System and method for intelligent management of medical care
AssigneeThe Callas Group, LLC
InventorConstantine Callas
Life of this patent
Estimating the term…
Abstract
A computerized medical care system provides validation of a diagnosis of a medical condition and requested medical services for treating the medical condition. The medial care system invokes multiple filters to determine the appropriateness of the diagnosis and medical service. Real time feedback is provided based on the determination. If the medical care cannot be validated, the feedback includes the reasons for the failure to validate, and any supporting materials for the lack of validation. The feedback may also prompt the requesting entity to provide additional information to help support the medical provider's position as to why the requested medical care is appropriate.
Claims20
In a computerized medical care system, a method for providing a medical pre-approval, the method comprising:
- receiving from a requesting device a medical code associated with a medical determination;
- identifying one or more filters enabled for the computerized medical care system;
- applying the identified one or more filters for the received medical code;
- determining validity of the medical determination based on the applied one or more filters;
- and
- providing feedback to the requesting device based on the determination of the validity of the medical determination, wherein the feedback prompts modification of the medical determination that is ultimately rendered to a patient if the medical determination is not validated.
A computerized medical care system for providing a medical pre-approval, the system comprising:
- a processor;
- and
- a memory operably coupled to the processor and storing program instructions therein, the processor being operable to execute the program instructions, the program instructions including:
- receiving from a requesting device a medical code associated with a medical determination;
- identifying one or more filters enabled for the computerized medical care system;
- applying the identified one or more filters for the received medical code;
- determining validity of the medical determination based on the applied one or more filters;
- and
- providing feedback to the requesting device based on the determination of the validity of the medical determination, wherein the feedback prompts modification of the medical determination that is ultimately rendered to a patient if the medical determination is not validated.
A computerized medical care system for providing a medical pre-approval, the system comprising:
- a computing engine configured to receive a diagnosis code identifying diagnosis of a medical condition and a service code identifying a requested medical service;
- a medical diagnosis filter coupled to the engine and configured to display a question that should be considered in making the diagnosis of the medical condition, the medical diagnosis filter further being configured to prompt a user response to the displayed question, validate the diagnosis if the expected response matches the user response, and invalidate the diagnosis if the expected response fails to match the user response;
- and
- a plurality of medical procedure filters coupled to the engine and configured to determine a validity of the requested medical service relative to the diagnosis based on each of the applied medical procedure filters,
- wherein the computing engine is configured to provide feedback based on the determination of the validity of the diagnosis and requested medical service, wherein the feedback prompts modification of the diagnosis or medical service that is ultimately rendered to a patient if respectively the diagnosis or requested medical service is not validated.
Dependencies are inferred from the claim text.