Healthcare Claims System with Centralized Data Pre-population
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Solution Overview
Problem
Current healthcare claim submission systems require re-entry of patient and provider information, leading to errors and increased processing overhead, and lack access to centrally stored information without specialized hardware or software at the point of service.
Innovation Solution
A system allowing registered healthcare providers to authenticate and submit claims via the Internet, with centralized storage of patient and provider data for security and efficiency, enabling real-time adjudication and providing customized provider location lists, patient directories, and superbill forms for accurate claim submission.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If customized claim forms are used by insurers and providers, then claims can be tailored to specific needs, but re-entry of patient and provider information is required and errors increase
Solution Approach 1:
The system pre-populates claim forms with patient and provider information retrieved from centralized databases before the user submits the claim. This preliminary action eliminates the need for manual re-entry of data, thereby maintaining customization capabilities while significantly reducing entry errors and improving reliability.
2Adaptability or versatility
If customized claim forms are used, then specific needs can be met, but processing overhead is increased
Solution Approach 1:
The system performs preliminary retrieval and pre-population of claim data from centralized databases before submission. This automation of data gathering and form preparation significantly reduces manual processing overhead while preserving the ability to customize claims to specific provider and patient needs.
3Reliability
If centralized storage of patient and provider data is implemented, then security is improved and searching efficiency is enhanced, but access without specialized hardware or software is limited
Solution Approach 1:
The system implements a universal web-based interface that allows any user with a standard web browser to access the centralized database securely. This multi-functional approach maintains high security standards while eliminating the need for specialized hardware or software, thereby improving accessibility without compromising data protection.
Data Source
AI summary
A method and system of submitting healthcare claims for adjudication at the point of service is provided. The system provides methods and secure central storage for providers of healthcare services to maintain user created and maintained patient lists, provider location lists, and superbill forms for healthcare claims submission according to the user's unique and individual requirements. The system transmits completed healthcare claims while protecting patient privacy, and provides real-time adjudication of the claims, giving an almost instantaneous claim result in the form of a patient summary receipt back to the point of service at the healthcare provider's location. This is achieved through a real-time interface with the enterprise server claims adjudication engine. Customized lists and superbill forms as required by the individual user are also stored on the enterprise server.