Note: Descriptions are shown in the official language in which they were submitted.
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METHOD AND SYSTEM OF ENCODING AND PROCESSING
ALTERNATIVE HEALTHCARE PROVIDER BILLING
CROSS-REFERENCE TO RELATED APPLICATION
This application claims the benefit of U.S.
Provisional Patent Application Serial No. 60/026,048,
filed September 13, 1996.
BACKGROUND OF THE INVENTION
1. FIELD OF THE INVENTION
The present invention relates to a method and system
to standardize, encode, and process healthcare
provider billing, more particularly, a computer
assisted system for encoding, describing and
processing fee charges for specific procedures of non-
conventional medicine. The process and system
compiles provider and patient data by geographical
location, specifically by state, for any alternative
practice and produces a universal set of codes to
identify fees falling within a legal or regulatory
scope associated with a provider's practice.
2. DESCRIPTION OF THE PRIOR ART
An objective of non-conventional medicine providers
is to become enrolled into managed care networks
wherein fee prices and payment for each procedure can
be negotiated for the mutual benefit of patients,
providers and payers. However, a number of obstacles
exist.
At present, non-conventional medicine is understood
to include a wide range of types of medicine and
- professions, including, but not limited to,
alternative, holistic, complementary, or integrative
healing. Moreover, each profession as understood by
the term non-conventional medicine further varies by
state due to legislative differences in licensing and
like regulatory controls. Also, conventional payers
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of healthcare costs, such as insurance companies,
managed care organizations, Medicare and Medicaid,
etc., fail to presently understand the alternative
procedures being used by alternative professionals,
and therefore do not have the information to
underwrite health policies. Consequently, claims made
by alternative healthcare professionals are being
denied by payers.
Yet, no claims payment system exists to adequately
address these problems. The system and method
according to the present invention has been developed
to overcome each of these problems, thus providing the
benefit of permitting comparison of conventional
treatment costs to non-conventional treatments as they
diverge from well-known diagnostic codes, i.e.
International Classification of Diseases, 9th
Revision, Clinical Modification (ICD-9-CM).
The American Medical Association currently controls
the ICD-9-CM and current procedural terminology (CPT)
codes used to diagnose and to bill for conventional
medicine. These codes are an insurance industry
standard by which to bill and process medical claims
by payers. Claims payment systems, relying on
negotiations with providers for managed care
solutions, depend on these coding systems to match
charges with treatments, translate costs into
statistics to identify costs, underwrite health
insurance policies, and track patient outcomes and
patient utilization.
As alternative medicine is brought into mainstream
medicine, alternative providers have attempted to use
- these codes; but their claims are not understood by
the payers because accurate descriptions of the
services they perform do not exist therein.
Furthermore, ICD-9-CM and CPT codes do not identify
the practitioner by profession. For these reasons,
"dummy billing codes" or codes designed by individual
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payers to cope with payment for alternative treatments
have been developed by a few carriers which offer
payment benefits to alternative medicine. Likewise,
state Medicaid and workers' compensation codes have
been modified to cope with integration of acupuncture
and naturopathy into each system.
In each of these instances, the source of the
descriptions of alternative services or treatments
originate not from schools or associations of
alternative medicine which are able to properly
identify and describe each treatment, but rather from
the payers themselves. Therefore, unfortunately,
these description codes are not comprehensive and fail
to account for all services performed in the office of
an alternative provider. Therefore, no independent
system presently exists to cope with the need for the
exchange of information in this field of health care,
and none can be expected to evolve from CPT codes of
the American Medical Association, whose mission is to
promote treatments used by conventional medical
doctors and which organization is not trained to
understand alternative treatments. The present result
is that alternative health care cannot be widely used
by the existing payer systems, such as Medicare and
Medicaid, until the descriptions of treatments by
alternative practitioners is put into standardized
terminology and given corresponding codes.
As an added complication, a working system must also
incorporate the licensing and "scope of practice"
regulations of each state in order to be useful to the
payers.
