annuity and insurance administration, and others

US 5291398 Method and system for processing federally insured annuity and life insurance investments

Abstract

The method and system for electronically processing transactional data and monitoring annuity funds includes identifying and storing annuity fund data, customer data, annuity beneficiary data, and banking institution data. Banking institutions which hold non-annuity funds for a particular annuity beneficiary are classified as non-available banking institutions for that beneficiary. The system sums all annuity funds identified with a single annuity beneficiary and designated for certificates of deposits issued by one of the banking institutions that is not classified as a non-available banking institution. If the sum exceeds the predetermined fund limit, that identified banking institution is classified as a non-available banking institution for that particular annuity beneficiary. The system then commands the transfer of all additional annuity funds identified with that single annuity beneficiary to another banking institution that is an available institution. In a preferred embodiment, the system generates various reports showing available banking institutions for each annuity beneficiary, non-available banking institutions for each annuity beneficiary, and the sum of all annuity funds for each respective annuity beneficiary that are provided by a corresponding customer. The method and system also stores and processes information regarding purchased certificates of deposit (CDs) and the due dates of those CDs such that when a particular CD becomes due and the principal is returned to the annuity company, the system declassifies the issuing banking institution from non-available to available for a particular annuity beneficiary or group of beneficiaries.

US 4987538 Automated processing of provider billings

Abstract

The inclusion of computer capability to process Workers' Compensation claims wherein a complexity of administrative rules determine maximum allowable benefits, the processing of which is not feasible for manual processing. The rules are converted to computer computations entered into the computer's memory. A computer process is devised to systematically examine the rules as they apply to a specific billing. In particular, the various modifiers that affect the allowable pay out are determined through this computer processing. Pre-stored information on prior billings for the same injury is considered for further modification of the allowable billing amount.

BACKGROUND OF THE INVENTION This invention has particular application to medical billings made against Workers' Compensation Insurance. Injuries and/or illnesses that occur on the job and are job related (hereafter collectively referred to as injuries) are typically covered under state sponsored Workers' Compensation Insurance. Professional persons, e.g. physicians, chiropractors, etc. (hereafter collectively referred to as providers) who treat such injured persons are required to abide by a set of administrative rules derived specifically to maintain control over costs under Workers' Compensation Insurance benefits. The rules necessarily deal with all the different types of services provided and the many variables or complications that may develop with any one injury occurrence, which may comprise a combination of injuries. The rules are intended to be all encompassing and adaptable to varying conditions. For example, the rules recognize that more than one doctor may beneficially participate in an operation. On the other hand, only one operating room will be used, one set of attendants, etc. Also, one doctor will more than likely provide follow-up examinations. Thus, as compared to a similar surgery performed by one doctor, the acceptable charges are different and they are not simply doubled just because two doctors are in attendance. The above is but a very simple example of how the rules vary for determining payment on billings filed against Workers+ Compensation Insurance. Heretofore billings submitted by professional providers (e.g. physicians) for Workers+ Compensation Insurance benefits (numbering in the dozens per day), were divided among insurance company employees who had the responsibility for the accuracy of those billings. Literally hundreds of rules are applicable and should be considered when processing the billings. Whereas the administrative rules are provided in written form in rule books which are readily available, the first requirement for effectively processing a billing is to be able to recognize when an exception to a general or basic rule exists, and exceptions are frequent. To have to go digging through the rule books when an exception is even suspected creates a log jam of unprocessed billings or requires so many processors as to render the solution more painful than the problem. Other problems can be cited but the unavoidable result was that due to the sheer complexity of the rules thousands of dollars were likely paid out daily in excess of the acceptable amount. This situation occurred without any question of integrity or competency. It was simply a product of expedience.  BRIEF DESCRIPTION OF THE INVENTION The solution to the dilemma, i.e. of overpaying on provider billings is accomplished in the present invention by involving the absolute memory and speed of a computer. The hundreds or thousands of variables applicable under the administrative rules was itemized, organized and converted into codes adaptable for software programming. The software was then developed to enable the computer to receive certain basic information, i.e. identification of the claim (based on a prior approval of insurance coverage), the identification of the provider, the treatment that was administered, and such further information as may be considered pertinent, e.g. provider billing date, date of treatment, and the like. From that information a search is conducted through the network of rules in a manner organized to determine the applicable rules, and from the rules, a determination of the maximum allowable payment for the provider billing. The above basic information is typically available from insurance billing forms prepared by the attending provider, e.g. a physician. The claim identification (which could consist of simply the patient name and date of injury) enables the computer to check its memory bank for other billings submitted for that same injury. This may or may not be pertinent as determined by the rules. The provider identification and the treatment provided enables the computer to determine that the provider is a qualified "professional" and what rules apply to the specific treatment provided. The rest is a matter of computation. Certain basic rules in combination determine the basic maximum allowable payment which is then modified by any modifying rules that are applicable. The invention will be more clearly understood and appreciated by reference to the following detail disclosure and the drawings referred to therein.