CASE MANAGEMENT OF HEALTHCARE FRAUD DETECTION INFORMATION

CASE MANAGEMENT OF HEALTHCARE FRAUD DETECTION INFORMATION

A healthcare fraud management system receives healthcare claims associated with a particular entity, selects rules, from a plurality of rules for detecting healthcare fraud, based on information associated with the healthcare claims, and processes the healthcare claims using the selected rules to ge...

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Bibliographische Detailangaben
Hauptverfasser: SCHWEYEN CORRINE L, HAGINS SCOTT, MAHONE SARALYN M, VAN ARKEL JOHN H, CURTIS TERRILL J, TADA DAVID D, WAGNER JAMES J
Format: Patent
Sprache:eng
Schlagworte:
CALCULATING
COMPUTING
COUNTING
DATA PROCESSING SYSTEMS OR METHODS, SPECIALLY ADAPTED FORADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORYOR FORECASTING PURPOSES
HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATIONTECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING ORPROCESSING OF MEDICAL OR HEALTHCARE DATA
INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTEDFOR SPECIFIC APPLICATION FIELDS
PHYSICS
SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE,COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORY OR FORECASTINGPURPOSES, NOT OTHERWISE PROVIDED FOR
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Zusammenfassung:A healthcare fraud management system receives healthcare claims associated with a particular entity, selects rules, from a plurality of rules for detecting healthcare fraud, based on information associated with the healthcare claims, and processes the healthcare claims using the selected rules to generate alarms. The healthcare fraud management system prioritizes, based on the generated alarms, healthcare information associated with the particular entity in relation to healthcare information associated with other entities. The healthcare fraud management system provides for display, prior to payment of the healthcare claims, the prioritized healthcare information associated with the particular entity and the other entities.