Abstract: Disclosed are systems, methods and devices for providing healthcare coverage matching and verification. In some aspects, a method includes receiving, from a frontend graphical user interface (GUI), a healthcare coverage application comprising client demographics that include at least two of the following: a last name, a first name, a birthdate, an identification number, an address and a request type associated with a client, using a parallel matching and verification architecture to determine, based on a first set of criteria, a matching database record from an eligibility database that corresponds to the healthcare coverage application, and communicate with a healthcare provider using electronic data interchange transactions, identify, based on a second set of criteria, a medical policy that corresponds to the matching database record, and verify the medical policy, and transmitting, to the frontend GUI, the medical policy to allow reception of the medical policy by the client.
Type:
Grant
Filed:
April 26, 2021
Date of Patent:
May 21, 2024
Assignee:
Health Management Systems, Inc.
Inventors:
Eric Hallemeier, Deb Grier, Gopi Kolla, Anand Padmanaban, Chris Lolo, Karthik Sundaram, Kevin Nyaribo
Abstract: Disclosed are systems, methods and devices for providing healthcare coverage matching and verification. In some aspects, a method includes receiving, from a frontend graphical user interface (GUI), a healthcare coverage application comprising client demographics that include at least two of the following: a last name, a first name, a birthdate, an identification number, an address and a request type associated with a client, using a parallel matching and verification architecture to determine, based on a first set of criteria, a matching database record from an eligibility database that corresponds to the healthcare coverage application, and communicate with a healthcare provider using electronic data interchange transactions, identify, based on a second set of criteria, a medical policy that corresponds to the matching database record, and verify the medical policy, and transmitting, to the frontend GUI, the medical policy to allow reception of the medical policy by the client.
Type:
Grant
Filed:
November 6, 2018
Date of Patent:
April 27, 2021
Assignee:
HEALTH MANAGEMENT SYSTEMS, INC.
Inventors:
Eric Hallemeier, Deb Grier, Gopi Kolla, Anand Padmanaban, Chris Lolo, Karthik Sundaram, Kevin Nyaribo
Abstract: An internet and/or intranet based database search system and method for conducting searches of highly confidential records such as individual patient medical records and to automate the process of securing required approvals to make such records available to a properly authorized and authenticated requesting party. The system's central premise is that the patient has a fundamental right to the confidentiality of their personal medical records and should control that right through specific, informed consent each time that a party requests to receive them. It reinforces the widely held conception of privacy in general as well as of the sanctity of the doctor/patient relationship by granting the doctor the right, subject to the patient's express permission, to initiate a search request.
Abstract: The present invention provides a system and method for scheduling appointments at any time with a professional, such as a doctor, dentist, veterinarian, or the like, or a professional service, such as a medical testing facility and the like, even when the office of the professional or professional service is closed. The system and method relate to an asynchronous Internet, intranet, and extranet-compatible 24-hour appointment scheduling interface for making such appointments. As such, they support open-standards architecture, provide an interface for proprietary system architecture, permit off-line review and posting, permit access controls and virus protection, allow central scheduling without loss of distributed control, support encrypted messaging to ensure privacy, and include context-sensitive help.
Type:
Grant
Filed:
March 16, 1998
Date of Patent:
February 5, 2002
Assignee:
Allcare Health Management System, Inc.
Inventors:
Desmond D. Cummings, Jr., Robert H. Shelton