Patent ID: 8050945
Filing Date: 2011-11-01
Classification: G06Q,G16H

Abstract:
1. One or more computer-storage media having computer-useable instructions embodied thereon for performing a method for adjudicating and reimbursing a care provider for services provided for a clinical event, the method comprising: receiving a transaction including a number of clinical event details electronically documented by a care provider at a point of care for the clinical event for which reimbursement is sought; accessing a first knowledge base comprising a number of evidence-based options for providing medically appropriate care; automatically selecting one or more options based on the clinical event details electronically documented by the care provider at the point of care for the clinical event for which reimbursement is sought; performing analysis of the clinical event details against the selected at least one option to determine the appropriateness of medical care; determining a level of reimbursement for a patient based on the appropriateness of medical care provided to the patient using electronic health record data elements associated with the patient from an electronic health record data store of a central computing system having historical electronic health record data elements received from a plurality of sources and using corresponding clinical event details electronically documented by the care provider at the point of care for the clinical event for which reimbursement is sought; and reimbursing the provider in real-time.