Finally, alternative codes should be distinct from
CPT. Cost outcome studies with conventional
treatments depend on this distinction and are crucial
to payers to underwrite the cost of adding alternative
medicine and to meet consumer demand.
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4
Thus, the present system and method takes advantage
of the failures of the current coding system to
provide accurate data and a universal terminology for
alternative medicine in a state-specific format. By
providing a system to which the alternative healthcare
provider may attach a code to a valid description of
services, the benefit of having alternative treatments
added to insurance coverage can be attained.
No national system of encoding or processing
alternative healthcare provider billing is known in
the prior art. However, among traditional healthcare
billing systems, several methods and systems are
known. For example, U.S. Pat. No. 4,491,725, issued
January 1, 1985, to Pritchard, describes a medical
claim verification and processing system in which a
medicard is used to access a central brokerage
computer for patient information for implementation of
a method to rapidly determine an insurance claim
payment for a specified patient service. The computer
stores a code conversion table for each possible
paying insurance carrier for converting patient
treatment codes into service codes associated with a
claim payment. The end result is an increase in the
speed of processing of information, which enables the
provider and patient to rapidly assess the current
status of the payment of a claim by an insurance
carrier. Such system fails to provide a method of
encoding non-traditional types of healthcare
treatments.
Moreover, such system and others like it apply only
to preexisting systems of codes, such as CPT codes
- adopted by many insurance companies and the federal
government for Medicare reimbursement. CPT codes are
standard patient treatment codes, as set forth by the
American Medical Association and adopted by the
federal government for Medicare reimbursement claims.
As part of a more comprehensive system, CPT codes set
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forth a five digit code to identify a particular type
of procedure in each of five main procedure rubrics:
Medicine; Anesthesia; Surgery; Radiology; and
Pathology. Each code typically covers a category of
5 specific medicinal procedures, as well as other
ancillary information, such as the location of such
procedure (e. g., emergency room, outpatient office
visit, etc.) and the'duration of such visit. Such
information is requested by the payer to properly
analyze whether reimbursement of payment claims for
patient services by the provider is warranted. As
noted, the CPT codes have become highly popular and
are being adopted by insurance companies to analyze
the appropriateness of a claim for payment.
However, CPTs are, at the least, cumbersome and
expansive, and often confuse the practitioner which
CPT code to use. For example, in cases where certain
specialties perform procedures which cross many sub-
specialties, the procedures fall into more than one of
the numerated rubrics of CPT codes, and the burden on
the practitioner to learn the proper classification
becomes particularly undue.
Therefore, systems have been developed to try to
automate the function of selecting the proper CPT
code. For example, and as described in U.S. Pat. No.
5,325,293, issued June 28, 1994, to Dorne, a system to
correlate medical procedures and medical billing codes
for interventional radiology procedures includes
generating raw codes which correspond with selected
medical procedures and then analyzes the raw codes to
generate a set of intermediate codes, which account
for the interrelation of the selected medical
procedures, without altering the raw codes. The
billing codes are then generated from the intermediate
codes.
To determine appropriateness of a treatment for a
procedure, even when the procedure has been properly
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classified under a CPT code, the procedure must be
appropriate to the diagnosis before payment is made by
a payer. Another system is discussed in U.S. Pat. No.
4,667,292, issued May 19, 1987, to Mohlenbrock, et
al., wherein the use of a computer system is provided
for identifying the most appropriate billing
categories, namely Diagnosis Related Groups (DRGs), as
also set forth by the federal government for Medicare
reimbursement. The Medicare payment system requires
first encoding diagnostic (ICD-9-CMs) and procedural
(CPT) information, which steps are dependent upon
several factors, including a principal diagnosis of
the patient's problem, the procedures performed upon
the patient, the age of the patient, and the presence
or absence of any complications or co-morbidity, DRGs
are determined in part by the ICD-9-CM coding system,
which refers to a coding system based on a compatible
with an accepted, original system of classification
system provided by the World Health Organization. The
ICD-9-CM codes are used in North America, being a
classification of diseases, injuries, impairments,
symptoms, medical procedures and causes of death. The
ICD-9-CMs are initially divided into Disease and
Procedure sections. These sections are further
subdivided into subsections which encompass anywhere
from 1-999 three digit disease or 1-99 two digit
procedure code categories. Within the three digit
code categories, there can be an additional 2 or
digits to divide the codes into subcategories which
further define either or both the disease
manifestations and diagnostic procedures. There are
- approximately 15,000 ICD-9-CM codes, of which only a
fraction are useful in the Medicare payment system,
and even less are relevant to determining patient
services of alternative healthcare providers.
