US 10,380,320 B2Granted

Data restructuring for consistent formatting

AssigneePassport Health Communications, Inc.

InventorsRichard W. Farmer, Donavon R. Feenstra

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Abstract

Consistently coded eligibility data is provided. Eligibility responses may be received from various payers comprising inconsistently coded eligibility benefit (EB) information provided in EB segments in various locations in the responses. A data restructuring engine may be operable to receive an eligibility response and restructure the response into a consistent format. Co-pay, co-insurance, benefit limitations, and benefit specific deductibles may be clarified by embedding coded strings in one or more message segments attached to EB segments. Service types, network indicators, place of service codes, and message text may be removed when a coded strings is created. Recoded eligibility responses may be provided to healthcare providers, providing coverage, eligibility, and benefit data in a consistent and standardized form, regardless of the payer sending the eligibility response.

Claims18

Dependent claims

A method of providing a recoded eligibility response as a machine-readable data structure comprising:

receiving, at a computing device that includes a restructuring engine, eligibility data in an original eligibility response;
parsing, by the restructuring engine of the computing device, the eligibility data in the original eligibility response for one or more eligibility benefit data elements and one or more message segments for free-form message text;
removing, by the restructuring engine of the computing device, the free-form message text from the one or more message segments and values of certain eligibility benefit data elements in the original eligibility response;
creating, by the restructuring engine of the computing device, the recoded eligibility response as the machine-readable data structure to include:
a message segment data structure and an eligibility benefit segment data structure, the message segment data structure comprising:
a place of service dimension,
a service type dimension,
a provider type dimension,
a relation of provider to payer dimension,
a relation of provider to patient dimension,
a reason for service dimension, and
a service category dimension;
a coded string to replace removed free-form message text;
one or more coded values for one or more of the place of service dimension, the service type dimension, the provider type dimension, the relation of provider to payer dimension, the relation of provider to patient dimension, the reason for service dimension, and the service category dimension of the message segment data structure;
an embedded tag to indicate a recoding operation for a coded string in a first message segment of the recoded eligibility response when the coded string includes inclusion information;
and
an embedded tag to indicate a recoding operation for a coded string in a second message segment of the recoded eligibility response when the coded string includes exclusion information;
and
sending, from the computing device, the recoded eligibility response to a requesting healthcare provider computer system.

16 more elements

A system to provide a recoded eligibility response as a machine-readable data structure comprising:

one or more processors;
a restructuring engine comprising executable instructions;
and
a memory coupled to the one or more processors, the one or more processors to execute the executable instructions of the restructuring engine to:
receive eligibility data in an original eligibility response;
parse the eligibility data in the original eligibility response for one or more eligibility benefit data elements and one or more message segments for free-form message text
remove the free-form message text from the one or more message segments and values of certain eligibility benefit data elements in the original eligibility response;
create the recoded eligibility response as the machine-readable data structure to include:
a message segment data structure and an eligibility benefit segment data structure, the message segment data structure comprising:
a place of service dimension,
a service type dimension,
a provider type dimension,
a relation of provider to payer dimension,
a relation of provider to patient dimension,
a reason for service dimension, and
a service category dimension;
a coded string to replace removed free-form message text;
one or more coded values for one or more of the place of service dimension, the service type dimension, the provider type dimension, the relation of provider to payer dimension, the relation of provider to patient dimension, the reason for service dimension, and the service category dimension of the message segment data structure;
an embedded tag to indicate a recoding operation for a coded string in a first message segment of the recoded eligibility response when the coded string includes inclusion information;
and
an embedded tag to indicate a recoding operation for a coded string in a second message segment of the recoded eligibility response when the coded string includes exclusion information;
and
provide the recoded eligibility response to a requesting healthcare provider computer system.

20 more elements

A non-transitory computer readable medium containing computer executable instructions which, when executed by a computing device, implement a restructuring engine to perform a method of providing a recoded eligibility response as a machine-readable data structure comprising:

receiving eligibility data in an original eligibility response;
parsing, by the restructuring engine, the eligibility data in the original eligibility response for one or more eligibility benefit data elements and one or more message segments for free-form message text;
removing, by the restructuring engine, the free-form message text from the one or more message segments and values of certain eligibility benefit data elements in the original eligibility response;
creating, by the restructuring engine, the recoded eligibility response as the machine-readable data structure to include:
a message segment data structure and an eligibility benefit segment data structure, the message segment data structure comprising:
a place of service dimension,
a service type dimension,
a provider type dimension,
a relation of provider to payer dimension,
a relation of provider to patient dimension,
a reason for service dimension, and
a service category dimension;
a coded string to replace removed free-form message text;
one or more coded values for one or more of the place of service dimension, the service type dimension, the provider type dimension, the relation of provider to payer dimension, the relation of provider to patient dimension, the reason for service dimension, and the service category dimension of the message segment data structure;
an embedded tag to indicate a recoding operation for a coded string in a first message segment of the recoded eligibility response when the coded string includes inclusion information;
and
an embedded tag to indicate a recoding operation for a coded string in a second message segment of the recoded eligibility response when the coded string includes exclusion information;
and
providing the recoded eligibility response to a requesting healthcare provider computer system.

16 more elements

Dependencies are inferred from the claim text.

Facts

Application: 13/757,282Filed 1 Feb 2013 · us provisional application
Priority: 3 Feb 2012
Published: US 2013/0204642 A18 Aug 2013
Granted: 13 Aug 2019
Term ends: Not estimatedThe source records don’t support an estimate.

Classification4 codes

G06Q 40/08
Finance; Insurance; Tax strategies; Processing of corporate or income taxes: insurance
G16H 40/20
ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or…:…
G06Q
Information and communication technology [ict] specially adapted for administrative, commercial, financial, managerial
G16H
Healthcare informatics, i.e. information and communication technology [ict] specially adapted for the