WO1995003569A3 - Systeme destine a determiner les sources primaire et secondaire de couverture medicale - Google Patents

Systeme destine a determiner les sources primaire et secondaire de couverture medicale Download PDF

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Publication number
WO1995003569A3
WO1995003569A3 PCT/US1994/008012 US9408012W WO9503569A3 WO 1995003569 A3 WO1995003569 A3 WO 1995003569A3 US 9408012 W US9408012 W US 9408012W WO 9503569 A3 WO9503569 A3 WO 9503569A3
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WIPO (PCT)
Prior art keywords
database
coverage
coordination
rules
benefits
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PCT/US1994/008012
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English (en)
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WO1995003569A2 (fr
Inventor
Patrick M Lawlor
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Patrick M Lawlor
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Application filed by Patrick M Lawlor filed Critical Patrick M Lawlor
Publication of WO1995003569A2 publication Critical patent/WO1995003569A2/fr
Publication of WO1995003569A3 publication Critical patent/WO1995003569A3/fr

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    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/02—Banking, e.g. interest calculation or account maintenance

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  • Business, Economics & Management (AREA)
  • Accounting & Taxation (AREA)
  • Finance (AREA)
  • Engineering & Computer Science (AREA)
  • Marketing (AREA)
  • Economics (AREA)
  • Development Economics (AREA)
  • Strategic Management (AREA)
  • Technology Law (AREA)
  • Physics & Mathematics (AREA)
  • General Business, Economics & Management (AREA)
  • General Physics & Mathematics (AREA)
  • Theoretical Computer Science (AREA)
  • Medical Treatment And Welfare Office Work (AREA)
  • Financial Or Insurance-Related Operations Such As Payment And Settlement (AREA)

Abstract

Procédé d'exploitation d'un ordinateur situé dans un hôpital (8), cabinet de médecin (9), laboratoire (10) ou pharmacie (11) permettant d'appliquer les règles concernant la coordination des prestations et des demandes dans le cadre d'une assurance maladie (51). Ledit ordinateur possède une première banque de données (14) contenant un fichier de recensement identifiant toutes les personnes par leur numéro de sécurité sociale ou leur numéro d'identification personnelle ainsi que par leurs régimes de couverture. Une seconde base de données (15) contient des informations sur la nature des régimes de couverture ainsi que sur les règles de coordination des prestations. Lorsqu'une demande est traitée (fig. 2a-2c), elle est d'abord vérifiée en ce qui concerne la personne et son numéro d'identification dans la première base de données (étape 29) pour déterminer tous les régimes selon lesquels la couverture pourrait être obtenue (fig. 2a-2c). Ensuite, la demande est traitée en ce qui concerne la couverture sur la base des informations contenues dans la seconde base de données ainsi que sur la base des règles de coordination des prestations pour déterminer les couvertures primaire et secondaire (étapes 43, 46-49, 51, 53-55). Eventuellement, la demande peut être traitée en vue du paiement selon lesdites couvertures primaire et secondaire (étapes 66-68). Toutes ces déterminations sont ensuite stockées dans une base de données historiques et peuvent être consultées ultérieurement (étape 39).
PCT/US1994/008012 1993-07-16 1994-07-18 Systeme destine a determiner les sources primaire et secondaire de couverture medicale WO1995003569A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US9309293A 1993-07-16 1993-07-16
US08/093,092 1993-07-16

Publications (2)

Publication Number Publication Date
WO1995003569A2 WO1995003569A2 (fr) 1995-02-02
WO1995003569A3 true WO1995003569A3 (fr) 1995-03-16

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Application Number Title Priority Date Filing Date
PCT/US1994/008012 WO1995003569A2 (fr) 1993-07-16 1994-07-18 Systeme destine a determiner les sources primaire et secondaire de couverture medicale

