System and method for managing requests for medical transportation
A call center for handling requests for medical transportation utilizes a system that assists a call center agent by automatically determining, or prompting the agent to ask for, all information needed to assess the level of service required and the effects of any applicable contractual provisions. The system captures information relating to the patient and the requested transportation, and applies service level rules representing the applicable regulatory requirements for medical transportation at the location of the patient to determine the required level of service based on the patient's condition and needs. The system further applies business rules representing the contractual provisions that are applicable to the requested transportation to determine responsibility for the cost of transportation, the authority of the requester to change the level of service or other aspects of the transportation, and the responsibility for the cost of transportation in the event that an aspect of the transportation has been changed.
1. An apparatus for managing requests for medical transportation, comprising:
a processor configured to execute instructions stored in computer-readable media;
at least one non-transitory computer readable media having stored thereupon a plurality of service level rules, the service level rules expressing associations between service levels of medical transportation and patient diagnoses, patient equipment needs during transportation, and patient medication needs during transportation;
the at least one non-transitory computer readable media further having stored thereupon a plurality of business rules, the business rules including rules expressing associations between locations of transportation, rules representing contractual provisions governing responsibility for a cost of requested transportation, and contractual transportation performance standards comprising response times for providing requested transportation;
an interface, running on the processor, for receiving, at the apparatus, a first request for transportation;
a rules engine, running on the processor and configured to receive the first request from the interface and to access the at least one non-transitory computer readable media, the rules engine being configured to, prior to a dispatch of transportation associated with the received first request, cause the processor to:
(1) apply said service level rules to details of the received first request for transportation, to determine a service level for said requested transportation,
(2) apply said business rules to the details of the received first request to determine performance standards for the requested transportation, and
(3) apply said business rules to details of the received first request to determine responsibility for a cost of the requested transportation; and
wherein the apparatus further comprises a module configured to cause a second request for transportation to be dispatched from the apparatus based on the service level and performance standards determined by the rules engine.
2. The apparatus claimed in claim 1 , wherein said business rules governing responsibility for the cost of said requested transportation operate on information including at least one of patient eligibility status, a type of a facility from which the requested transportation originates, a type of a destination facility of the requested transportation, a relationship between the facility and an insurer of the patient, and a level of service determined for the requested transportation.
3. The apparatus claimed in claim 1 , wherein said business rules further include rules representing contractual provisions governing authority of requesting parties to change at least one of a level of service and a performance standard determined by the system for the requested transportation, and
wherein the rules engine applies said business rules to information relating to said requested transportation to determine authority of a requesting party to change at least one of a level of service and a performance standard determined by the system for the requested transportation.
4. The apparatus claimed in claim 3 , wherein said business rules representing authority of requesting parties to change a level of service determined by the system for the requested transportation operate on information including at least one of a type of a facility from which the request is made, a type of the requester, affiliation of the requester with an insurer that grants permission for the requester to modify the service level, a desired new service level, a desired new response time, and a reason for requesting the change.
5. The apparatus claimed in claim 3 , wherein said business rules further include rules representing contractual provisions governing responsibility for a cost of requested transportation upon approval of a requested change of at least one of a service level and a performance standard determined by the system for requested transportation, and
wherein the rules engine applies said business rules to information relating to said requested transportation to determine responsibility for the cost of the requested transportation upon approval of a requested change of at least one of a service level and a performance standard determined by the system for the requested transportation.
6. The apparatus claimed in claim 5 , wherein said business rules representing contractual provisions governing responsibility for a cost of said requested transportation upon approval of a requested change of at least one of a service level and a performance standard operate on information including at least one of an original determination of responsibility for cost of the requested transportation, a type of change of service level, a reason for change of service level, a type of change of response time, and a reason for change of response time.
7. The apparatus claimed in claim 1 , wherein said business rules further include rules representing contractual provisions governing selection of a transportation provider for requested transportation, and
wherein the rules engine applies said business rules to information relating to said requested transportation to determine one or more transportation providers for providing the requested transportation in accordance with said contractual provisions governing selection of a transportation provider for requested transportation.