System for processing healthcare claim data

US7917378B2 · kind B2 · utility

Assignee

• Siemens Medical Solutions USA, Inc. · US

Inventors

• David Fitzgerald · New Garden Township, US
• Brian Lucas · Springfield, US
• Greg Long · Clay City, US
• David Klassen · Paoli, US
• John Hunter · North Wales, US
• Jon P. Zimmerman · London, GB

Key dates

• Filing date: Sep 20, 2002
• Grant date: Mar 29, 2011
• Expiry date: May 26, 2031

Classification

• Technology area (CPC G): Physics
• CPC primary: G16H15/00
• WIPO field: Medical technology
• WIPO sector: Instruments

Abstract

A claim pre-processing system employs trial adjudication to improve claim accuracy prior to claim submission to a healthcare payer institution or other entity. A system processes claim data related to provision of healthcare to a patient The system includes a claim data collator for collating data related to a claim for a particular patient for submission to a payer and a source of rules for use in processing collated claim data. A pre-processor submits the collated claim data for processing using the rules to validate the collated claim data is in condition for processing to initiate generation of payment. A claim processor submits the collated claim data to a payer, in response to successful validation by the pre-processor. A rules processor processes acquired claim data to identify a condition triggering application of a different set of rules for determining validity of an individual claim element. The pre-processor re-submits amended collated claim data for processing using the rules to validate the collated claim data is in condition for processing to initiate generation of payment, the amended collated claim data being received in response to unsuccessful validation using th…