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1. 发明授权

US08666787B2 Method and apparatus for repricing a reimbursement claim against a contract 有权
标题翻译：对合同重新定价报销索赔的方法和设备
公开(公告)号：US08666787B2
公开(公告)日：2014-03-04
申请号：US13709141
申请日：2012-12-10
申请人： TriZetto Corporation
发明人： Mark Lesswing , Dale Hoerle
IPC分类号： G06Q40/00
CPC分类号： G06F19/328 , G06Q10/10 , G06Q40/00 , G06Q40/04 , G06Q40/08 , G06Q50/22
摘要： 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.
摘要翻译：本文提供了根据至少一项合同重新定价报销索赔的方法。该方法可以包括步骤的组合，例如：将每个合同转换成一系列合同术语; 将索赔转为一系列索赔行，其中包含索赔代码，单位号码和索赔代码的相应费用; 比较索赔代码和合同条款，并确定其间的匹配; 确定与匹配合同条款相关联的任何优先级条件，并消除优先条件排除的任何匹配合同条款; 通过确定未排除的匹配合同条款的报销费用来计算索赔的报销金额; 并根据整个报销金额的任何折扣条件来确定和进行任何调整。

2. 发明授权

US10262374B2 System and method for processing payment bundles 有权
公开(公告)号：US10262374B2
公开(公告)日：2019-04-16
申请号：US14277037
申请日：2014-05-13
申请人： TriZetto Corporation
发明人： Jay Sultan , Howard Downs , Dale Hoerle
IPC分类号： G06Q50/22 , G06F19/00 , G06Q20/00 , G06Q40/08
摘要： A system and process for prospectively creating patient episodes of care and triggering associated payment bundles during the claim adjudication process facilitates real-time claim pricing in accordance with payment bundle rules to facilitate episodic payment in place of pay-for-service payment. Additionally, various processes are described for modeling patient episodes and payment bundles and unbundling episodic payments.

3. 发明申请

US20140067417A1 Novel Method and Apparatus For Repricing a Reimbursement Claim Against a Contract6 审中-公开
标题翻译：重新定价合同偿还索赔的新方法和设备6
公开(公告)号：US20140067417A1
公开(公告)日：2014-03-06
申请号：US14079627
申请日：2013-11-13
申请人： TriZetto Corporation
发明人： Mark Lesswing , Dale Hoerle
IPC分类号： G06F19/00
CPC分类号： G06F19/328 , G06Q10/10 , G06Q40/00 , G06Q40/04 , G06Q40/08 , G06Q50/22
摘要： 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.
摘要翻译：本文提供了根据至少一项合同重新定价报销索赔的方法。该方法可以包括步骤的组合，例如：将每个合同转换成一系列合同术语; 将索赔转为一系列索赔行，其中包含索赔代码，单位号码和索赔代码的相应费用; 比较索赔代码和合同条款，并确定其间的匹配; 确定与匹配合同条款相关联的任何优先级条件，并消除优先条件排除的任何匹配合同条款; 通过确定未排除的匹配合同条款的报销费用来计算索赔的报销金额; 并根据整个报销金额的任何折扣条件来确定和进行任何调整。

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