E-scan Data Systems, Inc.

John Wester

Bruce C Macartney-Filgate

Peter Douglas Beery

Michael L Considine

The software of the present invention provides a means for creating a file of unpaid claims for a service provider. The software is used to create one or more queries to compare information in the file of claims against records in a benefit provider's database to determine the eligibility status of the claim. A file is created containing each claim for which a matching record in the benefit provider's database is found, and the information from that matching record. A report can be generated from the file of matching claims and benefit provider records, so the claims can be submitted for payment by the service provider.

Health care patient benefits eligibility research system and methods

A system and method for determining eligibility for reimbursement for medical claims for patients may be implemented with computer software which compares a service provider's patient information against a benefit provider's database of covered persons to determine if the patient is eligible for benefits. The service provider records may be compressed by grouping all of the medical claims relating to a particular patient into one cluster represented by a composite medical claim, which may be used to query the benefit provider databases to determine if the patient is recognized. If the patient is recognized, every record within the cluster may be checked against the benefit provider's database to determine whether one or more patient medical claims are eligible for reimbursement.

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Austin, TX, United States of America

John Wester