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US8046242B1 (en) 2009-01-22 2011-10-25 Mckesson Financial Holdings Limited Systems and methods for verifying prescription dosages
US8099302B2 (en) 2000-01-21 2012-01-17 The Trizetto Group, Inc. Method of increasing efficiency in a medical claim transaction, and computer program capable of executing same
US8321283B2 (en) 2005-05-27 2012-11-27 Per-Se Technologies Systems and methods for alerting pharmacies of formulary alternatives
US8321243B1 (en) 2010-02-15 2012-11-27 Mckesson Financial Holdings Limited Systems and methods for the intelligent coordination of benefits in healthcare transactions
US8386276B1 (en) 2010-02-11 2013-02-26 Mckesson Financial Holdings Limited Systems and methods for determining prescribing physician activity levels
US8392214B1 (en) 2010-11-30 2013-03-05 Mckesson Financial Holdings Limited Systems and methods for facilitating claim rejection resolution by providing prior authorization assistance
US8538777B1 (en) 2008-06-30 2013-09-17 Mckesson Financial Holdings Limited Systems and methods for providing patient medication history
US8548824B1 (en) 2010-03-26 2013-10-01 Mckesson Financial Holdings Limited Systems and methods for notifying of duplicate product prescriptions
US8566117B1 (en) 2011-06-30 2013-10-22 Mckesson Financial Holdings Systems and methods for facilitating healthcare provider enrollment with one or more payers
US8626525B2 (en) 2008-06-23 2014-01-07 Mckesson Financial Holdings Systems and methods for real-time monitoring and analysis of prescription claim rejections
US8630873B1 (en) 2005-12-08 2014-01-14 Ndchealth Corporation Systems and methods for shifting prescription market share by presenting pricing differentials for therapeutic alternatives
US8635083B1 (en) 2008-04-02 2014-01-21 Mckesson Financial Holdings Systems and methods for facilitating the establishment of pharmaceutical rebate agreements
US8688468B1 (en) 2010-03-30 2014-04-01 Mckesson Financial Holdings Systems and methods for verifying dosages associated with healthcare transactions
US8788296B1 (en) 2010-01-29 2014-07-22 Mckesson Financial Holdings Systems and methods for providing notifications of availability of generic drugs or products

