Medical event contextualization and error detection system

Abstract

A computer-implemented method is described for contextualizing medical events and detecting errors, for example, in claims data. The method may include receiving medical event data from one or more reporting entities, and converting the received data by normalizing and grouping by provider and by medical event. The converted data is presented to the subject of the medical event(s), via a user interface (UI). The UI includes one or more interactive graphical elements (e.g., virtual buttons) each configured to provide feedback on specific aspects of the converted data for the medical event. Based on input from the subject via the UI, it is determined whether the subject believes the received data is correct. If the data is indicated to be incorrect, further investigation may be triggered, and the payor and / or reporting entity may be alerted.

Description

CROSS-REFERENCES[0001]The following applications and materials are incorporated herein, in their entireties, for all purposes: U.S. Provisional Patent Application Ser. No. 62 / 913,453, filed Oct. 10, 2019.FIELD[0002]This disclosure relates to systems and methods for detecting medical billing errors. More specifically, the disclosed embodiments relate to systems and methods for verifying the authenticity of medical events through medical claims and patient feedback.INTRODUCTION[0003]Explanations of Benefits (EOBs) and reported services utilize required codes which are difficult to understand for some patients. As such, patients may experience issues comprehending their EOB with service information, making medical billing errors even more difficult to detect and / or verify individually by the patient.SUMMARY[0004]The present disclosure provides systems, apparatuses, and methods relating to detection of medical event errors.[0005]In some embodiments, a computer-implemented method for con...

AI Technical Summary

Benefits of technology

The present disclosure provides systems, apparatuses, and methods for detecting errors in medical event data. The method involves receiving data from reporting entities, converting the data by normalizing and grouping it, and presenting it to the subject through a user interface. The interface includes interactive graphical elements that provide feedback on specific aspects of the data. The subject can then input through the interface to determine if the data is correct. The system can also include one or more processors, memory, and software programs to automate the detection of errors. The technical effect of this invention is to improve the accuracy and efficiency of detecting medical event errors and improve the reliability of medical data.

Problems solved by technology

Explanations of Benefits (EOBs) and reported services utilize required codes which are difficult to understand for some patients.

As such, patients may experience issues comprehending their EOB with service information, making medical billing errors even more difficult to detect and / or verify individually by the patient.

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