Mdi Technologies, Inc.

Richard R Willich

Robert John Snyder

Jason Reinis Green

Raymond Michael Wood

Methods and systems for adjudicating claims in health services environments are presented. An exemplary method for processing service provider claims for payment includes scheduling appointments with service providers, receiving claims from the service providers, determining whether at least one scheduled appointment corresponds with at least one received claim and determining that at least one scheduled appointment has not been identified as corresponding to at least one received claim within a predetermined period of time. Optionally, the method includes presenting the particular received claim for payment when at least one of the scheduled appointments corresponds to the particular received claim.

Method and system for adjudicating claims in a health services environment

An exemplary method for determining the appropriateness of service provider claims for payment includes scheduling appointments for patients with service providers based on requests for services, generating appointment information corresponding to each of the scheduled appointments, and capturing service information corresponding to claims received from the service providers for payment of charges associated with services rendered by the service providers to the patients. The method further includes automatically identifying candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments. Additionally, the method includes flagging the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim, and presenting the particular received claim for payment when at least one of the candidate appointments corresponds to the particular received claim.

Method and system for scheduling tracking, adjudicating appointments and claims in a health services environment

Methods and systems for tracking treatment of patients are presented. An exemplary method for tracking treatment of patients includes scheduling appointments for a patient with service providers based on requests for services and generating appointment information corresponding to each of the scheduled appointments; capturing service information corresponding to claims received from the service providers for payment of charges associated with services rendered by the service providers to the patient; and establishing for the patient an episode of care pertaining to treatment of a specified ailment and associating with the established episode of care at least one of the requests for services, the scheduled appointments, and the received claims for the patient that correspond to the treatment of the specified ailment.

Method and system for tracking treatment of patients in a health services environment

Methods and systems for acquiring claims in health services environments are presented. An exemplary method for processing service provider claims for payment includes: scheduling appointments with the service providers, receiving claims from the service providers, analyzing the scheduled appointments to identify at least one scheduled appointment corresponding to each of the received claims, automatically detecting scheduled appointments not identified as corresponding to any of the received claims within a predetermined period of time, and notifying respective service providers that no claims have been received for the detected scheduled appointments. Optionally, the method includes analyzing appointment information associated with a scheduled appointment to determine an anticipated number of received claims corresponding to the scheduled appointment, and automatically flagging the scheduled appointment for resolution when the scheduled appointment is identified as corresponding to fewer than the anticipated number of received claims within a predetermined period of time.

Method and system for acquiring claims in a health services environment

Methods and systems for adjudicating claims in health services environments are presented. An exemplary method for processing service provider claims for payment includes receiving a claim for payment, automatically identifying candidate appointments from a plurality of scheduled appointments based on a degree of similarity between service information associated with the received claim and appointment information associated with the scheduled appointments, analyzing the candidate appointments to determine whether to flag the received claim for resolution, and presenting the received claim for payment when at least one of the candidate appointments corresponds to the received claim. Optionally, the method includes automatically identifying already processed claims based on a degree of similarity between service information associated with the already processed claims and the service information associated with the received claim, analyzing the identified already processed claims to determine whether the received claim is a duplicate claim, and flagging potentially duplicate claims for resolution.

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St. Augustine, FL, United States of America

Richard R Willich