Devices, systems, and their methods of use for evaluating and processing remuneration claims from third-party obligator

A system for evaluating and processing claims on behalf of a patient receiving health treatments, the system comprising:

• a client computing device having a display coupled therewith, the display for displaying a graphical user interface to a first individual using the client computing device, the graphical user interface for generating an interactive dashboard for presentation via the display, the interactive dashboard configured for presenting a claims interview to the first individual and for receiving responses thereto from the first individual, the claims interview pertaining to a treatment proposed to be administered to a patient in order to treat one or more conditions thereof so as to produce a patient data packet, the client computing device including a communications module for transmitting the patient data packet via an associated network connection;
• a structured database, coupled to the client computing device via a network connection, the structured database containing one or more searchable libraries, each library including data files pertaining to an obligation agreement between the patient and a third-party obligator, the obligation agreement including a set of terms defining a coverage for one or more treatments, the structured database being configured for receiving the data packet from the client computing device;
• a server system coupled to both the structured database and the client computing device via the network connection, the server system for generating a project builder, the project builder for providing the graphical user interface to the client computing device via the network connection for local display thereby, the server system being configured for:
• generating the claims interview for display at the graphical user interface via the interactive dashboard, the client interview including one or more interrogatories that are configured for eliciting one or more responses from the first individual, the one or more responses being used to produce the patient data packet;
• receiving the patient data packet from the interactive dashboard via the network connection and for employing the patient data packet in the creation of an individualistic characteristic profile for the patient, the individualistic characteristic profile including a characterization of one or more conditions of the patient, one or more treatments proposed to be administered to the patient to alleviate the one or more conditions, and one or more terms of the obligation agreement determined to be pertinent to one or more of the conditions of the patient and the one or more treatments proposed to be administered, the one or more proposed treatments having a cost being associated therewith;
• comparing, using the individualistic characteristic profile for the patient, the one or more terms of the obligation agreement with the one or more proposed treatments to be administered to the patient, and determining if there is a conflict between them;
• determining, based on the comparing, a likelihood that the one or more proposed treatments to be administered are covered by the obligation agreement so as to produce a covered procedure plan, and further determining, using the covered procedure plan, a percentage of the cost that is likely be paid for each procedure of the proposed treatment so as to generate a total amount to be reimbursed;
• and
• comparing the one or more proposed treatments to be administered with the total amount to be reimbursed, and authorizing one or more of the proposed treatments to be administered based on the likelihood that the one or more proposed treatments will be covered.