Claim Management System for Automated Medical Code Analysis
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Solution Overview
Problem
Individuals with medical conditions face challenges in accessing current and relevant information about treatments, medications, and medical services due to the need to determine appropriate keywords and sift through search results, making it difficult to find valuable information.
Innovation Solution
A system that receives claim data from a health plan server, analyzes it to select medical codes, and displays relevant health content through a graphical user interface, including a claim management interface and information interface, using medical codes such as diagnosis, drug, or service provider codes to facilitate access to accurate information.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Loss of information
If users perform web searches to find medical information, then they can access a wide range of information, but they must determine the right keywords and sift through results to find relevant information
Solution Approach 1:
The system automatically analyzes claim data and provides relevant health content without requiring user intervention to select keywords or search for information. The claim management application performs self-service by autonomously identifying medical codes from claim data and retrieving corresponding health content, eliminating the need for users to manually search and filter information.
Solution Approach 2:
The system introduces an intermediary component (the claim management application) between the claim data and the health information. This intermediary automatically processes claim data, extracts medical codes, and retrieves relevant health content, serving as a mediator that eliminates the need for users to directly search and filter information themselves.
2Ease of operation
If users manually search for medical information, then they can find specific content, but the process requires determining keywords and sifting through search results
Solution Approach 1:
The system performs the entire information retrieval process automatically without user intervention. The claim management application autonomously analyzes claim data, identifies medical codes, searches for relevant health content, and displays results, completely eliminating the manual keyword selection and result filtering process for users.
Solution Approach 2:
The system performs preliminary actions by automatically analyzing claim data and identifying relevant medical information before the user even requests it. The claim management application proactively processes claim data, extracts medical codes, and prepares health content for display, eliminating the need for users to perform keyword selection and result filtering.
3Loss of information
If the system displays all claim data, then complete information is available, but relevant health content may be difficult to locate
Solution Approach 1:
The system extracts only the relevant health content from the complete claim data by automatically identifying medical codes and retrieving corresponding health information. The claim management application separates relevant health content from other claim data and displays it in a dedicated information interface, making it easily locatable while preserving access to complete claim data in the claim management interface.
Solution Approach 2:
The system segments the display into two distinct interfaces: the claim management interface showing complete claim data and the information interface showing extracted relevant health content. This segmentation allows users to access both complete information and easily locate relevant health content by separating them into different display areas.
Data Source
AI summary
A method including receiving claim data corresponding to a subscriber from a health plan server, analyzing the claim data to select a medical code, and displaying health content related to the medical code.