Patent Issued for Secure document exchange portal system with efficient user access (USPTO 11030697)

2021 JUN 25 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- From Alexandria, Virginia, NewsRx journalists report that a patent by the inventors Balasubramanian, Raja (Austin, TX, US), Bankwalla, Viraf (Austin, TX, US), Erard, Mark E. (Reston, VA, US), Monette, Michael C. (Austin, TX, US), Sabri, Mohammad A. (Austin, TX, US), Saunders, Bruce W. (Austin, TX, US), Stockton, Thomas (Austin, TX, US), Vaniderstine, Ryan (Austin, TX, US), filed on February 10, 2017, was published online on June 8, 2021.

The patent’s assignee for patent number 11030697 is Maximus Inc. (Reston, Virginia, United States).

News editors obtained the following quote from the background information supplied by the inventors: “

“Field

“The present invention relates to the field of services and systems that are used to administer and resolve claims. Embodiments of the invention relate to automation of secure exchange of electronic documents over a network related to independent medical review of worker’s compensation claims.

“Description of the Related Art

“Government and business entities that are involved in administering and resolving claims currently need to gather, sort, and/or identify large amounts of data from a variety of different sources. Once all of the necessary data is acquired it must be made available to a variety of different entities and persons with various different interests and goals. Sometimes the goals of different entities requiring access to the data are in opposition to one another. At least some of the data may be confidential and/or privileged and as such only certain groups may be allowed access to certain portions of the data.

“One such example of administering and resolving claims includes independent medical review of worker’s compensation claims in order to provide claims determinations for health insurance payers, workers compensation insurance payers or disability insurance payers. An Independent Medical Review (IMR) process is one in which medical doctors, relying on evidence-based treatment guidelines, have replaced judges as the first level arbiters in resolving disputes over the necessity of recommended medical services. These medical doctors are contracted by an independent review organization, to provide objective, unbiased determinations on what the root cause of the treatment was, whether there is medical necessity, if there was a sentinel event, what was the reason for it, etc.

“The IMR process is one which requires the review of numerous different files from different agencies (e.g., hospitals, doctors, insurance agencies, government agencies, police departments, fire departments, emergency services, attorneys, etc.) by numerous different groups (e.g., doctors, attorneys, insurance agents, etc.). These files and/or reports for even just a single case can number in the thousands of pages of documents.

“As such, electronic files of such documents can be very large (several hundred pages) sometimes taking a long time to download. Physicians spend significant time searching these large documents for just a handful of useful forms. Attorneys and injured workers may resubmit the same documents since they are unsure what information was provided by the claims administrators. These duplicate submissions results in duplicate work-quite often performed by high-cost physicians.

“Also, in files compiled from scanning documents from various sources at various times, documents in the file are very likely to be presented unordered, making it difficult to locate the relevant recent few documents that a physician needs to begin the review. In addition, many documents received in the system are scanned images of paper forms. The images cannot support text searches for key terms like a specific drug or medical condition.”

As a supplement to the background information on this patent, NewsRx correspondents also obtained the inventors’ summary information for this patent: “Systems and methods of providing secure exchange of electronic documents over a network related to independent medical review of worker’s compensation claims, including a secure document exchange portal. Document classification tools and case-level physician review tools, which can be used in conjunction with a secure document exchange portal, are also disclosed.

“In an embodiment, a secure exchange portal system for medical review includes a receiving system. The receiving system first authenticates and then authorizes the user to submit information. The system offers several alternative methods to provide files including web form uploads and web service based submissions. Regardless of which method is employed, the receiving system divides the incoming documents into individual smaller chunks, encrypts each of the chunks, stores them and creates metadata. By subdividing documents into smaller components, the secure exchange portal system can be used by stakeholders to efficiently access select portions of documents of the case, without having to download or access entire document files. The system controls access to each document depending on the authorizations of the user.

“In an embodiment, an automated document classification system for files under medical review includes a classification system implemented on one or more computer systems. A classification mechanism uses an ensemble of classifiers to identify specific information in files (e.g., a request for authorization, a utilization review determination, or a physician’s progress report).

“In an embodiment, a physician’s case-level review tool includes a search mechanism and leverages meta-data from the automated document classification system. The physician search tool provides one or more files having scanned medical records that are associated with a case under review. The file(s) include information classified by the classification mechanism as a pre-defined information type (e.g., a request for authorization, a utilization review determination, or a physician’s progress report). A selection of one or more elements of classified information is received from a physician user. One or more search terms are received from the physician user. The search mechanism performs a search based on the search terms. At least a portion of at least one of the elements of classified information is displayed to the physician user based on the search.

