Researchers Submit Patent Application, “Cloud-Based System And Method For Claiming Insurance For Out-Of-Pocket Medical Expenses”, for Approval (USPTO 20220261916): Lemonhealthcare

2022 SEP 07 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- From Washington, D.C., NewsRx journalists report that a patent application by the inventor HONG, Byungjin (Seoul, South Korea), filed on July 9, 2020, was made available online on August 18, 2022.

The patent’s assignee is Lemonhealthcare (Seoul, South Korea).

News editors obtained the following quote from the background information supplied by the inventors: “Indemnity medical insurance is health insurance that guarantees compensation for the actual amount of medical expenses paid by an insured in case of hospitalization or outpatient treatment due to illness or injury. In general, in order to make a claim for insurance, the insured visits a hospital or pharmacy, obtains various types of documentary evidence such as a medical expense bill, a diagnosis, a prescription, and a prescription medicine expense receipt, and then transmits the documentary evidence to the insurer via fax or email.

“As described above, in order to claim indemnity medical insurance, it is required to obtain documentary evidence from a medical institution, fill out a claim required by the insurer, and file a claim with the insurer. However, due to the complicated and inconvenient procedure, many insurers do not claim the insurance even though they are entitled to receive insurance premium according to the insurance contract when small medical expenses incur.

“In addition, there is a demand for simplification of the medical insurance claim process because issuance of various types of documentary evidence increases unnecessary workload and wasteful use of paper in medical institutions and an input error of claim data can happen in insurers.

“As a related art, there is Korean Patent Application Publication No. 10-2016-0069684 (titled FINANCIAL INSTITUTION SERVER AND AUTOMATIC INSURANCE REQUESTING METHOD THEREOF), but this related art merely discloses a technology for claiming insurance premium by photographing a medical expense bill and analyzing an image thereof.”

As a supplement to the background information on this patent application, NewsRx correspondents also obtained the inventor’s summary information for this patent application: “An objective of the present disclosure is to provide a system and a method for transmitting EDI data including an electronic signature of a medical institution to a cloud server and transmitting the EDI data to an insurer so that insurance is claimed easily.

“A systematic standard procedure for respective processes of individual medical institutions and insurers may be introduced, and there may be provided a cloud-based indemnity medical insurance claiming system and method capable of extracting medical treatment information as EDI data through calculation of a standardized API, regardless of a DBMS and a development language of a corresponding medical institution server, thereby effectively enabling insurance claim in a cloud computing environment.

“Another objective of the present disclosure is to simplify a process using a mobile device.

“In an existing processing method, there was a procedure in which a user prints and submits documentary evidence to an insurer, and the insurer also inputs claimed data. However, according to an embodiment of the present disclosure, it is possible to transmit electronically-signed original data in the form of EDI or electronic document to a cloud-based system through a mobile terminal of a user, without the existing processes for printing and inputting documentary evidence.

“In addition, indemnity insurance claim data transmitted to the cloud may be transmitted to an individual insurer through a specialized communication method and JavaScript Object Notation (JSON) by opening a virtual private network.

“Yet another objective of the present disclosure is to accurately claim information issued by a medical institution to an insurer. It is possible to transmit medical treatment information of a person (patient) as it is to an insurer through authentication of electronically-signed original data, authentication of a user terminal, and an app forgery/falsification preventing technology.

“In an aspect, a cloud-based indemnity medical insurance claiming method is provided, and the method includes: requesting, by a cloud server, claim data such as medical treatment details from a medical institution server when a request to claim indemnity medical insurance is received from a user terminal; extracting, by the medical institution server, patient information and medical treatment information stored in an EMR DB, and mapping, by an API builder, the medical treatment information according to a unique AP; and authenticating, by the medical institution server, the mapped medical treatment information through an electronic signature of a medical institution, encrypting the mapped medical treatment information, and transmitting EDI data including the medical treatment information to the cloud server.

“In another aspect, a cloud-based indemnity medical insurance claiming system is provided, and the system includes: a cloud server configured to request indemnity medical insurance claim from a medical institute server when a request to claim indemnity medical insurance is received from a user, to generate at least one of a receipt, a diagnosis, a prescription, a prescription medicine expense receipt, and a detailed medical expense bill when EDI data including medical treatment information is received from the medical institute server, and to delete the EDI data when insurance premium receipt information is confirmed by a user terminal; the medical institute server configured to extract patient information and medical treatment information from an EMR DB when a request to claim indemnity medical insurance is received from the cloud server, and to map the medical treatment information through an API builder using a unique API, wherein the API builder authenticates the mapped medical treatment information through an electronic signature of a medical institute, encrypts the medical information, and transmits EDI data including the encrypted medical information to the cloud server; and an insurer server configured to calculate insurance premium based on an insurance contract with a patient when the EDI data including the medical information is received from the cloud server, and to request medical treatment details from the could server, wherein the clouds server receives a request to confirm whether a claim is made for unclaimed details by checking the medical information, and the insurer server requests confirmation of personal information regarding the unclaimed details.

“According to the present disclosure, it is possible to develop EDI data for insurance claim, regardless of a heterogeneous DBMS of a medical institution server and a type of development language, through a standardized API.

“In addition, according to the present disclosure, it is possible to inquire insurance subscription details for each insurer with which a contract is made with an individual using a user terminal.

“In addition, according to the present disclosure, it is possible to inquire and make an indemnity medical insurance claim conveniently regardless of time and place using the user terminal, thereby improving user convenience.

