Method and system for scheduling tracking, adjudicating appointments and ...

US 20070255586A1

(io) Pub. No.: US 2007/0255586 Al (43) Pub. Date: Nov. 1, 2007

(54) METHOD AND SYSTEM FOR SCHEDULING TRACKING, ADJUDICATING APPOINTMENTS AND CLAIMS IN A HEALTH SERVICES ENVIRONMENT

(75) Inventors: Jason Reinis Green, Jacksonville, FL (US); Raymond Michael Wood, Jacksonville, FL (US); Robert John Snyder, St. Augustine, FL (US)

Correspondence Address:

BUCHANAN, INGERSOLL & ROONEY PC
POST OFFICE BOX 1404
ALEXANDRIA, VA 22313-1404 (US)

(73) Assignee: Medical Development International

Ltd., Inc., Ponte Verda Beach, FL (US)

(21) Appl. No.: 11/412,836

(22) Filed: Apr. 28, 2006

Publication Classification

(51) Int. CI.

G06Q 10/00 (2006.01)
A61B 5/00 (2006.01)

(52) U.S. CI 705/2; 600/300

(57) ABSTRACT

An exemplary method for determining the appropriateness of service provider claims for payment includes scheduling appointments for patients with service providers based on requests for services, generating appointment information corresponding to each of the scheduled appointments, and capturing service information corresponding to claims received from the service providers for payment of charges associated with services rendered by the service providers to the patients. The method further includes automatically identifying candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments. Additionally, the method includes flagging the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim, and presenting the particular received claim for payment when at least one of the candidate appointments corresponds to the particular received claim.

Capture service information corresponding to claims received from the service providers

Automatically identify candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments

Flag the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim

Present the particular received claim for payment when at least one of the candidate appointments corresponds to the particular

received claim

FIG. 1

Select the appointment information from pre-defined menus of appointment information

Assign a unique appointment identifier code to each scheduled appointment