data.
18. Method in accordance with one or more of the claims 10 - 17 by which steps for extracting data from health care provider files consist of one or more steps for: - by means of or with assistance from the processing computers, combining the health care provider files into one or more total files;
- extracting the data intended for specific health insurers from the total files and entering these data into health insurer files for the pre-determined health insurers .
19. Computer with programs for performing the method steps pertaining to the health care providers' computers in accordance with one or more of the claims 10 - 18.
20. Processing computer with programs for performing the method steps pertaining to the processing computers in accordance with one or more of the claims 10 - 18. 21. Computer with programs for performing the method steps pertaining to the health insurers' computers in accordance with one or more of the claims 10 - 18.
22. System of communicating computers in accordance with claims 19, 20 and/or 21 for performing the method in accordance with the claims 10 - 18.
23. Method for processing invoice data from a large number of health care providers for one or more health insurers, consisting of the following steps:
- sending health care provider invoices received by at least one health insurer to one or more processing computers;
- entering the invoice data in the processing computers;
- entering the invoice data in the health insurer files;
- transmitting the health insurer files to the health insurers' computers. 24. Method in accordance with claim 23 by which the transmission of the files between the various computers is performed by computer network or by communication network.
25. Method in accordance with claim 23 by which transmission of the files between the various computers is performed by means of physical transmission of digital data carriers .
26. Method in accordance with one or more of the claims 23 - 25 furthermore consisting of one or more steps for: - performing one or more checks on the invoice data by means of or with assistance from the processing computer, in order to determine which data are to be returned to the health care providers or the health care providers' computers, possibly via the health insurer; - returning these data to the health care providers by means of or with assistance from the processing computers, possibly via the health insurer.
27. Method in accordance with one or more of the claims 23 - 26 furthermore consisting of one or more steps for adding to the health insurer files additional data that are needed so that the data can be processed by computers of the health insurers for which the data are specifically intended, by means of or with assistance from the processing computer.
28. Method in accordance with one or more of the claims .23 - 27, furthermore consisting of one or more steps for: - performing checks on the health insurer files in order to determine which data are to be returned to a health care provider by means of or with assistance from the processing computers, possibly via the health insurer;
- extracting these data from the health insurer files so that these can be returned to the health care providers, possibly via the health insurer;
- returning to the health care provider the data identified during the check to be returned, possibly via the health insurer. 29. Method in accordance with one or more of the claims 23 - 28 furthermore consisting of one or more steps for converting the health insurer files into predetermined formats that are needed so that the computers of a pre-determined health insurer can processes them. 30. Method in accordance with one or more of the claims 23 - 29 furthermore consisting of one or more steps for:
- performing checks on the health insurer files in order to determine which data is to be returned to the health care provider, by means of or with assistance from a health insurer's computers;
- extracting these data from the health insurer files so that it can be returned to the processing computers ;
- returning to the health care provider by the processing computer the data identified during the check to be returned; - returning to the health care provider the data identified during the check to be returned to the health care provider.
31. Method in accordance with one or more of the claims 23 - 30 by which the evaluation steps consist of one or more steps for:
- combining the entry files into one or more total files by means of or with assistance from the processing computers;
- extracting from the total files data intended for specific health insurers and entering this data into health insurer files for the pre-determined health insurers .
PCT/US2002/017991 2001-06-07 2002-06-07 Method and system for processing invoice data WO2002101498A2 (en)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4858121A (en) * 1986-12-12 1989-08-15 Medical Payment Systems, Incorporated Medical payment system
US5519607A (en) * 1991-03-12 1996-05-21 Research Enterprises, Inc. Automated health benefit processing system
US5930759A (en) * 1996-04-30 1999-07-27 Symbol Technologies, Inc. Method and system for processing health care electronic data transactions

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4858121A (en) * 1986-12-12 1989-08-15 Medical Payment Systems, Incorporated Medical payment system
US5519607A (en) * 1991-03-12 1996-05-21 Research Enterprises, Inc. Automated health benefit processing system
US5930759A (en) * 1996-04-30 1999-07-27 Symbol Technologies, Inc. Method and system for processing health care electronic data transactions

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