System and method for managing requests for medical transportation

Abstract

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.

What is claimed is: 
     
         1 . A system for managing requests for medical transportation, comprising:
 a plurality of service level rules stored in computer readable media, 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;   a plurality of business rules stored in computer readable media, the business rules including rules expressing associations between locations of transportation and contractual transportation performance standards; and   a rules engine for applying said service level rules to received information relating to requested transportation to determine a service level for said requested transportation and for applying said business rules to received information to determine performance standards for said requested transportation.   
     
     
         2 . The system claimed in  claim 1 , wherein, if said received information is sufficient to determine a service level in accordance with said service level rules, the system determines a service level in accordance with said received information, and
 if said received information is not sufficient to determine a service level, the system displays on a user interface a request for additional information that is needed to determine a service level.   
     
     
         3 . The system claimed in  claim 1 , wherein said contractual transportation performance standards comprise response times for providing requested transportation. 
     
     
         4 . The system claimed in  claim 1 , wherein said business rules further include rules representing contractual provisions governing responsibility for a cost of requested transportation, and
 wherein the rules engine applies said business rules to information relating to said requested transportation to determine responsibility for a cost of the requested transportation.   
     
     
         5 . The system claimed in  claim 4 , 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. 
     
     
         6 . The system claimed in  claim 4 , 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.   
     
     
         7 . The system claimed in  claim 6 , 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. 
     
     
         8 . The system claimed in  claim 6 , 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.   
     
     
         9 . The system claimed in  claim 8 , 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. 
     
     
         10 . The system 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.   
     
     
         11 . A call center system for handling telephone calls from callers located in one or more geographic locations requesting medical transportation, comprising:
 a server comprising a rules engine for applying service level rules and business rules to information received from a caller regarding requested transportation; and   a call center agent computer communicating with said server, said computer displaying user interfaces for receiving information obtained by a call center agent from a caller regarding requested transportation and for displaying information determined through application of said service level rules and business rules to received information,   wherein the service level rules include rules expressing service level regulations that are applicable to locations served by the call center, and the system applies the service level rules to information regarding requested transportation to determine a service level for the requested transportation in accordance with regulations applicable at a location of a patient to be transported, and   wherein the business rules include rules representing contractual provisions applicable to transportation of patients served by the call center, and the system applies the business rules to information regarding requested transportation to determine at least one of a performance standard for the requested transportation, responsibility for a cost of the requested transportation, authority of a caller to change a service level determined by the system for the requested transportation, authority of a caller to change a performance standard determined by the system for the requested transportation, and responsibility for the cost of the requested transportation upon a change of a service level or performance standard.   
     
     
         12 . The system claimed in  claim 11 , wherein the location of the patient to be transported is determined in accordance with an access number dialed by a caller to contact the call center. 
     
     
         13 . The system claimed in  claim 11 , wherein the location of the patient to be transported is determined from location information entered by a call center agent. 
     
     
         14 . The system claimed in  claim 11 , further comprising a call management application for receiving information from a caller regarding requested transportation using the caller's telephone keypad, said information including at least one of a member id of a patient for whom transportation is requested, a facility id indicating a facility from which the call is placed, and an indication of whether emergency transportation is required. 
     
     
         15 . The system claimed in  claim 14 , wherein interaction of said call management application with said caller is customized in accordance with an access number dialed by said caller to contact the system. 
     
     
         16 . The system claimed in  claim 11 , further comprising a greeting module for receiving information identifying a type of a caller and for determining a contract applicable to the requested transportation. 
     
     
         17 . The system claimed in  claim 11 , further comprising a location module for receiving information identifying a location from which said requested transportation is to originate and a destination of said requested transportation. 
     
     
         18 . The system claimed in  claim 17 , wherein said location module further receives information identifying a type of a facility from which said requested transportation is to originate and a type of a destination facility of said requested transportation. 
     
     
         19 . The system claimed in  claim 11 , further comprising a patient information module for searching for and displaying information stored by the system relating to the patient to be transported and for entering information relating to the patient. 
     
     
         20 . The system claimed in  claim 11 , further comprising a service level determination module for presenting questions to a call center agent requesting information required to generate a service level determination for requested transportation, for receiving requested information and for presenting a service level determined in accordance with said requested information.