Patent ID: 8655685
Filing Date: 2014-02-18
Classification: G06Q

Abstract:
1. A computer-implemented method for providing information to medical providers regarding rejections of medical reimbursement claims, wherein medical reimbursement claims are submitted electronically from practice management computer systems of a plurality of medical providers to claims processing computer systems of a plurality of insurance payers for payment determinations, wherein an intermediary claim management system is in electronic communication between the practice management computer systems of the plurality of medical providers and the claims processing computer systems of the plurality of insurance payers, comprising the steps of: receiving a medical reimbursement claim at the intermediary claim management system electronically from a practice management computer system of a particular medical provider, wherein the medical reimbursement claim includes data corresponding to an encounter between a patient and the particular medical provider; submitting the medical reimbursement claim electronically from the intermediary claim management system to a claims processing computer system of a particular insurance payer for payment determination; receiving a response at the intermediary claim management system from the claims processing computer system of the particular insurance payer for the medical reimbursement claim; upon determination by the intermediary claim management system that if the response includes one or more claim rejection identifiers relating to specific issues in the medical reimbursement claim identified by the particular insurance payer: providing each associated predefined claim rejection description for the medical reimbursement claim to the particular medical provider, whereby the particular medical provider is able to determine if further action on the medical reimbursement claim is necessary as a function of the specific issues associated with the medical reimbursement claim.