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Health care payment adjudication and review system 원문보기

IPC분류정보
국가/구분 United States(US) Patent 등록
국제특허분류(IPC7판)
  • G06F-015/21
  • G06F-015/42
출원번호 US-0786123 (1991-10-31)
발명자 / 주소
  • Little John P. (Minneapolis MN) McMahon R. Scott (Eden Prairie MN) Gingrich Mark (Downingtown PA) Martin Roleigh H. (Eden Prairie MN)
출원인 / 주소
  • United Healthcare Corporation (Minneapolis MN 02)
인용정보 피인용 횟수 : 261  인용 특허 : 0

초록 ▼

A computerized expert system reviews and adjudicates medical health care payment requests made by physicians to payers, such as insurers, for procedures performed and services and materials rendered to patients in the course of treatment. The system adjudicates a payment request to minimize fraud an

대표청구항 ▼

In a networked computer processing system, a method for using a plurality of historical payment requests stored in a database in the networked computer processing system in the adjudication of one or more current payment requests, the method comprising the computer-implemented steps of: (a) identify

이 특허를 인용한 특허 (261)

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  160. Bonissone, Piero Patrone; Messmer, Richard Paul; Yang, Dan; Pavese, Marc; Patterson, Angela Neff; Mogro-Campero, Antonio; Varma, Anil; Durham, William Michael; Russell, Diane Marie; Subbu, Rajesh Venkat, Process for case-based insurance underwriting suitable for use by an automated system.
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  161. Bonissone, Piero Patrone; Cheetham, William Estel, Process for determining a confidence factor for insurance underwriting suitable for use by an automated system.
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  162. Bonissone, Piero Patrone; Messmer, Richard Paul; Patterson, Angela Neff; Yang, Dan; Pavese, Marc; Subbu, Rajesh Venkat; Aggour, Kareem Sherif, Process for optimization of insurance underwriting suitable for use by an automated system.
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  164. Provost,Wayne A.; Trimble,Ryan M., Processing an insurance claim using electronic versions of supporting documents.
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  165. Wayne A. Provost ; Vaughn C. Cecil ; John W. Kwant, Jr. ; Brian E. Peterson, Provider claim editing and settlement system.
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  166. Melchior, Peter; Meltzer, Lenore, Providing cargo insurance in a full service trade system.
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  167. Koll, Detlef; Polzin, Thomas, Providing computable guidance to relevant evidence in question-answering systems.
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  168. Brown, Stephen J.; Cherry, Julie C.; Clapp, Geoffrey J.; Gunabushanam, Gowthaman, Public health surveillance system.
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  169. Brown, Stephen J., Radio frequency based remote health monitoring.
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  170. Childress,Allen B., Relevance calculation for a reference system in an insurance claims processing system.
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  171. Brown, Stephen J., Remote health monitoring and maintenance system.
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  173. Brown, Stephen James, Remote health monitoring and maintenance system.
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  174. Lites, Barry, Securitization of a commercial transaction.
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  175. Lites, Barry, Securitization of a commercial transaction.
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  176. Adrian,Verne; Broussard,Marie Francoise; Morris,William; Myers,Keith G., System and method for allocating home health services.
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  177. Green, III, W. Thomas; Samples, Johnathan; Colquit, Jason; Gerena, Antonio; Ingram, James T., System and method for analyzing, collecting and tracking patient data across a vast patient population.
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  178. Green, III, W. Thomas; Ingram, James T.; Samples, Johnathan; Schulenburg, Gregory H.; Colquitt, Jason; Felt, Steve, System and method for analyzing, collecting, and tracking quality data across a vast healthcare provider network.
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  179. Meyer, Douglas Clifford; Haynes, Darrel Wayne; Kaag, Matthew Steven; Green, Joshua Willis; Vogel, Donna Louise, System and method for automated processing of claims.
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  180. Wolfe,Brian, System and method for displaying messages using a messages table.
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  181. Borsand, Steven F., System and method for dynamic quantity orders in an electronic trading environment.
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  182. Borsand, Steven F., System and method for dynamic quantity orders in an electronic trading environment.
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  183. Borsand, Steven F., System and method for dynamic quantity orders in an electronic trading environment.
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  184. Bazzani, Rod; Bohnsack, James; Callahan, Martin; Silva-Craig, Milton; Babcock, Kathy; Snitman, Michael, System and method for enhancing and authenticating an insurance eligibility transaction.
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  185. Wolfe,Brian; Spann,Allison W., System and method for externalization of formulas for assessing damages.
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  186. Jones, Gregory; Spann, Allison W., System and method for externalization of rules for assessing damages.
