Data processing: financial – business practice – management – or co – Automated electrical financial or business practice or... – Insurance
Reexamination Certificate
2011-01-18
2011-01-18
Sereboff, Neal R (Department: 3626)
Data processing: financial, business practice, management, or co
Automated electrical financial or business practice or...
Insurance
C705S002000, C705S003000
Reexamination Certificate
active
07873528
ABSTRACT:
A method for controlling healthcare claim payment losses including accessing information about a claim after a payer is prepared to pay, but prior to payment, evaluating the information including at least one of determining indications of fraud, validating service coding and editing as indicated, identifying possible payment discounts, and developing analytics indicative of risk for future claims, and providing loss control recommendations based at least partially on the evaluation, prior to paying the claim. Also a loss control system for healthcare claims with a loss control engine and a database in communication with the loss control engine, wherein the loss control engine accesses information about healthcare claims from the database after the claims have been processed for payment and wherein the loss control engine further analyses the claims for potential cost savings and returns a loss control recommendation for each claim to the database before payment of the respective claim.
REFERENCES:
patent: 5359509 (1994-10-01), Little et al.
patent: 5577169 (1996-11-01), Prezioso
patent: 6208973 (2001-03-01), Boyer et al.
patent: 6253186 (2001-06-01), Pendleton, Jr.
patent: 6341265 (2002-01-01), Provost et al.
patent: 6343271 (2002-01-01), Peterson et al.
patent: 6792410 (2004-09-01), Donovan et al.
patent: 6826536 (2004-11-01), Forman
patent: 7359880 (2008-04-01), Abel et al.
patent: 2001/0051919 (2001-12-01), Mason
patent: 2003/0149594 (2003-08-01), Beasley et al.
patent: 2003/0229519 (2003-12-01), Eidex et al.
patent: 2004/0111292 (2004-06-01), Hutchins
patent: 2005/0044357 (2005-02-01), Fano
patent: 2005/0273431 (2005-12-01), Abel et al.
patent: 2006/0217824 (2006-09-01), Allmon et al.
Internet Archive Wayback Machine—TC3Healthcare.com websites as downloaded on Apr. 5, 2010.
Phelan, John L “Pay Incentives to PHysicians for Filing Electronic Claims” Managed Care—Oct. 2003.
Press Release, “MEDInnovation launched as Single Source Solution for medical TPAs, through joint offering” Jun. 2005.
Notification of Transmittal of the International Search Report and the Written Opinion of the Int'l Searching Authority, or the Declaration, PCT/US2006/24860, dated Apr. 23, 2007, 9 pgs.
Bregante George J.
Day Daniel T.
Day Dennis J.
Day Edward R.
Knobbe Martens Olson & Bear LLP
Sereboff Neal R
TC3 Health, Inc.
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