System for communication of health care data

Abstract

An apparatus for communicating health care data from a sender to a receiver is provided. The apparatus has a first computer system, a second computer system, and a rules engine. The first computer system has health care data stored therein. The second computer system is in operable communication with, and is configured to extract the health care data from, the first computer system. The rules engine normalizes the extracted health care data to a predefined format.

What is claimed is: 
     
         1 . A computerized method of transmitting healthcare claims data between a provider and healthcare payor, the method comprising the steps of:
 providing a server configured to transmit healthcare claims data of a plurality of patients between a healthcare provider computer system and one or more healthcare payor computer systems, wherein the server is configured to perform the following steps:
 receiving healthcare claims data of one patient of the plurality of patients from the healthcare provider computer system from over the Internet; 
 converting the healthcare claims data of the one patient of the plurality of patients into a normalized format of a type that displays healthcare claims data from one or more sources such that any healthcare claims data having the same meaning will be expressed in the same format despite any prior formatting, by a normalization system which performs the steps of:
 predetermining how each healthcare claims data from the healthcare claims data of the one patient of the plurality of patients is to appear in its respective field by a rules engine; and 
 remodeling any healthcare claims data not expressed as predetermined by the normalized format into the normalized format to become normalized claims data such that all normalized claims data that expresses information having the same meaning is expressed in the same format. 
 
   
     
     
         2 . The computerized method of  claim 1 , further comprising the step of transmitting the healthcare claims data of the one patient of the plurality of patients as normalized claims data to one of the one or more healthcare payor computer systems over the Internet. 
     
     
         3 . The computerized method of  claim 1 , wherein the server is configured to perform additional steps of:
 receiving healthcare claims data of another patient of the plurality of patients from the healthcare provider computer system from over the Internet;   converting the healthcare claims data of the another patient of the plurality of patients into the normalized format by the normalization system which performs the steps of:
 predetermining how each healthcare claims data from the healthcare claims data of the another patient of the plurality of patients is to appear in its respective field by the rules engine; and 
 remodeling any healthcare claims data from the healthcare claims data of the another patient of the plurality of patients not expressed as predetermined by the normalized format into the normalized format to become normalized claims data of the another patient of the plurality of patients. 
   
     
     
         4 . The computerized method of  claim 3 , further comprising the step of transmitting the healthcare claims data of the another patient of the plurality of patients as normalized claims data to one of the one or more healthcare payor computer systems over the Internet. 
     
     
         5 . A computerized method of transmitting healthcare claims data between a provider and healthcare payor, the method comprising the steps of:
 providing a server configured to transmit healthcare claims data of a plurality of patients between a healthcare provider computer system and one or more healthcare payor computer systems, wherein the server is configured to perform the following steps:
 receiving healthcare claims data of one patient of the plurality of patients from the healthcare provider computer system from over the Internet, wherein the healthcare claims data is of a type that is configured to be used by a healthcare payor to adjudicate a claim of the one patient of the plurality of patients; 
 converting the healthcare claims data of the one patient of the plurality of patients into a normalized format of a type that displays healthcare claims data from one or more sources such that any healthcare claims data having the same meaning will be expressed in the same format despite any prior formatting, by a normalization system which performs the steps of:
 predetermining how each healthcare claims data from the healthcare claims data of the one patient of the plurality of patients is to appear in its respective field by a rules engine; and 
 remodeling any healthcare claims data not expressed as predetermined by the normalized format into the normalized format to become normalized claims data such that all normalized claims data that expresses information having the same meaning is expressed in the same format; and 
 
   transmitting the normalized claims data to one of the one or more healthcare payor computer systems to adjudicate the claim of the one patient of the plurality of patients.   
     
     
         6 . The computerized method of  claim 5 , further comprising the step of receiving an adjudication result related to the normalized claims data of the one of the plurality of patients from the one of the one or more healthcare payor computer systems from over the Internet. 
     
     
         7 . The computerized method of  claim 5 , further comprising the step of receiving an adjudicated amount related to the normalized claims data of the one of the plurality of patients from the one of the one or more healthcare payor computer systems from over the Internet; and transmitting information related to the adjudicated amount to the healthcare provider computer system. 
     
     
         8 . The computerized method of  claim 5 , wherein the server is configured to perform additional steps of:
 receiving healthcare claims data of another patient of the plurality of patients from the healthcare provider computer system from over the Internet;   converting the healthcare claims data of the another patient of the plurality of patients into the normalized format by the normalization system which performs the steps of:
 predetermining how each healthcare claims data from the healthcare claims data of the another patient of the plurality of patients is to appear in its respective field by the rules engine; and 
 remodeling any healthcare claims data from the healthcare claims data of the another patient of the plurality of patients not expressed as predetermined by the normalized format into the normalized format to become normalized claims data of the another patient of the plurality of patients; and 
   transmitting the normalized claims data to the one of the one or more healthcare payor computer systems to adjudicate the claim of the another patient of the plurality of patients.   
     
