Patent ID: 8533009
Filing Date: 2013-09-10
Classification: G06Q

Abstract:
1. A web-based method for managing insurance claim denials for a plurality of healthcare providers, comprising the steps of: comparing a claim denial of a healthcare provider to a denial status grid comprising a list of denial types and an appeal success rate for each denial type on the list by a review module of a server, wherein said review module provides a recommendation to proceed with or to decline to proceed with an appeal of the claim denial based on the comparison and a patient record associated with said claim denial; determining to proceed with the appeal of the claim denial based on the recommendation; preparing an appeals package comprising an appeals overturn letter and a supporting document in support of said appeal to said claim denial by said review module of said server; submitting said appeals package to an insurer associated with said claim denial by an appeals coordinating module of said server over said communications network to file said appeal to said claim denial; monitoring the progress of said appeal filed with said insurer by a process management module of said server; processing an appeal determination received from the insurer; and determining by an appeals decision matrix module of said server to file a second level appeal when said appeal is denied or partially denied.