Automated configuration of medical practice management systems
View Patent ↗A user (e.g., medical office manager, medical office insurance administrator, doctor) utilizes a medical practice configuration interface (e.g., web page) to input information about the user's medical practice (e.g., address, insurance plans, doctors, hospitals that the doctors utilize). Based on this information and/or rules associated with the insurance plans accepted at the user's medical practice, additional information is requested from the user about the user's medical practice (e.g., information needed for an insurance plan, information needed for a hospital). The user inputs the requested additional information utilizing the medical practice configuration interface. Configuration information for the user's medical practice is generated based on the information and/or the additional information inputted by the user. A user interface (e.g., web pages interfacing with the medical practice management server) and/or rules for the medical practice can be generated based on the configuration information.
1. A method for automated computerized configuration of a medical practice management system, the method comprising:
receiving, by a computerized medical practice management server, first information associated with a medical practice prior to configuring the medical practice to use the medical practice management system to process medical claims, wherein the first information includes information about the medical practice;
associating, by the computerized medical practice management server, one or more payor servers with the medical practice based on the first information;
generating, by the computerized medical practice management server, a request for second information that is required to configure the medical practice management system to process medical claims for patients of the medical practice, the request being based on (a) the first information and (b) one or more insurance rules stored in an insurance rules database that apply to one or more payor servers, wherein the one or more insurance rules apply to the one or more payor servers associated with the medical practice;
in response to the request, receiving, by the computerized medical practice management server, second information which comprises information indicative of requirements for submission of medical claims to the one or more payor servers;
generating, by the computerized medical practice management server, configuration information for the medical practice management system based on the first information and the second information, wherein the configuration information is used by the medical practice management server to ensure that medical claims transmitted from the medical practice satisfy the requirements of the one or more payor servers before the medical claims are transmitted to a payor server for payment; and
configuring, by the computerized medical practice management server, the medical practice management system for use by one or more users at the medical practice based on the configuration information so that the medical practice management system can process medical claims transmitted from the one or more users at the medical practice.
2. The method of claim 1 further comprising dynamically generating a user interface for one or more users of the medical practice based on the configuration information, the user interface comprising one or more fields including information from the configuration information.
3. The method of claim 1 further comprising updating stored configuration information for the medical practice stored in a medical practice information database with the configuration information.
4. The method of claim 1 further comprising:
determining whether to request additional information based on the first information, the second information, and the one or more insurance rules;
generating a request for additional information based on the first information, the second information, and the one or more insurance rules;
receiving additional information, which comprises information indicative of requirements for submission of medical claims to the one or more payor servers, based on the request for additional information; and
generating configuration information for the medical practice management system based on the first information, the second information, and the additional information, wherein the configuration information is used by the medical practice management server to ensure that medical claims transmitted from the medical practice satisfy the requirements of the one or more payor servers before the medical claims are transmitted to a payor server for payment.
5. The method of claim 1 wherein the configuration information comprises medical claim processing information, medical claim information utilized to generate medical claims for submission to one or more payor server, or both, the method further comprising:
generating one or more rules for the medical practice management system based on the configuration information; and
storing the one or more rules in the insurance rules database.
6. The method of claim 1 further comprising:
determining one or more errors are associated with the first information, second information, or both based on one or more rules associated with one or more payor servers;
generating a request for correct information; and
receiving correct information based on the request for correct information.
7. The method of claim 1 further comprising selecting third information for submission to a payor server based on the configuration information.
8. The method of claim 7 further comprising formatting the third information for submission to the payor server based on the configuration information.
9. A computer program product, tangibly embodied in a machine readable storage device, the computer program product including instructions being operable to cause a data processing apparatus to:
receive first information associated with a medical practice prior to configuring the medical practice to use the medical practice management system to process medical claims, wherein the first information includes information about the medical practice;
associate one or more payor servers with the medical practice based on the first information;
generate a request for second information that is required to configure the medical practice management system to process medical claims for patients of the medical practice, the request being based on (a) the first information and (b) one or more insurance rules stored in an insurance rules database that apply to one or more payor servers, wherein the one or more insurance rules apply to the one or more payor servers associated with the medical practice;
in response to the request, receive second information which comprises information indicative of requirements for submission of medical claims to the one or more payor servers;
generate configuration information for the medical practice management system based on the first information and the second information, wherein the configuration information is used by the medical practice management server to ensure that medical claims transmitted from the medical practice satisfy the requirements of the one or more payor servers before the medical claims are transmitted to a payor server for payment; and
configure the medical practice management system for use by one or more users at the medical practice based on the configuration information so that the medical practice management system can process medical claims transmitted from the one or more users at the medical practice.
10. An apparatus for automated computerized configuration of a medical practice management system, the system comprising:
a medical practice module configured to:
receive first information associated with a medical practice prior to configuring the medical practice to use the medical practice management system to process medical claims, wherein the first information includes information about the medical practice;
receive second information, which comprises information indicative of requirements for submission of medical claims to one or more payor servers, based on a request; and
configure the medical practice management system for use by one or more users at the medical practice based on the configuration information so that the medical practice management system can process medical claims transmitted from the one or more users at the medical practice;
a server configuration module in communication with the medical practice module configured to:
associate one or more payor servers with the medical practice based on the first information;
generate the request for the second information that is required to configure the medical practice management system to process medical claims for patients of the medical practice, the request being based on (a) the first information and (b) one or more insurance rules that apply to the one or more payor servers, wherein the one or more insurance rules apply to the one or more payor servers associated with the medical practice; and
generate configuration information for the medical practice management system based on the first information and the second information, wherein the configuration information is used by the medical practice management server to ensure that medical claims transmitted from the medical practice satisfy the requirements of the one or more payor servers before the medical claims are transmitted to a payor server for payment; and
an insurance rules database in communication with the server configuration module configured to store the one or more insurance rules.