Patent ID: 8265961

Claim:
A data processing apparatus adapted for providing medical pre-approval, the data processing apparatus comprising: a processor; and a memory coupled to the processor and having program instructions stored therein, the processor being operable to execute the program instructions, the program instructions including: providing a first interface option for identifying a first code for a diagnosed condition; providing a second interface option for identifying a second code for a proposed medical service for the diagnosed condition; providing a third interface option for identifying a proposed charge amount for the proposed medical service; receiving a request for medical pre-approval, the request including the first code for the diagnosed condition, the second code for the proposed medical service, and the proposed charge amount; retrieving historical data of past charge amounts stored in a data store for the proposed medical service; identifying a reasonableness value based on the historical data of past charge amounts, wherein the identified reasonableness value is configured to be traced to a specific past charge amount stored in the data store for a specific provider for the proposed medical service performed for a specific patient; comparing the proposed charge amount against the identified reasonableness value; determining whether the proposed charge amount is presumptively reasonable or unreasonable based on the comparison of the proposed charge amount against the identified reasonableness value; if the proposed charge amount is determined to be presumptively reasonable based on the comparison, providing information indicative of pre-approval of the proposed medical service or charge; and if the proposed charge amount is determined to be presumptively unreasonable based on the comparison, prompting submission of information justifying the proposed charge amount.