The Mohlenbrock et al. System is clearly only
directed at aiding in a determination which one of the
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large number of the predetermined list of payment
categories is appropriate fox reimbursement of a
provider and providing a thorough and complete billing
for maximum Medicare reimbursement under the Medicare
system. Unlike the present system and method, the
means are not directed at categorizing patient record
and provider billing information by valid terminology
and a corresponding code specific to alternative
medicine and by state scope of practice for each
provider type.
Other systems are also known for organizing medical
information into useful codes. In U.S. Pat. No.
5,002,630, issued March 19, 1991, to Wiltfong, a
business system comprising means for coding client
histories, listing plural procedures, terms or remarks
used in a specific office or business with a distinct
alphanumerical indicator. The coding of these factors
is directed to sequencing veterinary procedures most
frequently used in an office, and systemized into an
index of broad categories called a procedural index in
which each requires financial consideration to be
entered when such procedure is provided. A chain of
alphanumeric indicators can then be constructed to
identify the procedure, terms or remarks. However,
such system is directed not at systemizing the billing
external to the office, but is primarily intended as
an internal housekeeping measure.
None of the above inventions and patents, taken
either singly or in combination, is seen to describe
the instant invention as claimed.
SUI~IARY OF THE INVENTION
The present invention relates to a method and system
of encoding and processing healthcare provider
billing, more particularly, a computer assisted
network for encoding, documenting and processing
claims for a payment of specific procedures by
alternative therapy providers, grouped geographically
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and by specialty. The system employs a computer
accessing three main databases for identifying,
encoding and calculation of costs of provider
services. A resulting Alternative Billing Code (ABC)
is produced which can be compared and correlated with
insurance industry standard codes. The ABC has the
attribute of conveying multiple levels of information
through alpha-numeric characters in a consistent
manner which allows easy interpretation of the code.
The ABC is an assembly of terms from three additional
tables of terms stored in databases in the system,
namely tables of Standard Alternative Procedure
Descriptions (SAPDs), merged Provider Average Rates
(PARs) and Relative Value Units (RVUs).
The SAPD is a database of terms of standard
vocabulary and terminology used to describe
alternative treatments for communication within the
system. Expanded definitions for each SAPD will exist
in a separate subdatabase within an ABC or SAPD field
of each database for publication of the entire coding
system. The Provider Average Rate (PAR) is the
average cost for a procedure performed by a
hypothetical provider grouped by specialty and region.
The PAR is calculated by taking a sampling of groups
of at least 20 actual providers in a predetermined
profession or specialty and geographical area and
calculating an average rate for each procedure used.
The highest and lowest 10% of provider charges are
eliminated before the average rate is calculated.
RVU is a value unit given to a particular procedure,
good or service which equates any one service relative
- to the value of all other services. A conversion
factor is used to convert an RVU into a payment amount
which is acceptable to all parties, the payer and the
provider. When a provider becomes a member of a
network using the ABC, the provider agrees to a set of
conversion factors used by a payer, i.e. payment
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9
units, namely a fixed number of dollars. The relative
cost of a procedure is derived by assigning a
conversion factor for each branch of medicine,
surgery, pathology, and radiology, coded M, S, P and
R respectively. Data on existing conversion factors
based on codes that crossover between conventional
medicine and complementary medicine may be used to
establish RVU conversion factors with a payer.
However, Relative Value Units (RVUs) may also be
developed by surveying the prevalent provider service
charges in an area where no data exists. The PAR is
divided by the prevalent payer conversion factor as
negotiated and according to the terms of a Provider
Service Agreement under which a provider abides in
order to use the RVU and associated conversion factor
as offered by the payer. The conversion factor and
RVU are each stored in an RVU database which contains
every conversion factor rate for each payer as
negotiated.
