Patent Issued for System and user interface for acquisition and storage of patient medical insurance data (USPTO 11232373): Cerner Innovation Inc.

2022 FEB 10 (NewsRx) -- By a News Reporter-Staff News Editor at Hospital & Nursing Home Daily -- According to news reporting originating from Alexandria, Virginia, by NewsRx journalists, a patent by the inventors O’Shea, Daniel P (Downingtown, PA, US), Revak, Nicholas R (Downingtown, PA, US), filed on August 5, 2019, was published online on January 25, 2022.

The assignee for this patent, patent number 11232373, is Cerner Innovation Inc. (Kansas City, Kansas, United States).

Reporters obtained the following quote from the background information supplied by the inventors: “The Administrative Simplification section of the Health Insurance Portability and Accountability Act (HIPAA) 1996 provides standards for the exchange of information via electronic transactions between health care providers and third-parties involved in the financial settlement of health care claims. The reduction in the administrative costs for processing health care claims has not been realized to the extent Congress intended. The reasons for continued high administrative costs in spite of the standardization of the format and content of the information exchanged are many. The reasons include incomplete integration of information. Legacy provider and payer information systems are limited in their ability to process EDI (Electronic Data Interchange) standard compatible transactions automatically. Data integration is likely to be implemented as hospitals, physicians and health care payers upgrade or replace their legacy information systems. The replacement cycle for such systems is a long one, but newer systems are available that improve interoperability and integration of data exchanged by heterogeneous systems.

“Another reason administrative costs have failed to decline is that the anticipated increase in productivity and the resulting decrease in labor costs have been slow to materialize. This is due, in part, to the complexity of the health care payment system, which continues to require human involvement in the medical claims adjudication process. Most hospitals currently use a manual process to enter 35 eligibility response information into their information systems. A manual process is time consuming and prone to keying errors. Some hospitals have attempted to automate insurance eligibility response information data entry via scripting tools. However, the variability of insurance related information received from payer organizations makes comprehensive automation difficult. Hospitals assign different reimbursement plan codes based on information returned by a payer organization, such as a managed care provider name. This data may not be codified and not standardized. This makes text-based comparison difficult. Additionally, exception situations are common and often require human intervention. In some situations, users may need to contact a managed care provider to discuss information returned in a response message. This type of situation makes complete automation difficult. A system according to invention principles addresses these deficiencies and related problems.”

In addition to obtaining background information on this patent, NewsRx editors also obtained the inventors’ summary information for this patent: “A system is integrated with a hospital information system (HIS) to provide patient health insurance information identifying patient medical insurance eligibility coverage by sorting and parsing hatched electronic transaction message data to ensure accurate billing and account follow up. A system acquires patient medical insurance coverage identification data for use in medical reimbursement claim generation. An acquisition processor acquires medical insurance coverage information associating medical insurance coverage identifiers with corresponding patient identifiers for multiple different patients. A display processor initiates generation of data representing at least one display image for presenting an acquired medical insurance coverage identifier and corresponding patient identifier and enabling a user to initiate storage of the medical insurance coverage identifier in a record associated with the patient identifier in a healthcare information system. A communication processor initiates communication of the medical insurance coverage identifier for storage in the record associated with the patient identifier in a healthcare information system in response to a command received using the at least one display image.”

The claims supplied by the inventors are:

“1. A system for acquiring patient medical insurance coverage identification data for use in medical reimbursement claim generation, comprising: a receiving component for receiving a batch of patient insurance eligibility inquiries from at least one requesting organization, the patient insurance eligibility inquiries identifying payer organizations in association with respective individual patient records; a clearinghouse system for: transforming the batch of patient insurance eligibility inquiries from a first data format, compatible with the receiving component, into a second data format, wherein the second data format is one of a plurality of different data formats, compatible with at least one payer organization, for forwarding to the at least one payer organization; forwarding, to the at least one payer organization, the batch of patient insurance eligibility inquiries; receiving at least one response from the at least one payer organization from the forwarded batch of patient insurance eligibility inquiries, the at least one response comprising medical insurance coverage information and associating at least one medical insurance coverage identifier with at least one corresponding patient identifier; transforming the at least one response from the at least one payer organization, from the second data format into the first data format; and returning, to requesting organizations, the at least one response received from the at least one payer organization in the first format; a displaying component for displaying the at least one response from the at least one payer organization into a human readable format and representing the at least one medical insurance coverage identifier as a single display image; and a transferring component for, in response to a command received using an executable operation, automatically storing the at least one medical insurance coverage identifier in a patient record in a healthcare information system without transcribing the at least one medical insurance coverage identifier, wherein the patient record is associated with the at least one corresponding patient identifier, wherein the executable operation is initiated through user selection of at least one display image.