“In addition, it is possible to increase the processing efficiency through computerization of data input for the indemnity medical insurance claim.”

The claims supplied by the inventors are:

“1.-11. (canceled)

“12. A cloud-based indemnity medical insurance claiming method comprising: requesting, by a cloud server, claim data such as medical treatment details from a medical institution server when a request to claim indemnity medical insurance is received from a user terminal; extracting, by the medical institution server, patient information and medical treatment information stored in an EMR DB, and mapping, by an API builder, the medical treatment information according to a unique AP; and authenticating, by the medical institution server, the mapped medical treatment information through an electronic signature of a medical institution, encrypting the mapped medical treatment information, and transmitting EDI data including the medical treatment information to the cloud server.

“13. The cloud-based indemnity medical insurance claiming method of claim 12, converting, by the cloud server, at least one of a receipt, a diagnosis, a prescription, a prescription medicine expense receipt, and a detailed medical expense bill according to an insurer-specific structure based on the EDI data; wherein the method further comprises inquiring, by the cloud server, with an insurer server of an insurer selected by a user whether there is an insurance contract made between the user and the insurer.

“14. The cloud-based indemnity medical insurance claiming method of claim 13, further comprising: when an inquiry as to whether there is an insurance contract made between the user and the insurer is received from the cloud server, performing, by the insurer server, authentication based on user information stored in the insurer server and transmitting an authentication result to the cloud server; and calculating, by the insurer server, insurance premium based on an insurance contract with the user by receiving EDI data including medical treatment information from the cloud server.

“15. The cloud-based indemnity medical insurance claiming method of claim 14, further comprising: requesting, by the insurer server, the medical treatment details from the cloud server, and requesting, by the cloud server, confirmation whether to a claim is made for unclaimed details by checking the medical treatment information; and checking, by the insurer server, account information and requesting confirmation of personal information regarding the unclaimed details.

“16. The cloud-based indemnity medical insurance claiming method of claim 12, wherein in the converting of the medical treatment information by the API builder, a data source is generated, and repetitive verification is performed after simple writing through a SQL query writing guide and mapping to standard data through API builder

“17. A cloud-based indemnity medical insurance claiming system comprising: a cloud server configured to request indemnity medical insurance claim from a medical institute server when a request to claim indemnity medical insurance is received from a user, to generate at least one of a receipt, a diagnosis, a prescription, a prescription medicine expense receipt, and a detailed medical expense bill when EDI data including medical treatment information is received from the medical institute server, and to delete the EDI data when insurance premium receipt information is confirmed by a user terminal; the medical institute server configured to extract patient information and medical treatment information from an EMR DB when a request to claim indemnity medical insurance is received from the cloud server, and to map the medical treatment information through an API builder using a unique API, wherein the API builder authenticates the mapped medical treatment information through an electronic signature of a medical institute, encrypts the medical information, and transmits EDI data including the encrypted medical information to the cloud server; and an insurer server configured to calculate insurance premium based on an insurance contract with a patient when the EDI data including the medical information is received from the cloud server, and to request medical treatment details from the could server, wherein the clouds server receives a request to confirm whether a claim is made for unclaimed details by checking the medical information, and the insurer server requests confirmation of personal information regarding the unclaimed details.

“18. The cloud-based indemnity medical insurance claiming method system of claim 17, wherein the API builder comprises: a generation module configured to receive the patient information and the medical treatment information from the EMR DB to generate a data source; and a SQL writing module configured to write a SQL query and transmit the SQL query to a test module.

“19. The cloud-based indemnity medical insurance claiming method system of claim 17, wherein the cloud server comprises an EDI data storage, wherein when EDI data is received from a hospital server, the EDI data storage temporarily stores the EDI data, and when insurance premium receipt information is received from a user terminal, the EDI data storage deletes the EDI data stored therein.

“20. The cloud-based indemnity medical insurance claiming method system of claim 17, wherein the insurer server comprises: an insurance premium calculating unit configured to calculate insurance premium based on an insurance contract with a patient based on the EDI data; and a checking unit configured to check account information and insurance claim input information.

“21. The cloud-based indemnity medical insurance claiming method system of claim 20, wherein the cloud server further comprises a checking unit configured to check the account information or the insurance claim input information.

“22. The cloud-based indemnity medical insurance claiming method system of claim 17, wherein when a request to claim indemnity medical insurance upon completion of medicine payment is received from the user terminal, the cloud server receives EDI data including medical treatment and prescription information from a pharmacy server, and generates at least one of a prescription and a prescription medicine expense receipt, wherein the cloud server deletes the EDI data when insurance premium receipt information is confirmed by the user, wherein when the EDI data including medical treatment and prescription information is received from the cloud server, the insurer server calculates insurance premium based on an insurance contract with a patient and requests medical treatment and prescription details from the cloud server, wherein the cloud server receives a request to confirm whether a claim is made for unclaimed details by checking the medical treatment and the prescription details and the insurer server requests confirmation of personal information regarding the unclaimed details by checking account information.”

For additional information on this patent application, see: HONG, Byungjin. Cloud-Based System And Method For Claiming Insurance For Out-Of-Pocket Medical Expenses. Filed July 9, 2020 and posted August 18, 2022. Patent URL: https://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PG01&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.html&r=1&f=G&l=50&s1=%2220220261916%22.PGNR.&OS=DN/20220261916&RS=DN/20220261916

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