Device for the centralized management of medical tests and methods for using the same
AssigneeOptum, Inc.
InventorsJohn L. WILSON, François CHARETTE
Life of this patent
Estimating the term…
Abstract
Provided is a lab clearinghouse device configured to provide centralized management of medical tests across a plurality of medical providers, a plurality of lab payers, and a plurality of laboratories. The lab clearinghouse device is configured to communicate with a plurality of medical laboratories, medical providers, and lab payers to efficiently and effectively order and manage medical testing.
Claims20
A device for centralized management of medical tests across a plurality of medical providers, a plurality of lab payers, and a plurality of laboratories, the device comprising a processor and a memory storing computer instructions that, when executed by the processor, cause the device to:
- receive a lab request from a lab request initiator, the lab request initiator being associated with at least one medical provider of the plurality of medical providers, wherein the lab request comprises an order for one or more medical tests to be performed;
- derive, using the lab request, a lab code associated with a lab fee, wherein the lab code is specific to the one or more medical tests;
- cause the lab request to be adjudicated;
- and
- approve or deny the lab request based on adjudicating the lab request,
- wherein approving the lab request comprises:
- transmitting the lab fee indication to one lab payer of the plurality of lab payers;
- generating lab instructions associated with the lab request after the lab request has been adjudicated;
- and
- transmitting the lab instructions associated with the lab request to one laboratory of the plurality of medical laboratories for performance of one or more corresponding medical tests, and
- wherein denying the lab request comprises transmitting a lab request denial to the lab request initiator, the lab request denial indicating that the lab request needs to be revised.
A method of providing centralized management of medical tests across a plurality of medical providers, a plurality of lab payers, and a plurality of laboratories, the method comprising:
- receiving, by a lab clearinghouse circuitry, a lab request from a lab request initiator, the lab request initiator being associated with at least one medical provider of the plurality of medical providers, wherein the lab request comprises an order for one or more medical tests to be performed;
- translating, by an analytical engine, the lab request to a lab code associated with a lab fee, wherein the lab code is specific to the one or more medical tests;
- causing, by the analytical engine, the lab request to be adjudicated;
- and
- approving or denying the lab request based on adjudicating the lab request,
- wherein approving the lab request comprises:
- transmitting, by a communications interface, the lab fee to one lab payer of the plurality of lab payers,
- generating, by the analytical engine, lab instructions associated with the lab request after the lab request has been adjudicated, and
- transmitting, by the communications interface, the lab instructions associated with the lab request to one laboratory of the plurality of medical laboratories for performance of the lab instructions, and
- wherein denying the lab request comprises transmitting, by the communications interface, a lab request denial to the lab request initiator, the lab request denial indicating that the lab request needs to be revised.
A computer program product is provided comprising a non-transitory computer readable medium having computer program instructions stored therein, said computer program instructions when executed by a processor provide centralized management of medical tests across a plurality of medical providers, a plurality of lab payers, and a plurality of laboratories, by causing the computer program product to:
- receive a lab request from a lab request initiator, the lab request initiator being associated with at least one medical provider of the plurality of medical providers, wherein the lab request comprises an order for one or more medical tests to be performed;
- translate the lab request to a lab code associated with a lab fee, wherein the lab code is specific to the one or more medical tests;
- cause the lab request to be adjudicated;
- and
- approve or deny the lab request based on adjudicating the lab request,
- wherein approving the lab request comprises:
- transmitting the lab fee to one lab payer of the plurality of lab payers,
- generating lab instructions associated with the lab request after the lab request has been adjudicated, and
- transmitting the lab instructions associated with the lab request to one laboratory of the plurality of medical laboratories for performance of the lab instructions, and
- wherein denying the lab request comprises transmitting a lab request denial to the lab request initiator, the lab request denial indicating that the lab request needs to be revised.
Dependencies are inferred from the claim text.