“System And Method For Connecting Patients, Medical Service Providers, And Medical Insurance Providers” in Patent Application Approval Process (USPTO 20210183505)

2021 JUL 06 (NewsRx) -- By a News Reporter-Staff News Editor at Hospital & Nursing Home Daily -- A patent application by the inventor VELAGA, Krishna (East Brunswick, NJ, US), filed on February 3, 2021, was made available online on June 17, 2021, according to news reporting originating from Washington, D.C., by NewsRx correspondents.

This patent application is assigned to Orbit Healthcare Inc. (East Brunswick, New Jersey, United States).

The following quote was obtained by the news editors from the background information supplied by the inventors: “Receiving medical treatment is not a simple task. Both before and after a medical procedure is performed, there is information that must be communicated between the patient, the healthcare provider(s), and any relevant third parties, such as insurance companies. Each of these parties requires information from the other two to ensure that a correct procedure is performed, and that the procedure can be properly paid for.

“From the standpoint of patients, there exists various websites that enable users to search for healthcare providers, but these websites offer a way for the patients to communicate with the providers. There are multiple portals, websites, etc. that patients have to go through in order to both discuss issues with their healthcare providers and to determine if their insurance covers any procedures that are to be performed. This lack of easily accessible communicative means thus makes it difficult to exchange any pre-visit documentation without having to carry every required document and complete waiting room forms.

“From the standpoint of healthcare providers, the lack of pre-visit communication with the patients decreases efficiency at doctors’ offices, causes delays in appointments, and thus increase their cost of operating their practices.

“From the standpoint of third party players, such as insurance companies, there is a lack of visibility into provider services from the patient’s point of view until a claim adjustment is complete. This can lead to fraudulent claims.

“For at least these reasons, there is a need for a system and method for managing healthcare information that enables all of these parties to adequately interact with one another.

“Examples of related art are described below:

“U.S. Pat. No. 7,188,151 pertains to a system and method for network-based monitoring of physiological data. At least one patient-side device collects physiological data from a patient. A provider-side device receives the data from at least one patient-side device via a wide area network. An engine communicates with at least one patient-side device and the provider-side device. The engine manages transmission of the data from the patient-side device to the provider-side device.

“U.S. Pat. No. 7,752,060 pertains to an Internet-based system that involves a database and search capabilities for connecting patients with healthcare providers, e.g., physicians, hospitals, nursing homes, treatment facilities, etc., and further enables such providers to reach patients with whom they may not otherwise come into contact. A patient may access the healthcare provider information through a search conducted using a search engine, such as Google, Yahoo, etc. Alternatively, a patient may access the company Web site’s predetermined Web page that provides search capabilities on its database. A patient may research a healthcare provider based on criteria specified by the patient. Information provided to the patient may be in the form of a report, profile, ratings, etc., including patient-provided information, physician-verified information, and information verified by an independent third party. The verified information and ratings provided by the Web site enable patients to differentiate among healthcare providers and thereby select the provider that best meets their individual needs.

“U.S. Pat. No. 8,719,052 pertains to an Internet-based system that involves a database and search capabilities for connecting patients with healthcare providers, e.g., physicians, hospitals, nursing homes, treatment facilities, etc., and further enables such providers to reach patients with whom they may not otherwise come into contact. A patient may access the healthcare provider information through a search conducted using a search engine, such as Google, Yahoo, etc. Alternatively, a patient may access the company Web site’s predetermined Web page that provides search capabilities on its database. A patient may research a healthcare provider based on criteria specified by the patient. Information provided to the patient may be in the form of a report, profile, ratings, etc., including patient-provided information, physician-verified information, and information verified by an independent third party. The verified information and ratings provided by the Web site enable patients to differentiate among healthcare providers and thereby select the provider that best meets their individual needs.

“U.S. Patent Application No. 2002/0123909 pertains to methods to allow for patient/consumers to collect, store, organize, password protect, and share personal health, medical, dental, and pharmacy data without regard to healthcare provider systems are provided. Application software necessary for complete functionality is contained on a portable, pocket sized, re-write enabled compact disk. Application software necessary for providers (doctors, dentists, hospitals, pharmacies) to view, print, and modify data points is contained on the compact disk. Communication software for the automatic updating of patient information by provider billing/management systems is contained on the compact disk. All software functions necessary for the user/patient and providers to collect, store, update, organize, and share patient information is contained within the application software imbedded on the compact disk. The compact disk therefore is the medium for consumers to collect, organize, store, and share their patient information with providers authorized by the consumer thus optimizing the health history information available to providers. Providing this information to care givers at the time of service serves to improve care and protect the consumer from endangerment due to lack of health history information, care conflicts, and/or drug-drug interactions. Consumer/patient control of access to the application further serves to protect against breech of privacy and confidentiality.

