Automated system and method for reviewing medical and financial claim records and for identifying missing devices and/or services associated with medical and financial procedures

Abstract

This invention relates to a method and system that identifies pass-through items, medications and/or sub-procedures that are typically associated with the performance of medical procedures yet not listed on corresponding medical claim records. The invention includes the steps of storing a database of medical records on a first computer data storage medium, storing a database of event codes on a second computer data storage medium, and electronically transmitting the database of records to the second computer data storage medium. Each event code corresponds to a pass-through item, medication or sub-procedure. The invention analyzes a particular medical procedure and determines if an event code should be listed on the record corresponding to that particular medical procedure. If not, the invention transmits a report identifying the missing event code, and in one embodiment, generates a new record with the proper event code now properly listed. The transfer of claim record information, and any subsequent reports listing omitted event codes can be performed either automatically or at the user's request, via an intranet or Internet connection and allows the user to quickly determine which medical procedures listed in the claim records have omitted associated medical devices or sub-procedures, which, if listed, would be reimbursable to the medical facility.

Dependencies are inferred from the claim text.