Patent Document ID: 8655685
Application ID: 12795054

Base Claim:
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: retrieving a plurality of previously-received claim rejection identifiers from a claim management database associated with the intermediary claim management system, wherein the plurality of previously-received claim rejection identifiers were extracted from a plurality of prior responses received from the plurality of insurance payers corresponding to a plurality of prior medical reimbursement claims, and wherein each of the plurality of previously-received claim rejection identifiers comprises a unique format corresponding to its respective insurance payer; comparing each claim rejection identifier in the response to the retrieved plurality of previously-received claim rejection identifiers; matching each claim rejection identifier in the response to a corresponding previously-received claim rejection identifier from the plurality of prior responses corresponding to the plurality of prior medical reimbursement claims; retrieving a corresponding predefined claim rejection description associated with each matched previously-received claim rejection identifier from the claim management database, wherein each predefined claim rejection description is generated via the intermediary claim management system based on historical data collected from the received plurality of prior responses comprising the plurality of previously-received claim rejection identifiers having the formats unique to each of the plurality of insurance payers, and wherein each predefined claim rejection description provides a standardized description of a respective specific issue in the medical reimbursement claim; and storing the retrieved corresponding predefined claim rejection description in the claim management database in association with each claim rejection identifier for the medical reimbursement claim; and 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.

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Claim 3:
3. The method of claim 1 , wherein the step of matching each claim rejection identifier in the response to a corresponding previously-received claim rejection identifier and retrieving a corresponding predefined claim rejection description comprises linking each claim rejection identifier in the response with a corresponding previously-received claim rejection identifier and a corresponding predefined claim rejection description in a cross-referenced data structure in the claim management database for the medical reimbursement claim.