“U.S. Patent Application No. 2002/0128883 pertains to a system and method for on-line collaboration and advanced management of insurance claims with the direct sharing of claim data and information in real time. Information and data is shared between insurers and service providers and any other parties deemed necessary for enhanced resolution of the claim.

“U.S. Patent Application No. 2002/0169638 pertains to an integrated, electronic patient record system and method for providing real time point of care evaluation, management, testing, data entry, billing, and treatment via wireless, paperless medical care processing. The system includes automatic data entry from clinical equipment, structured and non-structured examination protocol templates, synoptic patient chart view, cross-linked billing and diagnosis, digital generation of medical claims, point of care data entry and laboratory results. The present invention facilitates the generation of computerized prescriptions and transfer of same and/or electronic medical records to the patient or other medical entity for which the patient has provided consent where required.

“U.S. Patent Application No. 2003/0028402 pertains to a method and system for electronically maintaining medical records and to facilitate availability and use of information relating to patients, as well as other information used in the operation of a medical facility. The system stores information such as patient charts, medical histories of patients, insurance information, including documentation requirements of insurance companies, timelines for calendaring events, and dictionaries of commonly or repetitively used information. The system permits inputting of information relating to a patient encounter or appointment with a patient and inputting information on business related contacts, including information on patients, pharmacies, physicians and insurance companies. The system further facilitates tracking of patients and their medical status, prescription writing, printing of reports, and preparation of insurance forms, including electronic claim forms.

“U.S. Patent Application No. 2004/0006496 pertains to a system and method for monitoring and managing, in real-time, interactions between a healthcare provider, a patient and an insurer is disclosed. The system and method comprises of a virtual or electronic waiting room. Management and monitoring of patient interactions and transactions is achieved by storing attributes associated with a patient and linking these attributes to a virtual representation of the patient, which may be accessed and manipulated via the electronic or virtual waiting room.

“U.S. Patent Application No. 2004/0210458 pertains to methods and platforms for enhancing collaboration and communication between a patient and his healthcare team. A personal health record is created for a patient and maintained by a service provider. The health record is updated with self-monitored or remote device readings. These readings are sent, in a secure format that insures patient privacy, to the service provider and inserted into a health record via a computer connected to the Internet or via a telephone line without the use of a computer, i.e., by directly connecting an intermediate device to a phone outlet. Other health and wellness data may be written to the health record via a computer or via conventional means. Personal health records are created with minimal effort from healthcare professionals and patients. Third-party companies in the healthcare industry, such as insurance companies and pharmaceutical companies, can sponsor programs encouraging the creation of personal health records and, in turn, receive depersonalized summary information from the service provider to study healthcare trends. By enhancing collaboration between patients and their healthcare teams, patients are more likely to improve their health conditions, particularly chronic conditions, and reduce healthcare costs.”

There is additional background information. Please visit full patent to read further.”

In addition to the background information obtained for this patent application, NewsRx journalists also obtained the inventor’s summary information for this patent application: “According to an embodiment of the present invention, a method is provided for managing healthcare information. The method includes the steps of: storing, in a memory, a database of a plurality of healthcare providers and a database of one or more users; enabling a user, using a graphical user interface, to search the database of the plurality of healthcare providers; receiving, from the user, using the graphical user interface, one or more search parameters; returning, to the user, a list of all healthcare providers that satisfy the search parameters; selecting, using the graphical user interface, a healthcare provider, from the list of healthcare providers that satisfy the search parameters, as a primary healthcare provider; storing, in the memory, a patient care history of the user; enabling remote access to the patient care history by the user, the primary healthcare provider, and a third party player using a data retrieval computer application; and enabling communication between the user, the primary healthcare provider, and the third party player using the data retrieval computer application.

“According to another embodiment of the present invention, a system is provided for managing healthcare information. The system includes a memory configured to store a data retrieval computer application, a database of a plurality of healthcare providers, a database of one or more users, and a patient care history for each user. The system further includes a graphical user interface. The system additionally includes a processor configured to run the access the data retrieval computer application, the database of a plurality of healthcare providers, and the database of one or more users, wherein when the processor runs the data retrieval computer application, is causes a computing device to: enable a user, using the graphical user interface, to search the database of the plurality of healthcare providers; receive, from the user, using the graphical user interface, one or more search parameters; return, to the user, a list of all healthcare providers that satisfy the search parameters; accept, using the graphical user interface, a healthcare provider, from the list of healthcare providers that satisfy the search parameters, as a primary healthcare provider; enable remote access to the patient care history by the user, the primary healthcare provider, and a third party player using a data retrieval computer application; and enable communication between the user, the primary healthcare provider, and the third party player using the data retrieval computer application.