To make claim for payment under the system, a claim
form from an alternative provider may be submitted by
paper or by electronic transmission to a central
database using the ABC or SAPD. The provider
identifies the payer and the state wherein the claim
for payment is filed. Such information is input into
the computer assisted system and processed so as to
retrieve from the RVU conversion factor database the
conversion factor linked with the appropriate SAPD and
policy plan, whereupon a price figure is calculated
for the associated procedure (RVU x conversion
factor). The system then checks to see if the
procedure is within the allowed scope of practice of
the provider in the state where the claim was filed.
Each provider using this system will have a list of
allowed charges for the state in which the provider
practices and a corresponding code to attach.
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The system encourages alternative providers to join
a managed care network using the ABC coding system to
ascertain rates for services by 1) providing a
provider's patient with the broadest possible coverage
5 for alternative treatment claims and 2) assuring
access by large populations subscribing to a
particular payer to member alternative providers,
thereby increasing the provider's patient base and in
turn income. If the provider is not a member of such
10 a network, any charges from the provider above the
payer's usual and customary fee schedule, or all
charges as in the case of an HMO, will become the
liability of the patient.
Accordingly, it is a principal object of the
invention to provide a comprehensive encoding system
for handling payment claims made by alternative
healthcare providers so that they have access to
managed care contracts.
It is another object of the invention to provide a
system in which provider price input conveys cost
average information of a group of peer providers,
particularly when no data otherwise exists for rates
in a given geographic location or state.
Still another object of the invention is to provide
a series of standardized terms corresponding to
training standards to thereby create the SAPD and to
organize this information so that alternative
providers, as well as payers, can retrieve the
information easily.
These and other objects of the invention will become
readily apparent upon further review of the following
- specifications and drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 is a block diagram in overview of the system
and its method of use.
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Fig. 2 is a diagrammatic representation of an
exemplary conversion table for tracking PD codes as
converted to the ABC code.
Fig. 3 is a diagrammatic representation of an
exemplary code conversion table from ABC codes of the
present invention to CPT or similar codes.
Similar reference characters denote corresponding
features consistently throughout the attached
drawings.
DETAILED DESCRIPTION OF TFiE PREFERRED EMBODIMENT
The present invention relates to a method and system
of encoding and processing healthcare provider
billing, more particularly, a computer assisted
network for encoding, documenting and processing fee
charges for specific procedures of alternative
healthcare providers, grouped geographically and by
specialty, which fee charges are further verified as
appearing within a predetermined scope of practice of
a provider as geographically grouped.
The system 10 is shown generally in overview in Fig.
1 and is named the Alternative Coding System (ACS).
The system is provided to interact with alternative
healthcare providers (herein "providers") 12, which
comprise various specialties and sub-specialties. The
table herein provides a suggested list of such
provider specialties, which range from traditional
medical arts, such as medicine by doctors and
osteopaths, which require broad certification or
licensing, and which arts are accepted by insurers as
payable for treatment claims, to non-traditional arts,
such as Homeopathy, which is currently not payable for
treatment claims by most insurers. Other arts, such
as Chiropractic, which has made a leap of acceptance
into the insurance industry payment system, are
included as well.
