Method of adjudicating medical claims based on scores that...

Details Method of adjudicating medical claims based on scores that... Method of adjudicating medical claims based on scores that...

2005-04-12

2005-04-12

Thomas, Joseph (Department: 2144)

Data processing: financial, business practice, management, or co

Automated electrical financial or business practice or...

Health care management

C705S004000

Reexamination Certificate

active

06879959

ABSTRACT:
A method of adjudicating a medical claim includes providing a requirements for a first claim and a second claim, receiving a medical claim for a medical procedure, setting a first score for the first claim and a second score for the second claim to an initial value, comparing components of the medical claim to the requirements of the first and second claims, changing the first and second scores for each one of the components that match one of the requirements and for each one of the requirements that is missing from the components, and selecting the first or second claim based upon predetermined criteria applied to their respective scores to determine either a monetary value of the medical procedure for a medical service provider associated with the medical procedure or a monetary value of medical coverage for a patient associated with the medical procedure.

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patent: 20020077854 (2002-06-01), Porterfield
patent: 11242701 (1999-09-01), None
patent: 2001-175724 (2001-06-01), None

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