     
         9 . The computerized method of  claim 8 , further comprising the step of receiving an adjudication result related to the normalized claims data of the another of the plurality of patients from the one of the one or more healthcare payor computer systems from over the Internet. 
     
     
         10 . The computerized method of  claim 8 , further comprising the step of receiving an adjudicated amount related to the normalized claims data of the another of the plurality of patients from the one of the one or more healthcare payor computer systems from over the Internet; and transmitting information related to the adjudicated amount to the healthcare provider computer system. 
     
     
         11 . A computerized method of transmitting healthcare data between a provider and healthcare payor, the method comprising the steps of:
 providing a server configured to transmit query about data related to healthcare eligibility or benefits of a plurality of patients between a healthcare provider computer system and one or more healthcare payor computer systems, wherein the server is configured to perform the following steps:
 receiving the query about data related to healthcare eligibility or benefits of one patient of the plurality of patients from the healthcare provider computer system from over the Internet; 
 transmitting the query about data related to healthcare eligibility or benefits to one of the one or more healthcare payor computer systems over the Internet; 
 receiving response data related to the one patient of the plurality of patients from the one of the one or more healthcare payor computer systems over the Internet; 
 transmitting the response data related to the one patient of the plurality of patients to the healthcare provider computer system over the Internet, wherein the response data related to the one patient of the plurality of patients has been converted into a normalized response data format of a type that displayed response data such that any response data having the same meaning would be expressed in the same format despite any prior formatting, wherein a normalization system predetermined how each response data from the response data related to the one patient of the plurality of patients was to appear in its respective field by a rules engine, and any of the response data related to the one patient of the plurality of patients not expressed as predetermined by the normalized response data format was converted into the normalized response data format to become normalized response data such that all normalized response data that expressed information having the same meaning is expressed in the same format. 
   
     
     
         12 . The computerized method of  claim 11 , wherein the server is configured to perform additional steps of:
 receiving query about data related to healthcare eligibility or benefits of another patient of the plurality of patients from the healthcare provider computer system from over the Internet;   transmitting the query about data related to healthcare eligibility or benefits to one of the one or more healthcare payor computer systems over the Internet;   receiving healthcare response data from the query about data related to healthcare eligibility or benefits of the another patient of the plurality of patients from the one of the one or more healthcare payor computer systems over the Internet;   transmitting the response data related to the another patient of the plurality of patients to the healthcare provider computer system over the Internet, wherein the response data related to the another patient of the plurality of patients has been converted into the normalized response data format of the type that displayed response data such that any response data having the same meaning would be expressed in the same format despite any prior formatting, wherein the normalization system predetermined how each response data from the response data related to the another patient of the plurality of patients was to appear in its respective field by the rules engine, and any of the response data related to the another patient of the plurality of patients not expressed as predetermined by the normalized response data format was converted into the normalized response data format to become normalized response data such that all normalized response data that expressed information having the same meaning is expressed in the same format.   
     
     
         13 . A computerized method of transmitting healthcare data between a provider and healthcare payor, the method comprising the steps of:
 providing a server configured to transmit healthcare referral data of a plurality of patients between a referring healthcare provider computer system, a referred healthcare provider computer system and one or more healthcare payor computer systems, wherein the server is configured to perform the following steps:   receiving healthcare referral data of one patient of the plurality of patients from the referring healthcare provider computer system from over the Internet;   evaluating the healthcare referral data received from the referring healthcare provider computer system using a rules-based system;   transmitting the healthcare referral data to the referred healthcare provider computer system.   
     
     
         14 . The computerized method of  claim 13 , wherein the server is configured to perform the additional step of: transmitting the healthcare referral data to one of the one or more healthcare payor computer systems. 
     
     
         15 . The computerized method of  claim 13 , wherein the server is configured to perform the additional steps of:
 receiving healthcare referral data of another patient of the plurality of patients from the referring healthcare provider computer system from over the Internet;   evaluating the healthcare referral data of the another patient of the plurality of patients received from the referring healthcare provider computer system using a rules-based system;   transmitting the healthcare referral data of another patient of the plurality of patients to the referred healthcare provider computer system.   
     
     
         16 . The computerized method of  claim 15 , wherein the server is configured to perform the additional step of: transmitting the healthcare referral data of the another patient of the plurality of patients to one of the one or more healthcare payor computer systems. 
     
