Christian A Berthaud

US Patent:

20050033612, Feb 10, 2005

Filed:

Sep 13, 2004

Appl. No.:

10/939635

Inventors:

Edward Donovan - Naperville IL, US
Wendy Towner - Bolingbrook IL, US
Christian Berthaud - Hinsdale IL, US

International Classification:

G06F017/60

US Classification:

705004000

Abstract:

The present claim repricing system generally includes a processor and a program and data memory coupled to the processor. The memory stores the requisite database tables, as well as program instructions for repricing several different types of claims, including physician, inpatient, and outpatient claims. The claim repricing system includes instructions for determining availability of insurance plan coverage to the patient based on an effective date of the employer insurance plan, as well as determining the availability of the physician or provider based on an effective provider date. The claim repricing system further handles specialty codes and exceptions. For example, the claim repricing system includes instructions for determining the presence of anesthesia specialty codes, and for determining the correct number of anesthesia units and an anesthesia repricing indicator. The anesthesia repricing indicator may be a percentage discount, for example, or a rate. Furthermore, the claim repricing system may operate in a batch processing mode to quickly, accurately, and reliable reprice large amounts of claims.

US Patent:

6792410, Sep 14, 2004

Filed:

May 7, 1999

Appl. No.:

09/307136

Inventors:

Edward Joseph Donovan - Naperville IL
Wendy Marie Towner - Bolingbrook IL
Christian Berthaud - Hinsdale IL

Assignee:

HFN, Inc. - Oak Brook IL

International Classification:

G06F 1760

US Classification:

705 4

Abstract:

The present claim repricing system generally includes a processor and a program and data memory coupled to the processor. The memory stores the requisite database tables, as well as program instructions for repricing several different types of claims, including physician, inpatient, and outpatient claims. The claim repricing system includes instructions for determining availability of insurance plan coverage to the patient based on an effective date of the employer insurance plan, as well as determining the availability of the physician or provider based on an effective provider date. The claim repricing system further handles specialty codes and exceptions. For example, the claim repricing system includes instructions for determining the presence of anesthesia specialty codes, and for determining the correct number of anesthesia units and an anesthesia repricing indicator. The anesthesia repricing indicator may be a percentage discount, for example, or a rate. Furthermore, the claim repricing system may operate in a batch processing mode to quickly, accurately, and reliable reprice large amounts of claims.