Abstract: Systems and methods for managing medical information for medical service providers are provided. Personnel are able to manage and track workflow operations, evaluate profitability, and maintain records in an integrated and streamlined manner by executing various modules of a software application.

Abstract: A method for managing content is provided. The method may include, by a content management apparatus, receiving a content request, searching for content information associated with the request, and causing writing of missing content information to an alert file. The method may provide default content information when content information is not otherwise located. A content request may comprise an application and context name. A response from a content management apparatus may comprise a location and map identifier used by a calling apparatus to locate and cause display of content. The method may provide synchronization capabilities in which content referenced by an application is searched for in order to track missing content in an alerts file, and to track the synchronization history or status of an application in a synchronization log. Corresponding systems, apparatuses, and computer program products are also provided.

Abstract: Systems and methods may facilitate healthcare provider enrollment with one or more payers. The systems and methods may include receiving identification of a plurality of payers; determining required enrollment information needed for the healthcare provider to enroll for one or more services of the plurality of payers; retrieving or receiving available enrollment information associated with the healthcare provider; determining missing enrollment information based upon a comparison of the required enrollment information and the available enrollment information; and delivering, by the service provider to the healthcare provider computer, a request for the missing enrollment information.

Abstract: Systems and methods are provided for overriding rejections of healthcare claim transactions. A healthcare claim transaction is received by a service provider from a healthcare provider computer and at least one edit is performed on the healthcare claim transaction. A rejection for the healthcare claim transaction is identified based at least in part on the at least one edit, and a message comprising an indication of the rejection is communicated to the healthcare provider computer. A reason for overriding the edit is received at an edit override web server from the healthcare provider computer, and override information for the rejection is generated based at least in part on the receipt of the override reason. The healthcare claim transaction is then reprocessed, and the generate override information is utilized to suppress the at least one edit during the reprocessing of the healthcare claim transaction.

Abstract: Methods, apparatuses, and computer program products are provided for an address system to identify a field and/or a row in a data structure. A method may include receiving a request to modify a field of data, wherein the field of data is identified by a received field key. A method may also include determining whether the field of data was rendered for display. A method may also include modifying the field in a tree structure in an instance in which the field of data was rendered for display, wherein the received field key is configured locate an address object that is related to the field. A method may also include modifying the field of data in a tree structure in an instance in which the field of data was not rendered for display by locating the received field key in a field key lookup map, wherein the field key lookup map is configured to locate the address object.

Abstract: An apparatus is provided for tracking real time metrics in a health care entity. The apparatus includes at least one memory and at least one processor configured to assign one or more predetermined thresholds to one or more medical events. The processor is further configured to track one or more actions of health care professionals associated with at least one of the medical events of a health care entity in real time. The processor is further configured to compare at least one of the predetermined thresholds to a determined value associated with the actions of the medical event to determine whether the medical event is performed efficiently. Corresponding computer program products and methods are also provided.

Abstract: An apparatus is provided for auditing protected health information of one or more patients. The apparatus includes at least one memory and at least one processor configured to detect a query to access information stored in a database including patient-related information. The processor is further configured to save the query in an event file. The processor is further configured to capture query-related information associated with the query and save the query-related information in the event file. The processor is further configured to determine that the query involves protected health information. The processor is further configured to transmit, in response to determining that the query involves protected health information, the query-related information to be used in a reporting table. Corresponding computer program products and methods are also provided.

Abstract: An apparatus is provided for retrieving information associated with one or more patients. The apparatus includes at least one memory and at least one processor configured to receive queries from devices of health care systems. The queries include data requesting information associated with patients that corresponds to specified items of information indicated in the queries. The queries also indicate a predetermined threshold to determine whether the requested information corresponds to respective patients. The processor is further configured to analyze stored patient information to determine items of the patient information that correspond to the specified items of the information. The processor is further configured to detect a subset of the items of the patient information related to health data that is determined to correspond to a respective patient(s) based on a determined value that equals or exceeds the predetermined threshold. Corresponding computer program products and methods are also provided.

Abstract: Systems, methods, apparatus, and computer program products are provided for accessing, navigating, and displaying multiple versions of claims in an efficient and customer-friendly manner. In various embodiments, claims can be processed and stored such that they can be displayed via an interface in a graphical format (e.g., textual, circular, hierarchical, etc.).

Abstract: Systems, methods, apparatus, and computer program products are provided for processing claims. In various embodiments, claims can be processed in accordance with a data-driven approach that limits changes to existing claims processing rules.

Abstract: Systems, methods, apparatus, and computer program products are provided for processing claims. In various embodiments, claims can be processed in accordance with a data-driven approach that limits changes to existing claims processing rules.

