Patent ID: 8311854
Filing Date: 2012-11-13
Classification: G06Q,G16H

Abstract:
1. A system for managing the care of patients and the reporting of the care by medical service providers to the patients' insurance providers, comprising: a demographics dataset stored in a database for the patients comprising data records on age, gender, and at least one medical condition code for each of the patients, said data records further comprising a plurality of quality measure codes with corresponding dates for each of the patients; a quality measure dataset stored in said database comprising a plurality of quality measure identifiers and corresponding sets of specification criteria, medical condition criteria and reportable quality measure codes, wherein said specification criteria are comprised of an age criteria and a gender criteria; a user interface in operable communication with said demographics dataset and said quality measure dataset, wherein said user interface comprises a plurality of patient information data fields, a selection screen listing said quality measure identifiers; a computer processor in operative communication with said demographics dataset, said quality measure dataset and said user interface, said computer processor comprising logical means that perform functions for selecting specified data records from said demographic dataset according to a defined quality measure identifier, wherein said defined quality measure identifier is selected from said quality measure identifiers through said user interface and correlates with a unique combination of said specification criteria and said reportable quality measure codes; a quality performance module comprising a set of algorithms and a set of error codes, wherein said error codes correspond to a set of corrective actions for the medical service providers, said quality performance module receiving said specified data records, performing an evaluation of said specified data records with said set of algorithms and determining a quality measure error code from said set of error codes according to said evaluation before said specified data records are submitted to the insurance providers, wherein said quality measure error code comprises a notification indicating a reporting requirement has not been met and further comprising a plurality of allowed reporting codes that satisfy said reporting requirement; and a reporting module in operable communication with said quality performance module and said user interface, wherein said reporting module creates insurance claim documentation for submission to at least one of the insurance providers, wherein said reporting module further creates a notice with said quality measure error code communicated to said user interface, wherein said notice is created before said insurance claim documentation is submitted to one of the insurance providers, wherein one of said allowed reporting codes corresponds to a reporting requirement correction that is made through said user interface to at least one data record in said claim documentation and wherein said reporting requirement correction resolves said quality measure error code for said data record before said insurance claim documentation is submitted to one of the insurance providers.