“2. The system of claim 1, wherein the medical insurance coverage information is derived from a database of information compiled by the clearinghouse system.

“3. The system of claim 1, wherein the medical insurance coverage information is received in Electronic Data Interchange (EDI) format transaction messages.

“4. The system of claim 1, further comprising a configuration processor configured to enable a user to configure image elements presented in at least one display image to have a user determined function.

“5. The system of claim 1, wherein the patient record comprises a patient account record that is updated to include the at least one medical insurance coverage identifier in response to the command received using at least one display image.

“6. The system of claim 5, wherein the displaying component employs individual code modules and class modules for providing the at least one display image.

“7. The system of claim 1, further comprising a workflow processor for automatically generating a claim for reimbursement for submission to the at least one payer organization associated with the at least one medical insurance coverage identifier.

“8. The system of claim 1, further comprising a configuration processor configured to read a configuration file at start-up and determine actions taken in response to activation of navigation buttons and associated displayed button labels.

“9. The system of claim 8, wherein the configuration file provides a target application executable code.

“10. The system of claim 1, wherein the transferring component is further configured to communicate a target application executable code to an application.

“11. The system of claim 10, wherein the application is one of a Windows-based application and an application run under a terminal emulation software.

“12. A method for acquiring patient medical insurance coverage identification data for use in medical reimbursement claim generation, the method comprising: receiving a batch of patient insurance eligibility inquiries from at least one requesting organization, the patient insurance eligibility inquiries identifying at least one payer organization in association with at least one patient record; transforming the batch of patient insurance eligibility inquiries from a first data format into a second data format, wherein the second data format is one of a plurality of different data formats, compatible with the at least one payer organization, for forwarding to the at least one payer organization; forwarding, to the at least one payer organization, the batch of patient insurance eligibility inquiries; receiving at least one response from at least one payer organization, the at least one response comprising medical insurance coverage information and associating at least one medical insurance coverage identifier with at least one corresponding patient identifier; transforming the at least one response from the at least one payer organization, from the second data format into the first data format; and returning, to the at least one requesting organization, the at least one response received from the at least one payer organization in the second data format; displaying the at least one response from the at least one payer organization into a human readable format and representing the at least one medical insurance coverage identifier as a single display image; and enabling a user to automatically store the at least one medical insurance coverage identifier in a record associated with the at least one corresponding patient identifier in a healthcare information system without transcribing the at least one medical insurance coverage identifier, in response to a command received using an executable operation, wherein the executable operation is initiated through user selection of at least one display image.

“13. The method of claim 12, wherein the medical insurance coverage information is received in Electronic Data Interchange (EDI) format transaction messages.

“14. The method of claim 12, further comprising enabling the user to configure image elements presented in at least one display image to have a user determined function.

“15. The method of claim 12, wherein the at least one patient record comprises a patient account record that is updated to include the at least one medical insurance coverage identifier in response to the command received using at least one display image.

“16. The method of claim 5, wherein providing the at least one display image further comprises employing individual code modules and class modules.

“17. The method of claim 12, further comprising automatically generating a claim for reimbursement for submission to the at least one payer organization associated with the at least one medical insurance coverage identifier.

“18. A method comprising: storing patient insurance related data in a repository, the patient insurance related data comprising insurance eligibility verification, wherein the repository is accessible by a healthcare information system (HIS); receiving, at the HIS, a request from at least one requesting organization for insurance eligibility verification for at least one patient; determining that, for the at least one patient, the repository lacks the insurance eligibility verification; creating an insurance eligibility inquiry file, wherein the insurance eligibility inquiry file comprises a list including the at least one patient; outputting demographic information for the at least one patient to the insurance eligibility inquiry file; and automatically transferring the insurance eligibility inquiry file to a clearinghouse, wherein the clearinghouse is configured to: process the insurance eligibility inquiry file for forwarding to a plurality of payer organizations and process responses from the plurality of payer organizations for return to the at least one requesting organization; transform the insurance eligibility inquiry file into a standard message format for storage in a clearinghouse database; communicate the insurance eligibility inquiry file to at least one payer organization of the plurality of payer organizations; receive an inquiry response message from the at least one payer organization; store the inquiry response message in a database in the clearinghouse; and transform the inquiry response message in the standard message format from individual payer organizations.

“19. The method of claim 18, wherein the automated transfer of the insurance eligibility inquiry file is conducted via a secure FTP server.

“20. The method of claim 18, wherein the standard message format is an Electronic Data Interchange compatible (EDI) format.”

For more information, see this patent: O’Shea, Daniel P. System and user interface for acquisition and storage of patient medical insurance data. U.S. Patent Number 11232373, filed August 5, 2019, and published online on January 25, 2022. 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=11232373.PN.&OS=PN/11232373RS=PN/11232373

(Our reports deliver fact-based news of research and discoveries from around the world.)