AUTOMATED PROCESSING OF ELECTRONIC MEDICAL DATA FOR INSURANCE AND DISABILITY DETERMINATIONS
Methods and systems are described for automated processing of medical data for insurance and disability determinations. Based on medical conditions claimed by a claimant, medical evidence queries are automatically generated to provide instructions to medical providers for conducting physical exams and laboratory tests and for retrieving medical records. After medical evidence is collected according to the queries, the medical evidence and related rating codes and decisions are displayed to rating personnel in a user-friendly format to assist in making a rating decision.
1 . A system for adjudicating a medical disability request, comprising:
a computer-readable storage comprising:
at least one claim, from a claimant, of a medical condition;
a predetermined set of medical evidence queries; and
a disability rules collection; and
a computer processor configured to select a plurality of claim-type specific medical evidence queries from the set based on the at least one claim and the disability rating rules collection, to exclude queries, from the plurality of claim-type specific medical evidence, that are not specific to the claim or claim type, and to receive medical evidence data responsive to the selected plurality of queries;
wherein the set contains a greater number of queries than the plurality of queries.
2 . The system of claim 1 , wherein the computer processor is further configured to display the generated medical evidence queries in a data collection protocol.
3 . The system of claim 1 , wherein the medical evidence data is received from an electronic data storage comprising electronic medical records.
4 . The system of claim 1 , wherein the medical evidence data comprises responses to the selected medical evidence queries.
5 . The system of claim 1 , wherein the medical evidence data is collected by a medical provider.
6 . The system of claim 5 , wherein the medical evidence data collected by the medical provider comprises at least one of reviewing and extracting data from medical records, taking a medical history of the claimant, receiving data from a physical exam, receiving data representative of laboratory tests, receiving data from radiological study results, or receiving data from nuclear medicine laboratory results.
7 . The system of claim 6 , wherein the medical history comprises at least one of a family history and a social history.
8 . The system of claim 1 , wherein the computer processor is further configured to determine a degree of disability based on the medical evidence data and on the disability rating rules collection.
9 . The system of claim 8 , wherein the computer processor is further configured to generate a report comprising the degree of disability.
10 . A method for adjudicating a medical disability request, comprising:
receiving at least one claim, from a claimant, of a medical condition;
selecting, using a computer processor and from a predetermined set of medical evidence queries, a plurality of claim-type specific medical evidence queries based on the at least one claim and a disability rating rules collection; and
receiving medical evidence data responsive to the selected plurality of queries;
wherein the selecting the predetermined set comprises excluding queries, from the plurality of claim-type specific medical evidence, that are not specific to the claim or claim type; and
wherein the set contains a greater number of queries than the plurality of queries.
11 . The method of claim 10 , further comprising displaying the selected medical evidence queries in a data collection protocol.
12 . The method of claim 10 , wherein the medical evidence data is received from an electronic data storage comprising electronic medical records.
13 . The method of claim 10 , wherein the medical evidence data comprises responses to the selected medical evidence queries.
14 . The method of claim 10 , wherein the receiving medical evidence data comprises receiving medical evidence data collected by a medical provider.
15 . The method of claim 14 , wherein the receiving medical evidence data collected by a medical provider comprises at least one of reviewing and extracting data from medical records, taking a medical history of the claimant, receiving data from a physical exam, receiving data representative of laboratory tests, receiving data from radiological study results, or receiving data from nuclear medicine laboratory results.
16 . The method of claim 15 , wherein the medical history comprises at least one of a family history and a social history.
17 . The method of claim 10 , further comprising determining a degree of disability based on the medical evidence data and on the disability rating rules collection.
18 . The method of claim 17 , further comprising generating a report comprising the degree of disability.
19 . A computer-readable medium having computer-executable instructions stored thereon for performing method for adjudicating a medical disability request, comprising:
receiving at least one claim, from a claimant, of a medical condition;
selecting, using a computer processor and from a predetermined set of medical evidence queries, a plurality of claim-type specific medical evidence queries based on the at least one claim and a disability rating rules collection; and
receiving medical evidence data responsive to the selected plurality of queries;
wherein the selecting the predetermined set comprises excluding queries, from the plurality of claim-type specific medical evidence, that are not specific to the claim or claim type; and
wherein the set contains a greater number of queries than the plurality of queries.