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US 2017/0323382 A1Published application
Healthcare related claim reconciliation
Assignee3M Innovative Properties Company
InventorJanice G. Ohlsson
Life of this patent
Estimating the term…
Abstract
Systems and methods for auditing and/or reconciling medical and financial data in a health record management software environment.
Claims20
A computer-implemented method comprising:
- receiving patient encounter information that defines, at least partially, a patient's encounter with a healthcare organization, the patient's encounter including at least one service provided to the patient;
- receiving remittance advice information that defines payments made to the benefit of the healthcare organization for at least one service provided to the patient and associated with the encounter;
- receiving as-submitted claim data that defines one or more requests for payments, the requests made to a payment organization for the at least one service provided to the patient;
- applying a set of rules to the patient encounter information, the remittance advice information, and the as-submitted claim data, the set of rules defining relationships between the as-submitted claim data and either or both of:
- the patient encounter information and the remittance advice information;
- and
- based on the application of the rules, identifying a discrepancy between the as-submitted claim data and either or both of:
- the patient encounter information and the remittance advice information.
5 more elements
10-11. (canceled)
A computer-implemented method comprising:
- receiving patient encounter information that defines, at least partially, a patient's encounter with a healthcare organization, the patient's encounter including at least one service provided to the patient;
- receiving claim data that defines one or more requests for payments, the requests made to a payment organization for the at least one service provided to the patient;
- applying a set of rules to the patient encounter information and the as-submitted claim data, the set of rules defining relationships between the sets of data;
- and,
- based on the application of the rules, identifying a discrepancy between the as-submitted claim data and the patient encounter information.
2 more elements
A computer-implemented method comprising:
- receiving remittance advice information that defines at least one payment made to the benefit of a healthcare organization for at least one service provided to a patient as part of the patient's encounter with the healthcare organization;
- receiving as-submitted claim data that defines one or more requests for payments, the requests made to a payment organization for the at least one service provided to the patient;
- applying a set of rules to the remittance advice information and the as-submitted claim data, the set of rules defining relationships among the sets of data;
- and,
- based on the application of the rules, identifying a discrepancy between the as-submitted claim data and the remittance advice information.
2 more elements
21-30. (canceled)
Dependencies are inferred from the claim text.