Payer provider connect engine
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United States of America Patent
Stats
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Sep 27, 2022
Grant Date -
Dec 28, 2017
app pub date -
Jun 28, 2016
filing date -
Jun 28, 2016
priority date (Note) -
In Force
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Importance
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Abstract
Systems, methods and computer program products to identify and close gaps in care are provided. Aspects of the present disclosure disclosed and described herein enable a payer may identify gaps in care based on information in the payer database. The payer can send this information to the provider prior to patient scheduling. The scheduling system at the provider can use this information to schedule patients and their medical needs (e.g., medical test, lab tests, imaging tests, etc.) before the next patient appointment. Primary care providers (PCPs) can then be made aware of the gaps in care information, as well as Hierarchical Condition Category (HCC) coding gap information, so they can perform a complete diagnosis using all available clinical data. PCP notes along with the treatment the patient receives can be combined with the RAF (Risk Adjustment Score) shared by the payers to ensure patient is assessed for all relevant conditions during the visit. Payers can then be informed electronically that the gap in care has been closed; the payer can also receive the resultant claims such that correct RAF scores can be computed and HCC coding gaps can be closed.
First Claim
Family
- 15 United States
- 10 France
- 8 Japan
- 7 China
- 5 Korea
- 2 Other
Patent Owner(s)
- VVC HOLDING CORPORATION
International Classification(s)
Inventor(s)
Inventor Name | Address | # of filed Patents | Total Citations |
---|---|---|---|
Aldridge, Saana | Seattle, US | 1 | 1 |
Maddison, Robert | South Burlington, US | 1 | 1 |
Maddox, Donna | Ballwin, US | 2 | 1 |
Rose, Eric | Boston, US | 41 | 1733 |
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