“It is an object of the present invention to provide for the method for managing healthcare information, wherein the search parameters are selected from the group consisting of: medical specialty; name; location; phone number; provider type; languages spoken; and type of insurance accepted.

“It is an object of the present invention to provide for the method for managing healthcare information, wherein the database of the plurality of healthcare providers includes identifiable information pertaining to each of the plurality of healthcare providers selected from the group consisting of: medical specialty; name; location; phone number; provider type; languages spoken; and type of insurance accepted.

“It is an object of the present invention to provide for the method for managing healthcare information, wherein the database of the one or more users includes identifiable information pertaining to each of the plurality of users selected from the group consisting of: name; address; phone number; insurance type; billing information; employer; languages spoken; and medical history.

“It is an object of the present invention to provide for the method for managing healthcare information, wherein the third party player is an insurance provider.

“It is an object of the present invention to provide for the method for managing healthcare information, further including coordinating between the primary healthcare provider and the insurance provider, using the data retrieval computer application, to determine an insurance eligibility of the user for one or more medical procedures.

“It is an object of the present invention to provide for the method for managing healthcare information, further including enabling remote access to the user’s insurance information and employment information to the user, the primary healthcare provider, and the insurance provider to facilitate determination of insurance eligibility.

“It is an object of the present invention to provide for the method for managing healthcare information, further including enabling remote access to the user’s insurance information and employment information to the user, the primary healthcare provider, and the insurance provider to facilitate payment of one or more medical procedures.

“It is an object of the present invention to provide for the method for managing healthcare information, wherein the database of one or more users includes a profile for each user.

“It is an object of the present invention to provide for the method for managing healthcare information, wherein the profile for each user includes any medical claims for that particular user.

“It is an object of the present invention to provide for the method for managing healthcare information, further including updating the medical claims for a particular user following approval or performance of a medical procedure.

“It is an object of the present invention to provide for the method for managing healthcare information, wherein the profile for each user further includes any outstanding payments due to the insurance provider for any medical procedures.

“It is an object of the present invention to provide for the method for managing healthcare information, further including automatically paying any outstanding balances using billing information provided by the user.

“It is an object of the present invention to provide for the method for managing healthcare information, wherein the enabling communication further includes enabling the user, the primary healthcare provider, and the third party player to communicate using a method selected from the group consisting of: e-mail; text message; video communication; and audio communication.”

The claims supplied by the inventors are:

“1. A method for managing healthcare information, comprising: storing, in a memory, a data retrieval computer application comprising a fraud detection engine, a database of a plurality of healthcare providers, and a database of one or more users, wherein the database of one or more users includes a profile for each user of the one or more users; enabling a user, using a graphical user interface (GUI), to search the database of the plurality of healthcare providers; receiving, from the user, using the GUI, one or more search parameters via the graphical user interface; returning, to the user, a list of all healthcare providers that satisfy the one or more search parameters; selecting, using the GUI, a healthcare provider from the database of a plurality of healthcare providers that satisfy the one or more search parameters as a primary healthcare provider; storing, in the memory, a patient care history of the user; enabling, through the data retrieval computer application, remote access to a centralized information store by the user, the primary healthcare provider, and a third party insurer such that the fraud detection engine is configured to monitor medical claims of the user submitted to the third party insurer, wherein the centralized information store comprises pre-visit identifying documentation for the user; enabling communication between the user, the primary healthcare provider, and the third party insurer using the data retrieval computer application, such that the fraud detection engine is configured to: receive a new medical claim for the user submitted by the third party insurer; transmit, in real-time, a claim verification message to the user for validation; in response to receiving a confirmation of the new medical claim or one or more line items of the new medical claim from the user, marking the new medical claim or the one or more line items of the new medical claim as validated; and transmitting a verification notification of the new medical claim or the one or more line items of the new medical claim to the third party insurer for acceptance; and in response to receiving a dispute of the new medical claim or the one or more line items of the new medical claim from the user, marking the new medical claim or the one or more line items of the new medical claim as disputed; and transmitting an audit notification to the third party insurer regarding the new medical claim or the one or more line items of the new medical claim.

“2. The method as recited in claim 1, wherein the search parameters are predefined, and wherein the search parameters are selected from the group consisting of: a medical specialty, a name, a location, a telephone number, a provider type, languages spoken, and a type of insurance accepted.

“3. The method as recited in claim 1, wherein the database of the plurality of healthcare providers includes identifiable information pertaining to each of the plurality of healthcare providers selected from the group consisting of: a medical specialty, a name, a location, a telephone number, a provider type, languages spoken, and a type of insurance accepted, and wherein the database of the one or more users includes identifiable information pertaining to each of the one or more users selected from the group consisting of: a name, an address, a telephone number, an insurance type, billing information, an employer, languages spoken, and a medical history.