Abstract: A method, apparatus and computer program product are provided to facilitate the manipulation of medical images. In the context of a method, the position of a user's hand upon a touch sensitive input device may be determined. Determining the position may include detecting instances in which the user's hand is in either a first or second positions upon the touch sensitive input device. In the first position, the method may also include enabling a first image manipulation mode in which a first image manipulation operation is enabled and interpreting a first type of input to be directing the first image manipulation operation. However, in the second position, the method may include enabling a second image manipulation mode in which a second image manipulation operation is enabled and interpreting the first type of input to be directing the second image manipulation operation instead of the first image manipulation operation.

Abstract: Systems, methods, apparatus, and computer program products are provided for accessing, navigating, and displaying multiple versions of claims in an efficient and customer-friendly manner. In various embodiments, claims can be processed and stored such that they can be displayed via an interface in a graphical format (e.g., textual, circular, hierarchical, etc.).

Abstract: Embodiments of the invention may include systems and methods for notifying a prescriber or other entity of duplicate product prescriptions. According to one embodiment, a method for processing prescriptions is provided that may include the operations of: receiving a healthcare transaction that identifies a current prescribed product, a patient, and a current prescriber who prescribed the current prescribed product; retrieving patient history for the patient; determining the following based on the patient history: that the patient has previously received a previous equivalent product equivalent to the current prescribed product identified in the healthcare transaction and an identity of a previous prescriber of the previous equivalent product; and transmitting a notification to at least one of the previous prescriber or the current prescriber, wherein the notification identifies potential duplicate products.

Abstract: A method, apparatus and computer program product are provided to facilitate the monitoring of the health of a plurality of computerized healthcare systems deployed at a plurality of different sites, such as at various healthcare facilities. In the context of a method, one or more sensor(s) may be identified that are to be downloaded and executed by a plurality of remote servers in order to provide for health monitoring of a computerized healthcare system. The method also receives the results of the health monitoring from the plurality of remote servers and determines a health score for the computerized healthcare system of a respective remote server based upon the results. The method may further cause a technician to be advised of the results and the healthcare score.

Abstract: Systems and methods may be provided for obtaining and providing patient medication history. The systems and methods may include receiving a request for medication history information of a patient, the request including identification information for the patient. At least one memory may be accessed utilizing at least a portion of the identification information, the at least one memory including information associated with pharmacy claims transactions stored in the at least one memory in near real time as the pharmacy claims transactions are processed. Information associated with the medication history of the patient is obtained from the at least one memory and communicated in response to the received request.

Abstract: Methods, apparatuses, and computer program products are provided for facilitating co-morbid care management. A method may include determining a plurality of medical conditions affecting a member enrolled in a care management plan. The method may further include activating, based at least in part upon the determined medical conditions, a plurality of member assessment modules. Each activated member assessment module may be associated with a respective determined medical condition and may comprise a set of assessment questions targeted to the medical condition with which the member assessment module is associated. The method may additionally include generating a blended co-morbid assessment question set based at least in part on the assessment question sets of the activated member assessment modules by blending the assessment question sets of the activated member assessment modules into a blended co-morbid assessment question set. Corresponding apparatuses and computer program products are also provided.

Abstract: Systems and methods are provided for auto-balancing of throughput in a real-time event-driven system. The systems and methods may include identifying a plurality of processing stages for a real-time event-driven system that receives a system-level event and provides a system-level output, wherein processing stages between a first processing stage and a last processing stage are arranged in a sequential order such that a respective output of an earlier processing stage is provided to a respective request queue of a later processing stage; determining a respective number of requests in each request queue of the plurality of processing stages; comparing the respective determined number of requests to at least one threshold to determine that at least one processing stage is over-utilized, and for the at least one processing stage that is determined to be over-utilized, increasing an allocation of hardware resources to the respective over-utilized processing stage.

Abstract: Systems and methods for processing rejected healthcare claim transactions for over-the-counter (“OTC”) products are provided. A healthcare claim transaction associated with a product requested by a customer may be received from a healthcare provider computer. The healthcare claim transaction may be communicated to a claims processor for adjudication, and a denied claim response for the healthcare claim transaction may be received from the claims processor. Based at least in part upon a classification of the product, the denied claim response may be converted to an approved claim response, and the approved claim response may be communicated to the healthcare provider computer. In certain embodiments, the above operations may be performed by one or more computers associated with a service provider.

Abstract: An apparatus is provided that includes a processor and a memory storing executable instructions that in response to execution by the processor cause the apparatus to at least perform a number of functions. The functions include selecting or receiving selection of a multimedia object including an associated identifier, and generating one or more audio tracks of audio tones representing the identifier. The multimedia object is presentable by a computing apparatus, and the audio track(s) collectively form an album for the multimedia object. The functions also include directing a transfer of the album including the audio track(s) to a media player for subsequent playback of the audio track(s). The computing apparatus is configured to pickup the audio tones of the audio track(s) during the playback, interpret the audio tones to identify the multimedia object from the identifier represented by the audio tones, and access and present the identified multimedia object.