Abstract: A method and system of submitting healthcare claims for adjudication at the point of service is provided. The system provides methods and secure central storage for providers of healthcare services to maintain user created and maintained patient lists, provider location lists, and superbill forms for healthcare claims submission according to the user's unique and individual requirements. The system transmits completed healthcare claims while protecting patient privacy, and provides real-time adjudication of the claims, giving an almost instantaneous claim result in the form of a patient summary receipt back to the point of service at the healthcare provider's location. This is achieved through a real-time interface with the enterprise server claims adjudication engine. Customized lists and superbill forms as required by the individual user are also stored on the enterprise server.

Abstract: An information collection and processing system and related automated method for use by an organization providing health care to a given population. The system includes an arrangement for storing information relating to a plurality of contractual relationships existing between the organization, a plurality of health care providers, and a plurality of payors. The storage arrangement also includes information relating to a plurality of patients in the given population, and information relating to transactions between the organization, providers and the payors.

Abstract: A method and system for enabling a service provider to file insurance claims electronically directly with the payer rather than through a clearinghouse. The system has two components interacting with an existing practice management system of a service provider and with online claim filing systems of insurance payers. The first is a software application installed on the service provider's computer to seek out billing information and create files suitable for filing of formatted claims with the payer's web sites. The second component is a web portal that interacts with both the first component and the payers' web sites to keep the former with formatting requirements and to facilitate filing of the claims electronically. The system uses a software “cookie” to convey instructions to the first component so that it can automatically connect to the appropriate page of each payer's web site.

Abstract: An information collection and processing system and related automated method are provided for use by an alliance of organizations providing health care to a given population. The system includes an arrangement for storing information relating to a plurality of contractual relationships existing between the alliance of organizations, a plurality of health care providers, and a plurality of payors (e.g., insurance companies). The storage arrangement also includes a portion for storing information relating to a plurality of patients in the given population, and another portion for storing information relating to transactions between the alliance, the providers and the payors.

Abstract: A computerized arrangement for detecting potentially fraudulent suppliers or providers of goods or services includes a processor, a storage device, an input device for communicating data to the processor and storage device, and an output device for communicating data from the processor and storage device. The storage device includes a claims data file for storing information relating to a plurality of claims submitted for payment by a selected supplier or provider, one or more encoding lookup tables for use with the claims data file to produce an encoded claims data file, and a neural network program for analyzing the encoded data to produce an indicator of potentially fraudulent activity. The indicator may be compared to a predetermined threshold value by the apparatus or method to identify fraudulent suppliers. In addition to the neural network, at least one expert system may be used in the identification process.