Vaughn C Cecil, 73281 Red Williams Rd, Crossville, TN 38571

6343271, Jan 29, 2002

Jul 17, 1998

09/118668

Brian E. Peterson - Salt Lake City UT
Vaughn C. Cecil - Crossville TN
Wayne A. Provost - Salt Lake City UT

P5 e.Health Services, Inc. - Salt Lake City UT

G06F 1760

705 4, 705 2

A claims processing system for electronically reviewing and adjudicating medical insurance claims. The claims processing systems include a benefits system, an automated adjudication system, a payment system, and a payment tracking system. The benefits system allows patients and health care providers to access patient and benefits information on-line. Using the automated adjudication system, health care providers may electronically prepare and submit claims for payment. Before a claim is submitted, a claims precheck process is used to determine whether the claim may be automatically adjudicated or instead must be manually adjudicated. If manual adjudication is indicated, the health care provider may the claim in an effort to achieve automated adjudication prior to claim submission. The claims processing system performs automatic adjudication on submitted claims or forwards the claims to a shop for manual adjudication. The payment system initiates payment to the health care provider using electronic funds transfer.

7194416, Mar 20, 2007

Nov 28, 2000

09/724097

Wayne A. Provost - Salt Lake City UT, US
Vaughn C. Cecil - Crossville TN, US
Brian E. Peterson - Salt Lake City UT, US

P5, Inc. - Salt Lake City UT

G06Q 40/00
G06Q 99/00

705 4, 7071041

Methods and systems for interactively creating and submitting insurance claims and determining whether the submitted claims are in condition for payment by an insurer. A medical technician operating a client computer establishes communication with a remote server. The remote server transmits a claim form to the client computer for display to the medical technician. Using the claim form, the technician enters patient identification information, which is transmitted to the server to determine whether the patient is a beneficiary of an approved insurance plan. If the patient is a beneficiary, the technician can prepare an insurance claim using the claim form displayed by the client computer. The technician enters a diagnosis code and a treatment code representing the diagnosis and treatment of the patient. The diagnosis and treatment codes are transmitted to the remote server, which processes the codes to determine whether the claim corresponds to health care services that are approved for payment. If the insurance claim is not in condition for payment, the medical technician is notified.

2002001, Feb 14, 2002

Sep 14, 2001

09/952568

Brian Peterson - Salt Lake City UT, US
John Kwant - Midvale UT, US
Vaughn Cecil - Crossville TN, US
Wayne Provost - Salt Lake City UT, US

G06F017/60

705/004000

Claims processing systems for electronically reviewing and adjudicating medical insurance claims. The claims processing systems include a benefits system, an automated adjudication system, a payment system, and a payment tracking system. The benefits system allows patients and health care providers to access patient and benefits information online. Health care providers may electronically receive partially completed claim forms containing patient and benefit information. Health care providers complete the claim forms with proposed health care treatment information and check whether the proposed claim qualifies for automated adjudication. The health care provider may amend unqualified claims in an effort to achieve automated adjudication prior to claim submission. The claims processing system performs automated adjudication on qualified claims. The payment system initiates payment to the health care provider using electronic funds transfer. The payment tracking system allows health care providers to monitor the payment status of a claim after submission.

2013031, Nov 28, 2013

May 23, 2013

13/901410

Vaughn Cecil - Provo UT, US

G06Q 40/08

705 4

A system and method for processing an appeal of an insurance claim is disclosed. The method involves a computer implemented process of receiving information about of a denied insurance claim, preparing the appeal, and generating a webpage that provides status information about the appeal to the parties to the appeal. The generated webpage can also provide an option to submit the appeal to an external appeals body when an internal appeals body has ruled unfavorably. Accordingly, the present invention can provide a single interface where an insured can submit appeals in a standard manner to facilitate the process of preparing and submitting appeals of denied insurance claims.

6341265, Jan 22, 2002

Dec 3, 1998

09/204886

Wayne A. Provost - Salt Lake City UT
Vaughn C. Cecil - Crossville TN
Brian E. Peterson - Salt Lake City UT

P5 e.Health Services, Inc. - Salt Lake City UT

G06F 1760

705 4, 705 2

Methods and systems for interactively creating and submitting insurance claims and determining whether the submitted claims are in condition for payment by an insurer. A medical technician operating a client computer establishes communication with a remote server. The remote server transmits a claim form to the client computer for display to the medical technician. Using the claim form, the technician enters patient identification information, which is transmitted to the server to determine whether the patient is a beneficiary of an approved insurance plan. If the patient is a beneficiary, the technician can prepare an insurance claim using the claim form displayed by the client computer. The technician enters a diagnosis code and a treatment code representing the diagnosis and treatment of the patient. The diagnosis and treatment codes are transmitted to the remote server, which processes the codes to determine whether the claim corresponds to health care services that are approved for payment. If the insurance claim is not in condition for payment, the medical technician is notified.