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專利

  

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Select the appointment information from pre-defined menus of appointment information

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Assign a unique appointment identifier code to each scheduled appointment

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FIG. 3

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Automatically populate a database with service information corresponding to claims received in an electronic format from the service

Manually enter into a database service information corresponding to claims received in a non-electronic format from the service providers

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providers

415 V \ Store images of the claims in the database

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420

\ Generate one or more reports based on individuallaggregated service information

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FIG. 4

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Q 505 \ intelligently route the particular received claim from a validation queue to an adjudicator l OR 510 . . ". 530 . . V. . \ Automatically identify already processed \ Automatically identify the candidate claims that correspond to a particular appointments that correspond to a particular received claim based on a degree of similarity received claim between the service information associated 1, Wmthe a_|"eady Processed ‘clams _and the 535 Automatically identify already processed semce '“f"_"mat'°" as_s°°'ate_d Wm‘ the claims that correspond to the particular partlcular recewed clam‘ received claim based on a degree of similarity 515 t between the service information associated Analyze the identified already processed with the a_h'eedY Pfeeessed _"-“aims _ahd the claims to determine if the particular received serwee lhformatloh assoelated with the claim is a duplicate claim Particular received claim 520 j l \ _ I _ f _ 540 Analyze the identified already processed Flag duphcate C anns or resolutlon \ claims to determine if the particular received 525 j laim is a duplicate claim c \ Automatically identify the candidate 545 j appointments that correspond to the particular received claim Flag duplicate claims for resolution FIG. 5

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Route the flagged claim to one or more trouble shooters for resolution

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Compile an audit history of the routing of the flagged claim among the trouble shooters

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Route resolved flagged claims to an adjudicator for expedited validation

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705

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Associate a unique claim identifier code of the particular received claim to a unique appointment identifier code of the candidate appointment that corresponds to the particular received claim

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Review a pricing signature for a service provider corresponding to the particular received claim to verify a payment amount for services rendered by the service provider

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routing of the particular received claim from the time the service information corresponding to particular received claim was captured to the time the particular received claim was presented for payment

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FIG. 7

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