Health care patient benefits eligibility research system and methods

Abstract

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.

1 - 10 . (canceled) 
     
     
         11 . A tangible, non-transitory computer program product for comparing a service provider's medical care claims against a benefit provider's database, the computer program product having a computer readable medium with a computer program executable by a computer embodied thereon, the computer program comprising instructions which, when executed by the computer, cause the computer to perform the following operations:
 a. generating a first file of claims from the service provider, wherein said first file is organized such that data associated with at least two fields for each of the claims is formatted for comparison with the benefit provider's database, wherein the at least two fields are different from each other;   b. executing a first query of the benefit provider's database using data from one of said at least two fields for a claim in the first file and executing a second query of the benefit provider's database using data from another of said at least two fields for said claim, wherein at least one of said first query and said second query includes data from different fields among said at least two fields for said claim;   c. adding said claim to a second file if a record in the benefit provider's database is responsive to said first query and said second query; and   d. generating a report indicative of one or more differences between said claim for which a responsive record was found and said responsive record.   
     
     
         12 . The tangible computer program product of  claim 11  wherein dissimilar information from said claim is shown in different print than information from said responsive record. 
     
     
         13 . The tangible computer program product of  claim 12  wherein said dissimilar information from said claim shown in different print is on a separate line of said report than said information from said responsive record. 
     
     
         14 . The tangible computer program product of  claim 11  further comprising instructions for generating a report indicative of the effectiveness of said first query and said second query in finding responsive records. 
     
     
         15 . The tangible computer program product of  claim 11  wherein either said first query or said second query uses data that includes a social security number and the first four letters of a last name. 
     
     
         16 . The tangible computer program product of  claim 11  wherein either said first query or said second query uses data that includes a social security number, a first name, and a last name with the first and last name switched. 
     
     
         17 . The tangible computer program product of  claim 11  wherein either said first query or said second query uses data that includes a date of birth, a first name, and a last name with the first and last name switched. 
     
     
         18 . The tangible computer program product of  claim 11  wherein either said first query or said second query uses data that includes a social security number, a first name, and either a first half or a second half of a hyphenated last name. 
     
     
         19 . The tangible computer program product of  claim 11  wherein either said first query or said second query uses data that includes a social security number, a first name, and a removed hyphen or space in a last name. 
     
     
         20 . A tangible, non-transitory computer program product for comparing a service provider's medical care claims against a benefit provider's database, the computer program product having a computer readable medium with a computer program executable by a computer embodied thereon, the computer program comprising instructions which, when executed by the computer, cause the computer to perform the following operations:
 a. generating a first file of claims from the service provider, wherein said first file is organized such that data associated with at least two fields for each of the claims is formatted for comparison with the benefit provider's database, wherein the at least two fields are different from each other;   b. for a plurality of claims in the first file, executing a first query of the benefit provider's database using data from one of said at least two fields and executing a second query of the benefit provider's database using data from another of said at least two fields, wherein at least one of said first query and said second query includes data from different fields among said at least two fields;   c. adding respective ones of said plurality of claims to a second file if a record in the benefit provider's database is responsive to either of said first query or said second query; and   d. generating a report indicative of the effectiveness of said first query and the effectiveness of said second query in finding responsive records.   
     
     
         21 . The tangible computer program product of  claim 20  further comprising instructions for generating a report indicative of one or more differences between a claim in said second file and a record found responsive to said first or second query. 
     
     
         22 . The tangible computer program product of  claim 20  further comprising instructions for sorting claims in said second file based on either an eligibility date or a billing deadline for a provided service. 
     
     
         23 . The tangible computer program of  claim 20  wherein at least one additional query is executed after a predetermined time period. 
     
     
         24 . A tangible, non-transitory computer program product for comparing a service provider's medical care claims against a benefit provider's database, the computer program product having a computer readable medium with a computer program executable by a computer embodied thereon, the computer program comprising instructions which, when executed by the computer, cause the computer to perform the following operations:
 a. generating a first file of claims from the service provider, wherein said first file is organized such that data associated with at least two fields for each of the claims is formatted for comparison with the benefit provider's database, wherein the at least two fields are different from each other;   b. executing a first query of the benefit provider's database using data from one of said at least two fields for a claim in the first file and executing a second query of the benefit provider's database using data from another of said at least two fields for said claim, wherein at least one of said first query and said second query includes data from different fields among said at least two fields;   c. adding said claim to a second file if a record in the benefit provider's database is responsive to said first query and said second query;   d. sorting said claim among other claims in said second file based on either an eligibility date or a billing deadline for a provided service;   e. generating a report indicative of one or more differences between said claim for which a responsive record was found and said responsive record, wherein dissimilar information from said claim is shown in different print than information from said responsive record; and   f. generating another report indicative of the effectiveness of said first query and the effectiveness of said second query in finding responsive records.