“In some embodiments, a method of secure exchange of information for medical review includes receiving a data stream from at least a first source, wherein the data stream is associated with an independent medical review. In some embodiments, the method may include dividing the received data stream into a plurality of chunks. The method may include encrypting the plurality of chunks.

“In certain embodiments, a method of managing a secure exchange portal system includes creating metadata for each of the stored documents. The metadata may include a block size and an initialization vector. The method may include using metadata to restrict access to some documents in a case to a first group of users. In some embodiments, the document metadata may also be used to restrict access to some case documents to a second set of users. In some embodiments, documents within a case may be restricted from users in both groups, accessible by both groups or accessible by members of one group and restricted to members of the other.

“In some embodiments, the first source comprises at least one paper document converted into an electronic file format. In some embodiments, the metadata comprises coded medical identifiers and/or an encryption key.

“In some embodiments, the method includes administering claims for a worker’s compensation claim using the plurality of chunks. The method may include resolving claims for a worker’s compensation claim using the plurality of chunks.

“In some embodiments, at least one of the plurality of chunks comprises multiple scanned documents. The method may include converting the data stream into a searchable format using character recognition. The method may include compressing the plurality of chunks.

“In some embodiments, the method includes providing a first access portal for a first group and a second access portal for a second group, wherein the first group and the second group are different.

“In some embodiments, users from multiple groups may be able to access the system through the same portal. In such a system, individuals of each group would have access afforded to them appropriate to the group in which they reside.

“While the invention is described herein by way of example for several embodiments and illustrative drawings, those skilled in the art will recognize that the invention is not limited to the embodiments or drawings described. It should be understood, that the drawings and detailed description thereto are not intended to limit the invention to the particular form disclosed, but on the contrary, the intention is to cover all modifications, equivalents and alternatives falling within the spirit and scope of the present invention as defined by the appended claims. The headings used herein are for organizational purposes only and are not meant to be used to limit the scope of the description or the claims. As used throughout this application, the word “may” is used in a permissive sense (i.e., meaning having the potential to), rather than the mandatory sense (i.e., meaning must). Similarly, the words “include”, “including”, and “includes” mean including, but not limited to.

“Various components may be described as “configured to” perform a task or tasks. In such contexts, “configured to” is a broad recitation generally meaning “having structure that” performs the task or tasks during operation. As such, the component can be configured to perform the task even when the component is not currently performing that task. In some contexts, “configured to” may be a broad recitation of structure generally meaning “having a feature that” performs the task or tasks during operation. As such, the component can be configured to perform the task even when the component is not currently on.

“Various components may be described as performing a task or tasks, for convenience in the description. Such descriptions should be interpreted as including the phrase “configured to.” Reciting a component that is configured to perform one or more tasks is expressly intended not to invoke 35 U.S.C. 112 paragraph (f), interpretation for that component.

“The scope of the present disclosure includes any feature or combination of features disclosed herein (either explicitly or implicitly), or any generalization thereof, whether or not it mitigates any or all of the problems addressed herein. Accordingly, new claims may be formulated during prosecution of this application (or an application claiming priority thereto) to any such combination of features. Regarding the appended claims, features from dependent claims may be combined with those of the independent claims and features from respective independent claims may be combined in any appropriate manner and not merely in the specific combinations enumerated in the appended claims.

“It is to be understood the present invention is not limited to particular devices or biological systems, which may, of course, vary. It is also to be understood that the terminology used herein is for describing embodiments only, and is not intended to be limiting. As used in this specification and the appended claims, the singular forms “a”, “an”, and “the” include singular and plural referents unless the content clearly dictates otherwise. Thus, for example, reference to “a linker” includes one or more linkers.”

The claims supplied by the inventors are:

“1. A method of managing a secure exchange portal system for medical review, comprising: receiving a data stream from at least a first source, wherein the data stream includes documents having data for a medical claim being evaluated under a medical review, and wherein the data stream includes at least two documents; dividing the received data stream into a plurality of chunks, wherein the chunks include sets of documents having the data for the medical claim being evaluated; individually encrypting at least two of the plurality of chunks, wherein individually encrypting each of the chunks includes generating one or more encryption keys for each chunk; creating metadata for the at least two documents, wherein the metadata includes data for the encryption keys, wherein creating the metadata includes creating a first set of metadata and a second set of metadata, the first set of metadata being used to restrict access to at least one of the chunks to a first group of users and the second set of metadata being used to restrict access to at least one of the chunks to a second group of users, wherein the first group of users is different from the second group of users, and wherein the first group of users accesses a specific portion of the at least one of the documents using the first set of metadata; and evaluating the medical claim based of the data for the medical claim in at least one of the plurality of chunks.