“4. The method as recited in claim 1, further comprising: coordinating between the primary healthcare provider and the third party insurer, using the data retrieval computer application, to determine an insurance eligibility of the user for one or more medical procedures.

“5. The method as recited in claim 1, further comprising: enabling remote access to the user’s insurance information and employment information to the user, the primary healthcare provider, and the third party insurer to facilitate a determination of insurance eligibility.

“6. The method as recited in claim 1, further comprising: enabling remote access to the user’s insurance information and employment information to the user, the primary healthcare provider, and the third party insurer to facilitate payment of one or more medical procedures.

“7. The method as recited in claim 1, wherein the profile for each user of the one or more users includes any medical claims for that particular user, and wherein the method further comprises: updating the medical claims for the user following approval or performance of a medical procedure.

“8. The method as recited in claim 1, wherein the profile for each user of the one or more users includes any outstanding payments due to the third party insurer for any medical procedures performed, and wherein the method further comprises: automatically paying any outstanding balances using billing information provided by the user.

“9. The method as recited in claim 1, wherein the enabling communication between the user, the primary healthcare provider, and the third party insurer using the data retrieval computer application further comprises enabling the user, the primary healthcare provider, and the third party insurer to communicate using a method selected from the group consisting of: e-mail; text message; video communication; and audio communication.

“10. The method as recited in claim 1, further comprising: enabling the user to designate one or more healthcare providers to a favorites list for future viewing.

“11. A system for managing healthcare information, comprising: a memory configured to store a data retrieval computer application comprising a fraud detection engine, a database of a plurality of healthcare providers, a database of one or more users, and a patient care history for each user, wherein the database of one or more users includes a profile for each user of the one or more users; a graphical user interface (GUI); and a processor configured to run the data retrieval computer application and access the database of a plurality of healthcare providers and the database of one or more users, wherein when the processor runs the data retrieval computer application, it causes a computing device to: enable a user, using the GUI, to search the database of the plurality of healthcare providers; receive, from the user using the GUI, one or more search parameters; return, to the user, a list of all healthcare providers that satisfy the one or more search parameters; accept, using the GUI, a healthcare provider, from the plurality of healthcare providers that satisfy the one or more search parameters as a primary healthcare provider; enable remote access to a centralized information store by the user, the primary healthcare provider, and a third party insurer such that the fraud detection engine is configured to monitor medical claims of the user submitted to the third party insurer, wherein the centralized information store comprises pre-visit identifying documentation for the user; enable communication between the user, the primary healthcare provider, and the third party insurer using the data retrieval computer application, such that the fraud detection engine is configured to: receive a new medical claim for the user submitted by the third party insurer; transmit, in real-time, a claim verification message to the user for validation; in response to receiving a confirmation of the new medical claim or one or more line items of the new medical claim from the user, marking the new medical claim or the one or more line items of the new medical claim as validated; and transmitting a verification notification of the new medical claim or the one or more line items of the new medical claim to the third party insurer for acceptance; and in response to receiving a dispute of the new medical claim or the one or more line items of the new medical claim from the user, marking the new medical claim or the one or more line items of the new medical claim as disputed; and transmitting an audit notification to the third party insurer regarding the new medical claim or the one or more line items of the new medical claim.

“12. The system as recited in claim 11, wherein the memory is further configured to store the one or more search parameters, and wherein the one or more search parameters are selected from the group consisting of: a medical specialty, a name, a location, a telephone number, a provider type, languages spoken, and a type of insurance accepted.

“13. The system as recited in claim 11, wherein the database of the plurality of healthcare providers includes identifiable information pertaining to each of the plurality of healthcare providers selected from the group consisting of: a medical specialty, a name, a location, a telephone number, a provider type, languages spoken, and a type of insurance accepted.

“14. The system as recited in claim 11, wherein the database of the one or more users includes identifiable information pertaining to each of the one or more users selected from the group consisting of: a name, an address, a telephone number, an insurance type, billing information, an employer, languages spoken, and a medical history.

“15. The system as recited in claim 11, wherein the processor is further configured to: enable coordination between the primary healthcare provider and the third party insurer using the data retrieval computer application to determine an insurance eligibility of the user for one or more medical procedures.

“16. The system as recited in claim 11, wherein the processor is further configured to: enable remote access to the user’s insurance information and employment information to the user, the primary healthcare provider, and the third party insurer to facilitate a determination of insurance eligibility.”

There are additional claims. Please visit full patent to read further.

URL and more information on this patent application, see: VELAGA, Krishna. System And Method For Connecting Patients, Medical Service Providers, And Medical Insurance Providers. Filed February 3, 2021 and posted June 17, 2021. 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=%2220210183505%22.PGNR.&OS=DN/20210183505&RS=DN/20210183505

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