     
         17 . A computerized method of transmitting healthcare data between a provider and healthcare payor, the method comprising the steps of:
 providing a server configured to transmit healthcare referral data of a plurality of patients between a referring healthcare provider computer system and one or more healthcare payor computer systems, wherein the server is configured to perform the following steps:   receiving healthcare referral data of one patient of the plurality of patients from the referring healthcare provider computer system from over the Internet;   evaluating the healthcare referral data of the one patient of the plurality of patients received from the referring healthcare provider computer system using a rules-based system;   transmitting the healthcare referral data of the one patient of the plurality of patients to one of the one or more healthcare payor computer systems to be evaluated for authorization.   
     
     
         18 . The computerized method of  claim 17 , wherein the server is configured to perform additional steps of: receiving an authorization response of the one patient of the plurality of patients from the one or more healthcare payor computer systems; and transmitting the adjudication response of the one patient of the plurality of patients to the referral healthcare provider computer system. 
     
     
         19 . The computerized method of  claim 17 , wherein the server is configured to perform additional steps of: receiving an authorization response of the one patient of the plurality of patients from the one or more healthcare payor computer systems; and transmitting the adjudication response of the one patient of the plurality of patients to a referred healthcare provider computer system. 
     
     
         20 . The computerized method of  claim 17 , wherein the server is configured to perform additional steps of:
 receiving healthcare referral data of another patient of the plurality of patients from the referring healthcare provider computer system from over the Internet;   evaluating the healthcare referral data of the another patient of the plurality of patients received from the referring healthcare provider computer system using a rules-based system;   transmitting the healthcare referral data of the another patient of the plurality of patients to one of the one or more healthcare payor computer systems to be evaluated for authorization   
     
     
         21 . The computerized method of  claim 20 , wherein the server is configured to perform additional steps of: transmitting the authorization data of the another patient of the plurality of patients to the referral healthcare provider computer system. 
     
     
         22 . The computerized method of  claim 20 , wherein the server is configured to perform additional steps of: transmitting the authorization data of the another patient of the plurality of patients to a referred healthcare provider computer system. 
     
     
         23 . A computerized method of transmitting healthcare data between a provider and healthcare payor, the method comprising the steps of:
 providing a server configured to transmit healthcare referral data of a plurality of patients between a referring healthcare provider computer system and one or more healthcare payor computer systems, wherein the server is configured to perform the following steps:   receiving healthcare referral data of one patient of the plurality of patients from the referring healthcare provider computer system from over the Internet;   converting the referral data of the one patient of the plurality of patients into a normalized format of a type that displays referral data from one or more sources such that any healthcare referral data having the same meaning will be expressed in the same format despite any prior formatting, by a normalization system which performs the steps of:
 predetermining how each referral data from the referral data of the one patient of the plurality of patients is to appear in its respective field by a rules engine; and 
 remodeling any referral data not expressed as predetermined by the normalized format into the normalized format to become normalized referral data such that all normalized referral data that expresses information having the same meaning is expressed in the same format. 
   transmitting the normalized referral data of the one patient of the plurality of patients to one of the one or more healthcare payor computer systems to be evaluated for authorization.   
     
     
         24 . The computerized method of  claim 23 , wherein the server is configured to perform additional steps of: receiving an authorization response of the one patient of the plurality of patients from the one or more healthcare payor computer systems; and transmitting the adjudication response of the one patient of the plurality of patients to the referral healthcare provider computer system. 
     
     
         25 . The computerized method of  claim 23 , wherein the server is configured to perform additional steps of: receiving an authorization response of the one patient of the plurality of patients from the one or more healthcare payor computer systems; and transmitting the adjudication response of the one patient of the plurality of patients to a referred healthcare provider computer system. 
     
     
         26 . The computerized method of  claim 23 , wherein the server is configured to perform additional steps of:
 receiving healthcare referral data of another patient of the plurality of patients from the referring healthcare provider computer system from over the Internet;   converting the referral data of the another patient of the plurality of patients into the normalized format by the normalization system which performs the steps of:
 predetermining how each referral data from the referral data of the another patient of the plurality of patients is to appear in its respective field by the rules engine; and 
 remodeling any referral data not expressed as predetermined by the normalized format into the normalized format to become normalized referral data such that all normalized referral data that expresses information having the same meaning is expressed in the same format. 
   transmitting the normalized referral data of the another patient of the plurality of patients to a of the one or more healthcare payor computer systems to be evaluated for authorization.   
     
     
         27 . The computerized method of  claim 26 , wherein the server is configured to perform additional steps of: transmitting the authorization data of the another patient of the plurality of patients to the referral healthcare provider computer system. 
     
     
         28 . The computerized method of  claim 26 , wherein the server is configured to perform additional steps of: transmitting the authorization data of the another patient of the plurality of patients to a referred healthcare provider computer system.