System and method of providing devices for injuries under worker's compensation coverage

Abstract

A computer system including a server and software, for example, provides items and services for injuries under workman's compensation coverage through a web portal. An automated request to provide an item is transmitted from the server over the network setting a specific price, such that the one or more of a plurality of providers is capable of accepting the automated request using the network connected to the server. A care cart may be customizable by the adjuster or the adjuster's employer. Items are added to automatically by the system to a care cart using an automated algorithm relating specific items to both an injury code and a zip code, and the system transmits the care cart to the adjuster portal and presents the adjuster with options.

What is claimed is: 
     
         1 . A computer-implemented method, comprising:
 specifically programming at least one computer device to perform at least the following:   importing claim information relating to ancillary items, ancillary services, or both offered for fulfillment of worker's compensation claims, wherein the claim information comprises at least the following:
 i) description of each ancillary item and each ancillary service, 
 ii) provider information, comprising: prices quoted by each provider from a plurality of providers and at least one geographic location associated with each provider, 
 iii) regulations governing reimbursement based on geographic locations of claimants, 
 iv) fee schedules of a plurality of payers, and 
 v) broker fees assessed for brokering services between the plurality of payers and the plurality of providers; 
   receiving, from a plurality of adjusters, a plurality of requests, wherein each request seeks a quote for a particular ancillary item, a particular ancillary service, or both, to fulfill at least one worker's compensation claim;   automatically calculating, in real time, upon receipt of each request for the particular ancillary item, the particular ancillary service, or both, based at least in part on the claim information, at least one reimbursement rate for the particular ancillary item, the particular ancillary service, or both;   generating the quote for the particular ancillary item, the particular ancillary service, or both, based on the at least one reimbursement rate, wherein the quote is configured for acceptance by a provider so that the provider need not complete additional paperwork to seek reimbursement; and   transmitting the quote to at least one provider.   
     
     
         2 . The computer-implemented method of  claim 1 , wherein the plurality of payers is selected from: insurance companies, Medicare, Medicaid, and state agencies. 
     
     
         3 . The computer-implemented method of  claim 1 , wherein the fee schedules are selected from: a usual and customary rate, an Ingenix usual rate, and a customary and reasonable rate. 
     
     
         4 . The computer-implemented method of  claim 1 , wherein the method further comprises:
 automatically calculating, in real time, for the at least one worker's compensation claim, at least one amount of savings resulting from a difference between a price quoted by the provider and the at least one reimbursement rate.   
     
     
         5 . The computer-implemented method of  claim 1 , wherein the claim information further comprises:
 vi) medical codes, and   vii) descriptions of injuries.   
     
     
         6 . The computer-implemented method of  claim 5 , wherein the medical codes comprise codes selected from at least two of the following groups: injury codes, ICD codes, and procedure codes. 
     
     
         7 . The computer-implemented method of  claim 1 , wherein the automatically calculating the at least one reimbursement rate occurs in near real time. 
     
     
         8 . The computer-implemented method of  claim 4 , wherein the automatically calculating the at least one amount of savings occurs in near real time. 
     
     
         9 . A computer-implemented method, comprising:
 specifically programming at least one computer device to perform at least the following:   importing information relating to ancillary items, ancillary services, or both offered for fulfillment of worker's compensation claims, wherein the information comprises:
 i) description of each ancillary item and each ancillary service, 
 ii) provider information, comprising: prices quoted by each provider and at least one geographic location associated with each provider, 
 iii) regulations governing reimbursement based on a geographic location of a claimant, 
 iv) fee schedules of a plurality of payers, and 
 v) broker fees assessed for brokering services between the plurality of payers and the plurality of providers; 
   receiving, from a plurality of adjusters, a plurality of worker's compensation claims for to particular ancillary items, particular ancillary services, or both;   automatically calculating, in real time, upon receipt of each worker's compensation claim, based at least in part on the claim information, at least one reimbursement rate for each particular ancillary item, each particular ancillary service, or both associated with a particular worker's compensation claim;   automatically auditing, in real time, a compliance of the particular worker's compensation claim based at least in part on:
 i) the imported information and 
 ii) the at least one reimbursement rate; and 
   automatically generating at least one alert when the compliance of the particular worker's compensation claim is deficient.   
     
     
         10 . The computer-implemented method of  claim 9 , wherein the plurality of payers is selected from: insurance companies, Medicare, Medicaid, and state agencies. 
     
     
         11 . The computer-implemented method of  claim 9 , wherein the fee schedules are selected from: a usual and customary rate, an Ingenix usual rate, and a customary and reasonable rate. 
     
     
         12 . The computer-implemented method of  claim 9 , wherein the method further comprises:
 automatically calculating, in real time, for each worker's compensation claim, at least one amount of savings resulting from at least one difference between at least one price quoted by a particular provider and the at least one reimbursement rate.   
     
     
         13 . The computer-implemented method of  claim 9 , wherein the claim information further comprises:
 vi) medical codes, and   vii) descriptions of injuries.   
     
