# US 2019/0244302 A1 · Medical claim database relationship processing

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- Number: US 2019/0244302 A1
- Document ID: US20190244302A1
- Status: Published application
- Kind: A1
- Application number: 16/270,346
- Filed: 2019-02-07
- Published: 2019-08-08
- Earliest claimed: 2018-02-07
- Assignees: Sunbelt Medical Management, LLC
- Applicants: Sunbelt Medical Management, LLC
- Inventors: YORAM S. LEVY
- Web page: https://patentgrep.com/patent/US20190244302A1

## CPC

- G06Q 40/08: Insurance
- G06F 16/27: Replication, distribution or synchronisation of data between databases or within a distributed database system; Distributed database system architectures therefor
- G06Q 20/145: {Payments according to the detected use or quantity}
- G16H 10/60: for patient-specific data, e.g. for electronic patient records
- G16H 15/00: ICT specially adapted for medical reports, e.g. generation or transmission thereof
- G06Q 10/10: Office automation; Time management
- G16H 40/20: for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
- G06Q: INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06F: ELECTRIC DIGITAL DATA PROCESSING (computer systems based on specific computational models G06N)
- G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA

## Abstract

A method for processing relationships in a medical claims database using a computerized system having a processor and a non-transitory memory includes storing multi-field medical claim data and multi-field insurance claim data in a relational electronic database. The insurance claim data corresponds to at least a portion of the medical claim data. A worklist template is defined using at least one filter and at least one multiplier. The at least one filter excludes at least a portion of the medical claim data, and the at least one multiplier defines a weighted value applicable to at least one field of the multi-field medical claim data. The processor converts the medical claim data into standardized values by applying the at least one multiplier to at least one field of the multi-field medical claim data. A biller worklist is assigned based on a hierarchy of the standardized values.

## Claims

### Claim 1

A method for processing relationships in a database using a computerized system having a processor and a non-transitory memory, the method comprising:
storing multi-field medical claim data and multi-field insurance claim data in a relational electronic database, wherein the insurance claim data corresponds to at least a portion of the medical claim data;
defining a worklist template using at least one filter and at least one multiplier, wherein the at least one filter excludes at least a portion of the medical claim data, and wherein the at least one multiplier defines a weighted value applicable to at least one field of the multi-field medical claim data;
converting, by the processor, the medical claim data into standardized values by applying the at least one multiplier to at least one field of the multi-field medical claim data; and
assigning a biller worklist based on a hierarchy of the standardized values.

### Claim 2 (depends on 1)

The method of claim 1, wherein at least one multiplier is applied to one of: a claim balance and a claim age of the medical claim data.

### Claim 3

A method for medical claims billing management using a computerized system having a processor and a non-transitory memory, the method comprising:
electronically collecting multi-field medical claim data from a relational, subject-oriented electronic medical records (EMR) database of a medical provider;
electronically retrieving multi-field insurance claim data from a remote insurance database, wherein the insurance claim data corresponds to at least a portion of the medical claim data; and
providing a plurality of dashboards on a computerized graphical user interface for viewing the collected medical claim data and the retrieved insurance claim data, wherein the plurality of dashboards comprises at least:
a plurality of billing view dashboards, each providing a prioritization of a handling of a portion of the medical claim data to a medical claim analyst, wherein the medical claim analyst communicates with an insurance provider associated with the portion of the medical claims data according to a schedule determined by the prioritization; and
at least one manager view dashboard providing workflow information corresponding to the plurality of billing view dashboards.

### Claim 4 (depends on 3)

The method of claim 3, wherein the insurance claim data is retrieved using at least one from the set of: web scraping, an open database connectivity interface, or an application programming interface.

### Claim 5 (depends on 3)

The method of claim 3, wherein the EMR database is a distributed database.

### Claim 6 (depends on 3)

The method of claim 3, further comprising the step of filtering the retrieved insurance claim data according to at least one from the set of: a claim age, a claim balance, a payer, a status, a provider, a CPT code, and an action code.

### Claim 7 (depends on 3)

The method of claim 3, wherein the prioritization is determined by applying at least one multiplier to at least a portion of the medical claim data.

### Claim 8 (depends on 7)

The method of claim 7, wherein the at least one multiplier is applied to a claim balance of the medical claim data to create a standardized value of the medical claim data.

### Claim 9 (depends on 7)

The method of claim 7, wherein the at least one multiplier is applied to a claim age of the medical claim data to create a standardized value of the medical claim data.

### Claim 10 (depends on 7)

The method of claim 7, wherein the prioritization is determined by a hierarchy of at least one from the set of: a claim age, a claim balance, a payer, a status, a provider, a CPT code, and an action code.

### Claim 11 (depends on 3)

The method of claim 3, wherein the prioritization is determined by a user of the at least one manager view dashboard and is displayed on at least one of the plurality of billing view dashboards.

### Claim 12

A system for medical claims billing management, comprising:
at least one billing computer device having a processor and non-transitory computer-readable memory;
a relational, subject-oriented electronic medical records (EMR) database of a medical provider containing multi-field medical claim data;
a remote insurance database containing multi-field insurance claim data corresponding to at least a portion of the medical claim data;
a server having a processor and non-transitory computer-readable memory, the server accessible over at least one network system by the billing computer device, the EMR database, and the insurance database; and
a billing management application running at least partially on the server, wherein the billing management application:
collects multi-field medical claim data from the EMR database;
retrieves multi-field insurance claim data from the insurance database;
provides a plurality of dashboards on a computerized graphical user interface for viewing the collected medical claim data and the retrieved insurance claim data, wherein each of the plurality of dashboards provides a prioritization of a handling of a portion of the medical claims data to a medical claim analyst workstation/computing device, wherein the medical claim analyst communicates with an insurance provider associated with the portion of the medical claims data according to a schedule determined by the prioritization; and
provides at least one manager view dashboard providing workflow data corresponding to the plurality of billing view dashboards.

### Claim 13 (depends on 12)

The system of claim 12, wherein the insurance claim data is retrieved using at least one from the set of: web scraping, an open database connectivity interface, or an application programming interface.

### Claim 14 (depends on 12)

The system of claim 12, wherein the EMR database is a distributed database.

### Claim 15 (depends on 12)

The system of claim 12, wherein the retrieved insurance claim data is filtered according to at least one from the set of: a claim age, a claim balance, a payer, a status, a provider, a CPT code, and an action code.

### Claim 16 (depends on 12)

The system of claim 12, wherein the prioritization is determined by applying at least one multiplier to at least a portion of the medical claim data.

### Claim 17 (depends on 16)

The system of claim 16, wherein the at least one multiplier is applied to a dollar value of the medical claim data to create a standardized value of the medical claim data.

### Claim 18 (depends on 16)

The system of claim 16, wherein the at least one multiplier is applied to a claim age of the medical claim data to create a standardized value of the medical claim data.

### Claim 19 (depends on 16)

The system of claim 16, wherein the prioritization is determined by a hierarchy of at least one from the set of: a claim age, a claim balance, a payer, a status, a provider, a CPT code, and an action code.

### Claim 20 (depends on 12)

The system of claim 12, wherein the prioritization is determined by a user of the at least one manager view dashboard and is displayed on at least one of the plurality of billing view dashboards.