Systems and methods for automated processing and assessment of an insurance disclosure via a network
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United States of America Patent
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N/A
Issued Date -
Apr 19, 2007
app pub date -
Aug 15, 2006
filing date -
Oct 19, 2005
priority date (Note) -
Abandoned
status (Latency Note)
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Abstract
The present invention relates to methods and systems for automated processing and assessment of an insurance disclosure. One embodiment of the invention can comprise an automated disclosure processing application engine. The automated disclosure processing application engine can be adapted to receive health care-related information. Health care-related information, also known as a 'disclosure,' can include, but is not limited to, a medical claim, a precertification notice, prescription drug history, or any other information related to a medical or insurance claim for reimbursement or payment. Health care-related information can be received at any time, such as in real time, a predefined basis, daily, or on a less or more frequent basis. Health care-related information can be stored in a database, such as a AWAC.RTM. database. A portion of the health care-related information can be compared to at least one financial parameter. A portion of the health care-related information can also be compared to at least one clinical parameter. An output can be generated based in part on either the comparison with at least the financial parameter or the clinical parameter.
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