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US8126742B2 (en) 2003-05-09 2012-02-28 Accenture Global Services Limited Automated assignment of insurable events
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US20060111924A1 (en) * 2004-11-24 2006-05-25 Franz Hollich Method and system for warranty claim processing
US7438218B2 (en) 2005-02-28 2008-10-21 Per-Se Technologies Systems and methods for pharmacy reimbursement claim resubmission
US7933786B2 (en) 2005-11-01 2011-04-26 Accenture Global Services Limited Collaborative intelligent task processor for insurance claims
US7840424B2 (en) 2006-02-10 2010-11-23 Ndchealth Corporation Systems and methods for retaining or shifting prescription market share
US7957983B2 (en) 2006-03-31 2011-06-07 Mckesson Specialty Arizona Inc. Healthcare provider, administrator and method for effectuating a medication therapy management, adherence and pharmacosurveillance program
US8744874B2 (en) 2006-04-28 2014-06-03 Ndchealth Corporation Systems and methods for personal medical account balance inquiries
US8489411B1 (en) 2006-06-07 2013-07-16 Ndchealth Corporation Systems and methods for auditing fee calculations associated with claim reimbursement from pharmacy benefit management services
US7792793B2 (en) 2007-04-24 2010-09-07 Kryptiq Corporation Data export/import from multiple data source to a destination data repository using corresponding data exporters and an importer
US7979285B2 (en) 2007-05-03 2011-07-12 Ndchealth Corporation Systems and methods for enhanced min/max edit for drug claim submission verification
US8515786B2 (en) 2008-02-22 2013-08-20 Accenture Global Services Gmbh Rule generation system adapted for an insurance claim processing system
US8478769B2 (en) 2008-02-22 2013-07-02 Accenture Global Services Limited Conversational question generation system adapted for an insurance claim processing system
US8060379B1 (en) 2008-04-13 2011-11-15 Mckesson Financial Holdings Limited Systems and methods for alternate pricing for prescription drugs
US8521557B1 (en) 2008-06-16 2013-08-27 Mckesson Financial Holdings Limited System and methods for processing rejected healthcare claim transactions for over-the-counter products
US8036918B1 (en) 2008-06-16 2011-10-11 McKesson Financial Holdings Ltd. Systems and methods for conversions of denied transactions through patient funding
US7912741B1 (en) 2008-06-30 2011-03-22 Mckesson Financial Holdings Limited Systems and methods for copay adjustments
US8639523B1 (en) 2008-07-13 2014-01-28 Mckesson Financial Holdings Systems and methods for managing a prescription rewards program
US7720697B1 (en) 2008-08-28 2010-05-18 Mckesson Financial Holdings Limited Systems and methods for pharmacy claims-based condition identification proxies
US8386274B1 (en) 2008-09-17 2013-02-26 Mckesson Financial Holdings Limited Systems and methods for a prescription safety network utilizing eligibility verification transactions
US8036913B1 (en) 2008-10-28 2011-10-11 Mckesson Financial Holdings Limited Systems and methods for prescription pre-fill processing services
US8036914B1 (en) 2009-02-19 2011-10-11 Mckesson Financial Holdings Limited Systems and methods for supporting drug or product recalls
US9734541B1 (en) 2009-05-05 2017-08-15 Mckesson Corporation Systems and methods for a healthcare network survey solution
US11080790B2 (en) 2009-09-24 2021-08-03 Guidewire Software, Inc. Method and apparatus for managing revisions and tracking of insurance policy elements
US8560340B1 (en) 2009-11-30 2013-10-15 Mckesson Financial Holdings Limited Systems and methods for overriding rejections of healthcare claim transactions
US8762163B1 (en) 2009-11-30 2014-06-24 Mckesson Financial Holdings Limited Systems and methods for processing healthcare claim transactions that are rejected due to a host error
US8762181B1 (en) 2009-12-31 2014-06-24 Mckesson Financial Holdings Limited Systems and methods for evaluating healthcare claim transactions for medicare eligibility
US8682697B1 (en) 2010-03-25 2014-03-25 Mckesson Financial Holdings Systems and methods for generating edits for healthcare transactions to address billing discrepancies
US8335672B1 (en) 2010-03-26 2012-12-18 Mckesson Financial Holdings Limited Systems and methods for the identification of available payers for healthcare transactions
US8392219B1 (en) 2010-05-10 2013-03-05 Mckesson Financial Holdings Limited Systems and methods for streamlined patient enrollment for one or more healthcare programs
US8244556B1 (en) 2010-06-23 2012-08-14 Mckesson Financial Holdings Limited Systems and methods for generating payor sheets associated with payors for healthcare transactions
US8473598B1 (en) 2011-03-30 2013-06-25 Mckesson Financial Holdings Systems and methods for monitoring and reporting on virtual application delivery
US8983855B1 (en) 2011-05-16 2015-03-17 Mckesson Financial Holdings Systems and methods for evaluating adherence to a project control process
