Patent ID: 8332234

Claim:
A computer implemented and user assisted method of providing medical referrals for medical insurance claims, comprising: receiving, by a computer, a reported medical insurance claim; collecting, by the computer, data related to the reported medical insurance claim; transmitting, by the computer, the reported medical insurance claim and the collected data relating to the reported claim to medical referral logic; automatically performing, by the computer, the medical referral logic on the reported medical insurance claim and the collected data to determine whether a medical referral is warranted based upon predetermined referral criteria; when the medical referral is warranted, automatically transmitting, by the computer, the reported medical insurance claim and the collected data to a medical case management system to determine whether to assign the reported medical insurance claim to a medical personnel; when the medical referral is not warranted, preventing, by the computer, the reported medical insurance claim and the collected data from being referred to the medical case management system; collecting, by the computer, updated data relating to the reported medical insurance claim when the data changes; when the updated collected data is present, automatically performing, by the computer, the medical referral logic on the reported medical insurance claim and the updated collected data to determine whether a medical referral is warranted based upon the predetermined referral criteria; and when the medical referral is warranted, automatically transmitting, by the computer, the reported medical insurance claim and the updated collected data to a medical case management system to determine whether to assign the reported medical insurance claim to the medical personnel.