“2. The method of claim 1, wherein the first source comprises a plurality of paper documents converted into an electronic file.

“3. The method of claim 1, further comprising converting the data stream into a searchable format using character recognition.

“4. The method of claim 1, wherein the metadata further includes coded medical identifiers for the sets of documents having the data for the medical claim being evaluated.

“5. The method of claim 1, wherein the first group of users accesses the at least one of the plurality of chunks using a back-office system through an integration server.

“6. The method of claim 1, wherein evaluating the medical claim includes administering a worker’s compensation claim based on the at least one of the plurality of chunks.

“7. The method of claim 1, wherein evaluating the medical claim includes resolving a worker’s compensation claim based on the at least one of the plurality of chunks.

“8. The method of claim 1, further comprising compressing the plurality of chunks.

“9. The method of claim 1, further comprising providing a first access portal for the first group and a second access portal for the second group.

“10. The method of claim 1, wherein the metadata comprises a block size and an initialization vector.

“11. A secure exchange portal system for medical review, comprising: a receiving system implemented on one or more computer systems, wherein the receiving system receives a data stream from at least a first source, wherein the data stream includes documents having data for a medical claim being evaluated under a medical review, wherein the data stream includes at least two documents, and wherein the receiving system is configured to implement: dividing the received data stream into a plurality of chunks, wherein the chunks include sets of documents having the data for the medical claim being evaluated; individually encrypting at least two of the plurality of chunks, wherein individually encrypting each of the chunks includes generating one or more encryption keys for each chunk; creating metadata for the at least two document, wherein the metadata includes data for the encryption keys, wherein creating the metadata includes creating a first set of metadata and a second set of metadata, the first set of metadata being used to restrict access to at least one of the chunks to a first group of users and the second set of metadata being used to restrict access to at least one of the chunks to a second group of users, wherein the first group of users is different from the second group of users and wherein the first group of users accesses a specific portion of the at least one of the documents using the first set of metadata; and evaluating the medical claim based on the data for the medical claim in at least one of the plurality of chunks.

“12. A non-transitory, computer-readable storage medium comprising program instructions stored thereon, wherein the program instructions, when executed on one or more computers, cause the one or more computers to implement a receiving system configured to: receiving a data stream from at least a first source, wherein the data stream includes documents having data for a medical claim being evaluated under an independent medical review, and wherein the data stream includes at least two documents; dividing the received data stream into a plurality of chunks, wherein the chunks include sets of documents having the data for the medical claim being evaluated; individually encrypting at least two of the plurality of chunks, wherein individually encrypting each of the chunks includes generating one or more encryption keys for each chunk; creating metadata for the at least two documents, wherein the metadata includes data for the encryption keys, wherein creating the metadata includes creating a first set of metadata and a second set of metadata, the first set of metadata begin used to restrict access to at least one of the chunks to a first group of users and the second set of metadata being used to restrict access to at least one of the chunks to a second group of users, wherein the first group of users is different from the second group of users, and wherein the first group of users accesses a specific portion of the at least one of the documents using the first set of metadata; and evaluating the medical claim based on the data for the medical claim in at least one of the plurality of chunks.

“13. The system of claim 11, wherein the receiving system is further configured to implement evaluating the medical claim based on the data for the medical claim in at least one of the plurality of chunks.

“14. The system of claim 11, wherein the receiving system is further configured to implement evaluating the medical claim includes resolving a worker’s compensation claim based on the at least one of the plurality of chunks.

“15. The system of claim 11, wherein the metadata further includes coded medical identifiers for the sets of documents having the data for the medical claim being evaluated.

“16. The system of claim 11, wherein the receiving system is further configured to implement providing a first access portal for the first group and a second access portal for the second group.

“17. The storage medium of claim 12, further comprising evaluating the medical claim based on the data for the medical claim in at least one of the plurality of chunks.

“18. The storage medium of claim 12, further comprising evaluating the medical claim includes resolving a worker’s compensation claim based on the at least one of the plurality of chunks.

“19. The storage medium of claim 12, wherein the metadata further includes coded medical identifiers for the sets of documents having the data for the medical claim being evaluated.

“20. The storage medium of claim 12, further comprising providing a first access portal for the first group and a second access portal for the second group.”

For additional information on this patent, see: Balasubramanian, Raja. Secure document exchange portal system with efficient user access. U.S. Patent Number 11030697, filed February 10, 2017, and published online on June 8, 2021. Patent URL: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=11030697.PN.&OS=PN/11030697RS=PN/11030697

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