Inventors:
William Jay MCCALLUM - Fort Worth TX, US
Jack Edward MCCALLUM - Fort Worth TX, US
International Classification:
G06Q 50/00, G06N 5/02, G06Q 40/00, G06Q 10/00
Abstract:
The present invention relates generally to healthcare, and more specifically to a process for more completely and more accurately identifying and collecting health insurance plan members' medical diagnoses in compliance with the regulations of one or more health insurance payors such as, but not limited to, the United States Centers for Medicare and Medicaid Services' (“CMS”) Medicare Advantage regulations. In particular, the present invention provides a system, method, or computer program product whereby health insurance companies may ensure that their members are accurately diagnosed and that claims are accurately filed by reviewing existing member medical records to identify additional diagnoses which may have been treated but not specifically identified in claims filed by the members' health care provider.