Payer provider connect engine
US11455690B2 · kind B2 · utility
Assignee
Inventors
Key dates
| Filing date | Jun 28, 2016 |
| Grant date | Sep 27, 2022 |
| Priority date | — |
| Expiry date | Mar 22, 2037 |
Classification
- Technology area (CPC G)Physics
- CPC primaryG16H40/20
- WIPO fieldMedical technology
- WIPO sectorInstruments
Abstract
Systems, methods and computer program products to identify and close gaps in care are provided. Aspects of the present disclosure disclosed and described herein enable a payer may identify gaps in care based on information in the payer database. The payer can send this information to the provider prior to patient scheduling. The scheduling system at the provider can use this information to schedule patients and their medical needs (e.g., medical test, lab tests, imaging tests, etc.) before the next patient appointment. Primary care providers (PCPs) can then be made aware of the gaps in care information, as well as Hierarchical Condition Category (HCC) coding gap information, so they can perform a complete diagnosis using all available clinical data. PCP notes along with the treatment the patient receives can be combined with the RAF (Risk Adjustment Score) shared by the payers to ensure patient is assessed for all relevant conditions during the visit. Payers can then be informed electronically that the gap in care has been closed; the payer can also receive the resultant claims such that correct RAF scores can be computed and HCC coding gaps can be closed.
Source: USPTO / EPO open patent data. Objective bibliographic and citation counts.