     
         14 . The computer-implemented method of  claim 13 , wherein the medical codes comprise codes selected from at least two of the following groups: injury codes, ICD codes, and procedure codes. 
     
     
         15 . The computer-implemented method of  claim 9 , wherein the automatically calculating the at least one reimbursement rate occurs in near real time. 
     
     
         16 . A specifically programmed computer system, comprising:
 a non-transient computer memory having at least one region for storing computer executable program code; and   at least one processor for executing the program code stored in the memory, wherein the program code performs at least the following:   importing claim information relating to ancillary items, ancillary services, or both offered for fulfillment of worker's compensation claims, wherein the claim information comprises at least the following:
 i) description of each ancillary item and each ancillary service, 
 ii) provider information, comprising: prices quoted by each provider from a plurality of providers and at least one geographic location associated with each provider, 
 iii) regulations governing reimbursement based on geographic locations of claimants, 
 iv) fee schedules of a plurality of payers, and 
 v) broker fees assessed for brokering services between the plurality of payers and the plurality of providers; 
   receiving, from a plurality of adjusters, a plurality of requests, wherein each request seeks a quote for a particular ancillary item, a particular ancillary service, or both, to fulfill at least one worker's compensation claim;   automatically calculating, in real time, upon receipt of each request for the particular ancillary item, the particular ancillary service, or both, based at least in part on the claim information, at least one reimbursement rate for the particular ancillary item, the particular ancillary service, or both;   generating the quote for the particular ancillary item, the particular ancillary service, or both, based on the at least one reimbursement rate, wherein the quote is configured for acceptance by a provider so that the provider need not complete additional paperwork to seek reimbursement; and   transmitting the quote to at least one provider.   
     
     
         17 . The computer system of  claim 16 , wherein the plurality of payers is selected from:
 insurance companies, Medicare, Medicaid, and state agencies.   
     
     
         18 . The computer system of  claim 16 , wherein the fee schedules are selected from: a usual and customary rate, an Ingenix usual rate, and a customary and reasonable rate. 
     
     
         19 . The computer system of  claim 16 , wherein the program code further performs at least the following:
 automatically calculating, in real time, for the at least one worker's compensation claim, at least one amount of savings resulting from a difference between a price quoted by the provider and the at least one reimbursement rate.   
     
     
         20 . The computer system of  claim 16 , wherein the claim information further comprises:
 vi) medical codes, and   vii) descriptions of injuries.   
     
     
         21 . The computer system of  claim 20 , wherein the medical codes comprise codes selected from at least two of the following groups: injury codes, ICD codes, and procedure codes. 
     
     
         22 . The computer system of  claim 16 , wherein the automatically calculating the at least one reimbursement rate occurs in near real time. 
     
     
         23 . The computer system of  claim 19 , wherein the automatically calculating the at least one amount of savings occurs in near real time. 
     
     
         24 . A specifically programmed computer system, comprising:
 a non-transient computer memory having at least one region for storing computer executable program code; and   at least one processor for executing the program code stored in the memory, wherein the program code performs at least the following:   importing claim information relating to ancillary items, ancillary services, or both offered for fulfillment of worker's compensation claims, wherein the claim information comprises:
 i) description of each ancillary item and each ancillary service, 
 ii) provider information, comprising: prices quoted by each provider and at least one geographic location associated with each provider, 
 iii) regulations governing reimbursement based on a geographic location of a claimant, 
 iv) fee schedules of a plurality of payers, and 
 v) broker fees assessed for brokering services between the plurality of payers and the plurality of providers; 
   receiving, from a plurality of adjusters, a plurality of worker's compensation claims for to particular ancillary items, particular ancillary services, or both;   automatically calculating, in real time, upon receipt of each worker's compensation claim, based at least in part on the claim information, at least one reimbursement rate for each particular ancillary item, each particular ancillary service, or both associated with a particular worker's compensation claim;   automatically auditing, in real time, a compliance of the particular worker's compensation claim based at least in part on:
 i) the imported information and 
 ii) the at least one reimbursement rate; and 
   automatically generating at least one alert when the compliance of the particular worker's compensation claim is deficient.   
     
     
         25 . The computer system of  claim 24 , wherein the plurality of payers is selected from:
 insurance companies, Medicare, Medicaid, and state agencies.   
     
     
         26 . The computer system of  claim 24 , wherein the fee schedules are selected from: a usual and customary rate, an Ingenix usual rate, and a customary and reasonable rate. 
     
     
         27 . The computer system of  claim 24 , wherein the program code further performs at least the following:
 automatically calculating, in real time, for each worker's compensation claim, at least one amount of savings resulting from at least one difference between at least one price quoted by a particular provider and the at least one reimbursement rate.   
     
     
         28 . The computer system  24 , wherein the claim information further comprises:
 vi) medical codes, and   vii) descriptions of injuries.   
     
     
         29 . The computer system of  claim 28 , wherein the medical codes comprise codes selected from at least two of the following groups: injury codes, ICD codes, and procedure codes. 
     
     
         30 . The computer system of  claim 24 , wherein the automatically calculating the at least one reimbursement rate occurs in near real time.