Invention Grant
- Patent Title: Method and apparatus for repricing a reimbursement claim against a contract
- Patent Title (中): 对合同重新定价报销索赔的方法和设备
-
Application No.: US13352960Application Date: 2012-01-18
-
Publication No.: US08407071B2Publication Date: 2013-03-26
- Inventor: Mark Lesswing , Dale Hoerle
- Applicant: Mark Lesswing , Dale Hoerle
- Applicant Address: US CO Greenwood Village
- Assignee: The TriZetto Group, Inc.
- Current Assignee: The TriZetto Group, Inc.
- Current Assignee Address: US CO Greenwood Village
- Agency: King & Spalding LLP
- Agent Dawn-Marie Bey
- Main IPC: G06Q40/08
- IPC: G06Q40/08

Abstract:
A method for repricing a reimbursement claim under at least one contract is provided herein. The method may include a combination of steps such as: converting each contract into a series of contractual terms; converting a claim into a series of claim lines, containing claim codes, unit numbers and corresponding charges for the claim codes; comparing claim codes and contractual terms and identifying matches therebetween; determining any priority conditions associated to the matching contractual terms, and eliminate any matching contractual terms that are excluded by the priority conditions; calculating the reimbursement amount for the claim by determining the reimbursement charges for the non-excluded matching contractual terms; and determining and making any adjustments depending upon any discount terms for the entire reimbursement amount.
Public/Granted literature
- US20120130754A1 Novel Method and Apparatus For Repricing a Reimbursement Claim Against a Contract Public/Granted day:2012-05-24
Information query