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  187. Curtin, Mary Jo; Reinke, John P.; Bettes, Charles, System and method for facilitating claims processing.
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  188. Ross, Brian Dale; Stegman, Lauren Daniel; Rehemtulla, Alnawaz, System and method for facilitating the pre-publication peer review process.
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  189. Ross,Brian Dale; Stegman,Lauren Daniel; Rehemtulla,Alnawaz, System and method for facilitating the pre-publication peer review process.
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  190. Kimmel,Scott T., System and method for implementing healthcare fraud countermeasures.
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  191. Callas, Constantine, System and method for intelligent management of medical care.
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  193. Santalo, Albert; Sardinas, Ben Andrew; Pacheco, Alan; Stephens, Jihad, System and method for managing account receivables.
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  194. Lefco, Bruce; Brindley, James, System and method for managing payments for health care services.
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  199. Lefco, Bruce; Brindley, James, System and method for managing payments for health care services.
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  200. Ammer, Mary J.; Belcher, Deborah J.; Harold, Monique; Khoury, Esther, System and method for managing the exchange of information between healthcare systems.
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  201. Bair Steven L. ; Meredith Ronald L. ; Tillotson Danny R. ; Inglis Philip, System and method for optimizing behaviorial health care collection.
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  202. Green, III, W. Thomas; Ingram, James T.; Samples, Johnathan; Schulenburg, Gregory H.; Colquitt, Jason; Felt, Steve, System and method for performing medical research across a vast patient population.
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  203. Childress,Allen B.; Jones,Gregory, System and method for processing insurance claims using a table of contents.
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  204. Sultan, Jay; Downs, Howard; Hoerle, Dale, System and method for processing payment bundles.
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  205. Sultan, Jay; Downs, Howard; Hoerle, Dale, System and method for processing payment bundles.
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  206. Robbins, Jr., John J.; Robbins, Sr., John J.; Hoffman, Glen A., System and method for providing a credit card with back-end payment filtering.
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  207. Green, III, W. Thomas; Ingram, James T.; Samples, Johnathan; Schulenburg, Gregory H.; Colquitt, Jason; Felt, Steve, System and method for recruiting patients for medical research across a vast patient population.
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  208. Bair Steven L. ; Meredith Ronald L. ; Tillotson Danny R. ; Inglis Philip, System and method for reporting behavioral health care data.
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  209. Jakstadt, Eric G.; Waterston, Michael L.; Badari, Vasantha; Pfost, Jarrod E., System and method for secure third-party development and hosting within a financial services network.
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  210. Jakstadt, Eric G.; Waterston, Michael L.; Badari, Vasantha; Pfost, Jarrod E., System and method for secure third-party development and hosting within a financial services network.
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  211. Green, III, W. Thomas; Ingram, James T.; Samples, Johnathan; Schulenburg, Gregory H.; Colquitt, Jason; Felt, Steve, System and method for tracking and reporting clinical events across a vast patient population.
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  212. Hoerle, Dale E.; Hensley, Jeffery K., System and method for using a first electronic representation of contract terms for generating a second electronic representation of the contract terms.
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  213. Bonissone, Piero Patrone; Aggour, Kareem Sherif; Subbu, Rajesh Venkat; Yan, Weizhong; Iyer, Naresh Sundaram; Chakraborty, Anindya, System and process for a fusion classification for insurance underwriting suitable for use by an automated system.
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  214. Bonissone,Piero Patrone; Aggour,Kareem Sherif; Subbu,Rajesh Venkat; Yan,Weizhong; Iyer,Naresh Sundaram; Chakraborty,Anindya, System and process for a fusion classification for insurance underwriting suitable for use by an automated system.
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  215. Bonissone, Piero Patrone; Iyer, Naresh Sundaram, System and process for detecting outliers for insurance underwriting suitable for use by an automated system.
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  216. Bonissone, Piero Patrone; Iyer, Naresh Sundaram, System and process for dominance classification for insurance underwriting suitable for use by an automated system.
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  217. Bonissone, Piero Patrone; Messmer, Richard Paul; Subbu, Rajesh Venkat; Yan, Weizhong; Chakraborty, Anindya, System and process for multivariate adaptive regression splines classification for insurance underwriting suitable for use by an automated system.
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  218. Adrian, Verne; Broussard, Marie-Francoise; Morris, William; Myers, Keith G., System for allocating home health services.
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  219. Bonissone, Piero Patrone; Messmer, Richard Paul; Yang, Dan; Pavese, Marc; Patterson, Angela Neff; Mogro Campero, Antonio; Varma, Anil; Durham, William Michael; Russell, Diane Marie; Subbu, Rajesh Venkat, System for case-based insurance underwriting suitable for use by an automated system.
