Medical claim database relationship processing

Abstract

A method for data processing of remotely collected medical claims billing data collects medical claim data and insurance claim processing data from remote databases over a network system. A plurality of visual dashboards on a computerized graphical user interface of a plurality of user computers are connected to a server for viewing a claims worklist generated from the medical claim data and the insurance claim processing data. At least one claim is requested from the claims worklist using the visual dashboard of the computerized graphical user interface of at least one of the plurality of user computers. An action is executed on the at least one claim using the at least one of the plurality of user computers, wherein the action comprises transmission of claim action data to the at least one remote insurance database using the network system.

What is claimed is: 
     
         1 . A method for data processing of remotely collected medical claims billing data using a computerized system having a processor and a non-transitory memory, the method comprising:
 electronically collecting, on a server, multi-field medical claim data from a relational, subject-oriented database over at least one electronic network system, the multi-field medical claim data having been submitted to a payer entity, wherein the multi-field medical claim data has at least an external claim identifier;   electronically collecting, on the server, multi-field insurance claim processing data from at least one remote insurance database over the at least one electronic network system, wherein the multi-field insurance claim processing data is correlated to the multi-field medical claim data based on the external claim identifier;   providing a plurality of visual dashboards on a computerized graphical user interface of a plurality of user computers connected to the server for viewing a claims worklist generated from the collected multi-field medical claim data and the collected multi-field insurance claim processing data, each of the plurality of visual dashboards viewable and interactable by a user;   requesting at least one claim from the claims worklist using the visual dashboard of the computerized graphical user interface of at least one of the plurality of user computers; and   executing an action on the at least one claim using the at least one of the plurality of user computers, wherein the action comprises transmission of claim action data to the at least one remote insurance database using the at least one electronic network system.   
     
     
         2 . The method of  claim 1 , further comprising selecting the action from a populated list of claim actions displayed on the visual dashboard, wherein the populated list of claim actions is based on historical claim action data. 
     
     
         3 . The method of  claim 2 , wherein the populated list of claim actions is correlated to the collected multi-field medical claim data and the collected multi-field insurance claim processing data based on at least one correlation factor, wherein the at least one correlation factor is one or more of: an identity of a payer of a claim of the multi-field medical claim data, a medical clinic originating the medical claim, a medical claim code, or a payment denial reason code. 
     
     
         4 . The method of  claim 2 , wherein executing the action on the at least one claim using the at least one of the plurality of user computers further comprises recording textual data describing at least a portion of steps taken during execution of the action. 
     
     
         5 . The method of  claim 4 , wherein the populated list of claim actions displayed on the visual dashboard is further based on the recorded textual data. 
     
     
         6 . The method of  claim 2 , wherein the populated list is searchable using at least one of:
 textual keyword or alphanumerical code.   
     
     
         7 . The method of  claim 2 , wherein after executing the action, a user provides a rating of a selected claim action from the populated list of claim actions. 
     
     
         8 . The method of  claim 1 , wherein the external claim identifier comprises one or more of: a medical clinic originating the multi-field medical claim data; a payer of a claim for the multi-field medical claim data; a payment denial reason code; or an age of the at least one claim. 
     
     
         9 . The method of  claim 1 , wherein a payer is associated with each remote insurance database, wherein an identifier of the payer is standardized and canonically mapped within a database on the server. 
     
     
         10 . The method of  claim 1 , wherein the claims worklist is generated based on one or more of: a medical clinic originating the multi-field medical claim data; an age of the at least one claim; a payer of a claim for the multi-field medical claim data; a monetary claim balance; or a history of work on the at least one claim. 
     
     
         11 . A system for data processing of remotely collected medical claims billing data using a computerized system having a processor and a non-transitory memory, the system comprising:
 a plurality of billing computer devices having a processor and non-transitory computer-readable memory;   a server having a processor and non-transitory computer-readable memory, the server accessible over at least one network system by the plurality of billing computer devices;   a relational, subject-oriented database containing multi-field medical claim data, wherein the multi-field medical claim data is electronically collected on the server over at least one electronic network system, the multi-field medical claim data having been submitted to a payer entity, wherein the multi-field medical claim data has at least an external claim identifier;   at least one remote insurance database containing multi-field insurance claim processing data, wherein the multi-field insurance claim processing data is electronically collected on the server over the at least one electronic network system, wherein the multi-field insurance claim processing data is correlated to the multi-field medical claim data based on the external claim identifier; and   a billing management application running at least partially on the server and accessible by the plurality of billing computer devices, wherein each of the plurality of billing computer devices has a visual dashboard on a computerized graphical user interface which is connected to the server for viewing a claims worklist generated from the collected multi-field medical claim data and the collected multi-field insurance claim processing data, wherein each of the plurality of visual dashboards viewable and interactable by a user, and wherein the billing management application:
 requests at least one claim from the claims worklist using the visual dashboard of the computerized graphical user interface of at least one of the plurality of user computers; and 
 executes an action on the at least one claim using the at least one of the plurality of user computers, wherein the action comprises transmission of claim action data to the at least one remote insurance database using the at least one electronic network system. 
   
     
     
         12 . The system of  claim 11 , further wherein the action is selected from a populated list of claim actions displayed on the visual dashboard, wherein the populated list of claim actions is based on historical claim action data. 
     
     
         13 . The system of  claim 12 , wherein the populated list of claim actions is correlated to the collected multi-field medical claim data and the collected multi-field insurance claim processing data based on at least one correlation factor, wherein the at least one correlation factor is one or more of: an identity of a payer of a claim of the multi-field medical claim data, a medical clinic originating the medical claim, a medical claim code, or a payment denial reason code. 
     
     
         14 . The system of  claim 12 , wherein during execution of the action on the at least one claim using the at least one of the plurality of user computers, textual data describing at least a portion of steps taken is recorded. 
     
     
         15 . The system of  claim 14 , wherein the populated list of claim actions displayed on the visual dashboard is further based on the recorded textual data. 
     
     
         16 . The system of  claim 12 , wherein the populated list is searchable using at least one of: textual keyword or alphanumerical code. 
     
     
         17 . The system of  claim 12 , wherein after executing the action, a user provides a rating of a selected claim action from the populated list of claim actions. 
     
     
         18 . The system of  claim 11 , wherein the external claim identifier comprises one or more of: a medical clinic originating the multi-field medical claim data; a payer of a claim for the multi-field medical claim data; a payment denial reason code; or an age of the at least one claim. 
     
     
         19 . The system of  claim 11 , wherein a payer is associated with each remote insurance database, wherein an identifier of the payer is standardized and canonically mapped within a database on the server. 
     
     
         20 . The system of  claim 11 , wherein the claims worklist is generated based on one or more of: a medical clinic originating the multi-field medical claim data; an age of the at least one claim; a payer of a claim for the multi-field medical claim data; a monetary claim balance; or a history of work on the at least one claim.