US8756075B1 (en) 2011-05-18 2014-06-17 Trizetto Corporation System and method for processing payment bundles
US8781854B1 (en) 2011-08-12 2014-07-15 Mckesson Financial Holdings Systems and methods for identifying healthcare transactions with a risk of failing to include appropriate directions for use
US10296976B1 (en) 2011-09-23 2019-05-21 Cognizant Trizetto Software Group, Inc. System and method for calculating estimated payment based on partial coding data
US8626529B1 (en) 2011-11-17 2014-01-07 Mckesson Financial Holdings Systems and methods for identifying risk evaluation and mitigation strategies (REMS) compliance
US8650645B1 (en) 2012-03-29 2014-02-11 Mckesson Financial Holdings Systems and methods for protecting proprietary data
US10192193B1 (en) 2012-06-28 2019-01-29 Mckesson Specialty Care Distribution Corporation Systems and methods for improving central pharmacy-type dispensing operations
US9460077B1 (en) 2012-06-29 2016-10-04 Mckesson Corporation Data validation
US10318923B1 (en) 2012-08-01 2019-06-11 Cognizant Trizetto Software Group, Inc. Payment assurance and claim pre-validation
US10489859B1 (en) * 2013-08-29 2019-11-26 Allstate Insurance Company Life insurance clearinghouse
US10417380B1 (en) 2013-12-31 2019-09-17 Mckesson Corporation Systems and methods for determining and communicating a prescription benefit coverage denial to a prescriber
US10489552B2 (en) 2014-02-14 2019-11-26 Mckesson Corporation Systems and methods for determining and communicating patient incentive information to a prescriber
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US10360203B2 (en) 2014-03-31 2019-07-23 Mckesson Specialty Care Distribution Corporation Systems and methods for generating and implementing database audit functionality across multiple platforms
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US10642957B1 (en) 2014-10-21 2020-05-05 Mckesson Corporation Systems and methods for determining, collecting, and configuring patient intervention screening information from a pharmacy
US10496793B1 (en) 2014-12-15 2019-12-03 Mckesson Corporation Systems and methods for determining eligibility in a prescription safety network program
US10423759B1 (en) 2015-01-16 2019-09-24 Mckesson Corporation Systems and methods for identifying prior authorization assistance requests in healthcare transactions
US10157262B1 (en) 2015-03-10 2018-12-18 Mckesson Corporation Systems and methods for determining patient financial responsibility for multiple prescription products
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Cited By (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8099302B2 (en) 2000-01-21 2012-01-17 The Trizetto Group, Inc. Method of increasing efficiency in a medical claim transaction, and computer program capable of executing same
US8738402B2 (en) 2000-01-21 2014-05-27 Trizetto Corporation Medical of increasing efficiency in a medical claim transaction, and computer program capable of executing same
US8321283B2 (en) 2005-05-27 2012-11-27 Per-Se Technologies Systems and methods for alerting pharmacies of formulary alternatives
US8630873B1 (en) 2005-12-08 2014-01-14 Ndchealth Corporation Systems and methods for shifting prescription market share by presenting pricing differentials for therapeutic alternatives
US8635083B1 (en) 2008-04-02 2014-01-21 Mckesson Financial Holdings Systems and methods for facilitating the establishment of pharmaceutical rebate agreements
US8626525B2 (en) 2008-06-23 2014-01-07 Mckesson Financial Holdings Systems and methods for real-time monitoring and analysis of prescription claim rejections
US8538777B1 (en) 2008-06-30 2013-09-17 Mckesson Financial Holdings Limited Systems and methods for providing patient medication history
US8046242B1 (en) 2009-01-22 2011-10-25 Mckesson Financial Holdings Limited Systems and methods for verifying prescription dosages
US8788296B1 (en) 2010-01-29 2014-07-22 Mckesson Financial Holdings Systems and methods for providing notifications of availability of generic drugs or products
US8386276B1 (en) 2010-02-11 2013-02-26 Mckesson Financial Holdings Limited Systems and methods for determining prescribing physician activity levels
US8321243B1 (en) 2010-02-15 2012-11-27 Mckesson Financial Holdings Limited Systems and methods for the intelligent coordination of benefits in healthcare transactions
US8548824B1 (en) 2010-03-26 2013-10-01 Mckesson Financial Holdings Limited Systems and methods for notifying of duplicate product prescriptions
US8688468B1 (en) 2010-03-30 2014-04-01 Mckesson Financial Holdings Systems and methods for verifying dosages associated with healthcare transactions
US8392214B1 (en) 2010-11-30 2013-03-05 Mckesson Financial Holdings Limited Systems and methods for facilitating claim rejection resolution by providing prior authorization assistance
US8566117B1 (en) 2011-06-30 2013-10-22 Mckesson Financial Holdings Systems and methods for facilitating healthcare provider enrollment with one or more payers

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