WO2003088124A3 - A system and user interface supporting use of rules for processing healthcare and other claim data - Google Patents

A system and user interface supporting use of rules for processing healthcare and other claim data Download PDF

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Publication number
WO2003088124A3
WO2003088124A3 PCT/US2003/010193 US0310193W WO03088124A3 WO 2003088124 A3 WO2003088124 A3 WO 2003088124A3 US 0310193 W US0310193 W US 0310193W WO 03088124 A3 WO03088124 A3 WO 03088124A3
Authority
WO
WIPO (PCT)
Prior art keywords
rules
data
repository
patient
processor
Prior art date
Application number
PCT/US2003/010193
Other languages
French (fr)
Other versions
WO2003088124A2 (en
Inventor
David Fitzgerald
Brian Lucas
Greg Long
Sr David Hiebert Klassen
John Hunter
Original Assignee
Siemens Med Solutions Health
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
Priority claimed from US10/308,648 external-priority patent/US20030191667A1/en
Application filed by Siemens Med Solutions Health filed Critical Siemens Med Solutions Health
Priority to EP03746586A priority Critical patent/EP1525550A2/en
Priority to CA002482433A priority patent/CA2482433A1/en
Priority to JP2003584988A priority patent/JP2005522789A/en
Publication of WO2003088124A2 publication Critical patent/WO2003088124A2/en
Publication of WO2003088124A3 publication Critical patent/WO2003088124A3/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
    • G06Q40/02—Banking, e.g. interest calculation or account maintenance

Abstract

A centralized rules repository maintains consistently expressed rules used to process patient claim data in supporting medical procedure eligibility verification, patient referrals, treatment authorization, data entry editing, electronic claim submission, claim status determination and electronic remittance processing. A system for managing rules used for processing claim data related to provision of healthcare to a patient includes an interface processor for acquiring data representing rules from a plurality of different sources. The system includes a rules repository for accumulating data representing acquired rules and a rules processor for initiating application of a selected rule derived from the repository to process claim data in response to a received message. A result processor processes a result being derived by the application of the selected rule to the claim data for output. The interface processor also transforms acquired rules to a common syntax suitable for storage in the rules repository.
PCT/US2003/010193 2002-04-12 2003-04-03 A system and user interface supporting use of rules for processing healthcare and other claim data WO2003088124A2 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
EP03746586A EP1525550A2 (en) 2002-04-12 2003-04-03 A system and user interface supporting use of rules for processing healthcare and other claim data
CA002482433A CA2482433A1 (en) 2002-04-12 2003-04-03 A system and user interface supporting use of rules for processing healthcare and other claim data
JP2003584988A JP2005522789A (en) 2002-04-12 2003-04-03 Systems and user interfaces that support the use of rules to process health care and other billing data.

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US37276402P 2002-04-12 2002-04-12
US60/372,764 2002-04-12
US10/308,648 US20030191667A1 (en) 2002-04-09 2002-12-03 System and user interface supporting use of rules for processing healthcare and other claim data
US10/308,648 2002-12-03

Publications (2)

Publication Number Publication Date
WO2003088124A2 WO2003088124A2 (en) 2003-10-23
WO2003088124A3 true WO2003088124A3 (en) 2005-02-10

Family

ID=29254279

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2003/010193 WO2003088124A2 (en) 2002-04-12 2003-04-03 A system and user interface supporting use of rules for processing healthcare and other claim data

Country Status (4)

Country Link
EP (1) EP1525550A2 (en)
JP (1) JP2005522789A (en)
CA (1) CA2482433A1 (en)
WO (1) WO2003088124A2 (en)

Families Citing this family (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8626536B2 (en) * 2004-08-31 2014-01-07 Electronic Commerce for Healthcare Organizations, Inc. Intelligent router for medical payments
US20070021977A1 (en) * 2005-07-19 2007-01-25 Witt Biomedical Corporation Automated system for capturing and archiving information to verify medical necessity of performing medical procedure

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5359509A (en) * 1991-10-31 1994-10-25 United Healthcare Corporation Health care payment adjudication and review system
US5481647A (en) * 1991-03-22 1996-01-02 Raff Enterprises, Inc. User adaptable expert system
US5519607A (en) * 1991-03-12 1996-05-21 Research Enterprises, Inc. Automated health benefit processing system
EP1081622A2 (en) * 1999-09-01 2001-03-07 NCR International, Inc. Expert system
US6343271B1 (en) * 1998-07-17 2002-01-29 P5 E.Health Services, Inc. Electronic creation, submission, adjudication, and payment of health insurance claims

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5519607A (en) * 1991-03-12 1996-05-21 Research Enterprises, Inc. Automated health benefit processing system
US5481647A (en) * 1991-03-22 1996-01-02 Raff Enterprises, Inc. User adaptable expert system
US5359509A (en) * 1991-10-31 1994-10-25 United Healthcare Corporation Health care payment adjudication and review system
US6343271B1 (en) * 1998-07-17 2002-01-29 P5 E.Health Services, Inc. Electronic creation, submission, adjudication, and payment of health insurance claims
EP1081622A2 (en) * 1999-09-01 2001-03-07 NCR International, Inc. Expert system

Also Published As

Publication number Publication date
WO2003088124A2 (en) 2003-10-23
EP1525550A2 (en) 2005-04-27
JP2005522789A (en) 2005-07-28
CA2482433A1 (en) 2003-10-23

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