EP 1493117 A4 20071128 - A SYSTEM FOR PROCESSING HEALTHCARE CLAIM DATA
Title (en)
A SYSTEM FOR PROCESSING HEALTHCARE CLAIM DATA
Title (de)
SYSTEM ZUM VERARBEITEN VON GESUNDHEITSVERSORGUNGS-ANSPRUCHDATEN
Title (fr)
SYSTEME DE TRAITEMENT DE DONNEES DE DEMANDES DE SOINS DE SANTE
Publication
Application
Priority
- US 0310191 W 20030403
- US 37102702 P 20020409
- US 24798002 A 20020920
Abstract (en)
[origin: WO03087979A2] 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 the rules.
IPC 1-7
IPC 8 full level
G06Q 10/00 (2006.01); G06Q 50/00 (2006.01)
CPC (source: EP)
G06Q 10/10 (2013.01)
Citation (search report)
- No Search
- See references of WO 03087979A2
Designated contracting state (EPC)
DE GB IT
DOCDB simple family (publication)
WO 03087979 A2 20031023; WO 03087979 A3 20040325; CA 2480599 A1 20031023; EP 1493117 A2 20050105; EP 1493117 A4 20071128; JP 2005522766 A 20050728
DOCDB simple family (application)
US 0310191 W 20030403; CA 2480599 A 20030403; EP 03723890 A 20030403; JP 2003584856 A 20030403