Data processing: financial – business practice – management – or co – Automated electrical financial or business practice or... – Insurance
Reexamination Certificate
2011-03-29
2011-03-29
O'Connor, Gerald J. (Department: 3686)
Data processing: financial, business practice, management, or co
Automated electrical financial or business practice or...
Insurance
C705S002000
Reexamination Certificate
active
07917378
ABSTRACT:
A claim pre-processing system employs trial adjudication to improve claim accuracy prior to claim submission to a healthcare payer institution or other entity. A system processes claim data related to provision of healthcare to a patient The system includes a claim data collator for collating data related to a claim for a particular patient for submission to a payer and a source of rules for use in processing collated claim data. A pre-processor submits the collated claim data for processing using the rules to validate the collated claim data is in condition for processing to initiate generation of payment. A claim processor submits the collated claim data to a payer, in response to successful validation by the pre-processor. A rules processor processes acquired claim data to identify a condition triggering application of a different set of rules for determining validity of an individual claim element. The pre-processor re-submits amended collated claim data for processing using the rules to validate the collated claim data is in condition for processing to initiate generation of payment, the amended collated claim data being received in response to unsuccessful validation using the rules.
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International Search Report.
deNovis, Inc. http://www.denovis. com/product/claims.htm.
FitzGerald David
Hunter John
Klassen, Sr. David Hiebert
Long Greg
Lucas Brian
Burke Alexander J
O'Connor Gerald J.
Rangrej Sheetal R
Siemens Medical Solutions USA , Inc.
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