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  220. Hasan, Malik M.; Wallen, J. Dominic; Peterson, John C.; Korpman, Ralph A.; Post, Cindy A., System for communication of health care data.
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  221. Hasan, Malik M.; Wallen, J. Dominic; Peterson, John C.; Post, Cindy A.; Korpman, Ralph A., System for communication of health care data.
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  222. Hasan, Malik M.; Wallen, J. Dominic; Peterson, John C.; Post, Cindy A.; Korpman, Ralph A., System for communication of health care data.
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  223. Hasan, Malik M.; Wallen, J. Dominic; Peterson, John C.; Post, Cindy A.; Korpman, Ralph A., System for communication of health care data.
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  224. Hasan, Malik M.; Wallen, J. Dominic; Peterson, John C.; Post, Cindy A.; Korpman, Ralph A., System for communication of health care data.
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  225. Hasan, Malik M.; Wallen, J. Dominic; Peterson, John C.; Post, Cindy A.; Korpman, Ralph A., System for communication of health care data.
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  226. Hasan, Malik M.; Wallen, J. Dominic; Peterson, John C.; Post, Cindy A.; Korpman, Ralph A., System for communication of health care data.
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  227. Korpman, Ralph A.; Peterson, John C.; Post, Cindy A.; Wallen, J. Dominic; Hasan, Malik M., System for communication of health care data.
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  228. Korpman, Ralph A.; Peterson, John C.; Post, Cindy A.; Wallen, J. Dominic; Hasan, Malik M., System for communication of health care data.
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  229. Bonissone, Piero Patrone; Cheetham, William Estel, System for determining a confidence factor for insurance underwriting suitable for use by an automated system.
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  230. Field Richard G., System for invoice record management and asset-backed commercial paper program management.
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  231. Field,Richard G., System for invoice record management and asset-backed commercial paper program management.
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  232. Haughton John F. ; Merenyi Robert C. ; Harris Jeff ; Sherman Alexander, System for managing applied knowledge and workflow in multiple dimensions and contexts.
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  233. Balogh, Mary, System for processing unpaid healthcare claims.
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  235. Rowe, III, James C.; Williams, Warren K., Systems and methods for alerting pharmacies of formulary alternatives.
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  237. Franklin, Dave; Blanton, Ilene; James, Mary Kay; Moyer, Kevin; Pennente, Kimberly, Systems and methods for decoding payer identification in health care data records.
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  238. Liu, David; Reisz, Sean Daniel; Picard, Thomas A., Systems and methods for determining prescribing physician activity levels.
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  239. Casu, Jennifer Michelle, Systems and methods for facilitating the establishment of pharmaceutical rebate agreements.
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  240. Ball, Sarah Johnston; Coffman, Suzanne Agner; Pinsonneault, Roger George, Systems and methods for look-alike sound-alike medication error messaging.
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  241. Ringold, James Morgan, Systems and methods for monitoring controlled substance distribution.
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  242. Denny, Jr., James McCahill; Bridge, Thomas Craig; Bradley, Kenneth Paul; Edwards, Shawn Kevin, Systems and methods for monitoring the status of medical claims.
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  243. daCosta, Patricia A.; Harris, Sr., Patrick I., Systems and methods for notifying of duplicate product prescriptions.
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  244. Metzger, Michael David; Russell, Diane M.; Perry, Timothy Patrick Jon, Systems and methods for performing data collection.
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  245. Perry, Timothy P. J.; Metzger, Michael David; Russell, Diane Marie; Bryant, Mary Kathryn; Helt, David John, Systems and methods for performing workflow.
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  247. Ringold, James Morgan, Systems and methods for providing notifications of availability of generic drugs or products.
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  248. Kaye, Elizabeth S.; Liggin, Reed; Dennis, John Taylor; Reisz, Sean Daniel; Sauers, Jeffrey Scott; Williams, Jessica Landisman; Smith, Charles David, Systems and methods for providing patient medication history.
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  250. Wiley, II, Joseph Lee; Burkett, Kenneth E., Systems and methods for shifting prescription market share by presenting pricing differentials for therapeutic alternatives.
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  258. Whiting-O'Keefe Quinn, Techniques for estimating charges of delivering healthcare services that take complicating factors into account.
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  259. Kramer,Kevin M.; Gaetjens,Steven C.; Voges,Harold C., Trainable, extensible, automated data-to-knowledge translator.
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