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TABLE
Accupressure Pain Management
Acupuncture Personal Fitness
Training
Alexander Technique Physical Therapy
Applied Kinesiology Polarity
Aromatherapy Psychiatry
Art Therapy Psychology
Aston Patterning Psychic Healing
Athletic Training
Psychoneuroimmunology
Ayurveda Psychotherapy
Bioenergetics Qi Gong
Breath Work Reflexology
Chelation Reichian Therapy
Chinese Massage (Body & Mind)
Chiropracty Rolfing
Crystal Healing Rosen Method
Colonic Therapy Sex Therapy
Communication Therapy Shamanism
Craniosacral Therapy Shiatsu
Curanderas/Sobendoras Sleep Disorders
Dance Therapy Social Work
Holistic Dentistry Sound Therapy
Dream Therapy Sports Therapy
Drama Therapy Spiritual Healing
Faith Healing Stress Management
Feldenkrais Structural Integration
Functional Integration Substance Abuse
Guided Imagery Tai Chi
Hakomi Therapy Touch for Health
Health Food Stores Therapeutic Touch
Hellerwork Trager Work
Herbal Medicine Transition
Holistic Medicine (Death Counseling)
Home Health Care Tui Na
Homeopathy Water (Pool) Therapy
Hospice Holistic Wellness
Medicine
Hypnotherapy Yoga Therapy
Iridology Massage Therapy
Midwifery Music Therapy
Naturopathy Neuromuscular Therapy
Nutrition Counseling Native American
Healing
Neurolinguistic Programming 0 r i a n t a 1 / C
h i n a s a
Medicine
Osteopathic Medicine
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The list, although not comprehensive, is the basis
fox an encoding procedure yielding a multi-level and
user-friendly code, called ABC (Alternative Billing
Code) 34 generated by the system 10 through a series
of encoding steps. The encoding process includes a
series of steps 32,36,38,52,54,57, each step encoding
terms to represent cost input and code reports from
any provider by state and zip code.
Unlike CPT codes, the ABC has the attribute of
consistency in its assemblage whereby it can convey
information through alpha-numeric characters and hence
multiple levels ~of information. Such code is
generally described as an assembly of a series of
terms and sub-terms chosen from four tables, namely
tables of Alternative Practice Type (APT),
Standardized Alternative Procedure Descriptions
(SAPD), PD (Provider Data), and Relative Value Units
(RVU), each stored in databases 14,16,20,22 of the
system. The RVU database 22 is generated from
calculations from the provider enrollment packet as
grouped by specialty and region and is therefore
included as a subdatabase within the PD database 20.
For example, each specialty listed on the Table
defines a general provider category into which
specific treatment or procedures may fall, each
category having an alphabetic code term assigned to
it, such as CH for Chiropractic. Thus, a rubric is
created and designated by the code "CH" for all
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chiropractic procedure charges. This two-letter code
allows the system to isolate all procedures within the
scope of practice (SOP) of chiropractors. This
provides the basis of the Alternative Practice Type
(APT) table. Therefore each APT table would, for
example, contain a listing for the rubric of
Chiropractic, "CH," or Midwife "MW," thereby defining
a category by which the system separates other
information, such as cost averages and scope of
practice, relevant to each profession or specialty.
Because present medical terminology is inadequate
for the breadth of terminology needed to adequately
define each of the procedures and the like of
alternative healthcare, each of the specialties may
form associations to help implement, evaluate, modify
or otherwise present suggested code terms,
abbreviations, lists of procedures, apparatus, health
foods, and other details of treatment regarding their
own specialty. As in traditional medicine having
CPTs, the resulting table, the SAPD table, stored in
the SAPD database 16 of the system, is a comprehensive
listing of procedures, apparatus and professions and
the like for each specialty and for each category of
APT.
Referring again to Fig. 1, the Alternative Coding
System (ACS) 10 includes an operable computer system
having components of any platform type having
programmable memory and a central processing unit
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(cpu). In the computer system, the APT tables are
stored in and retrievable from the APT database 14 and
the SAPD tables are stored in and retrievable from
SAPD database 16. Thus, when a patient from the
5 patient pool 8 is seen by a provider 12, a claim form
18 for payment of services and treatment as provided
by a participating specialist is submitted to ACS 10
for encoding. At later stages of development of ACS
use, it is foreseen that each provider 12 is provided
10 with electronic means to communicate with ACS, either
by computer terminal with remote communications means
such as modem, or Internet e-mail. Such connections
would provide interactive means for communicating
appropriate code term information such that the
15 encoding process may begin in the provider's office.
Thus, such claim form 18 may be submitted either in
the traditional hard copy from sent by mail or the
like, or by remote electronic communications means
such as by the Internet.
To become a participating specialist, a provider may
apply to ACS and be provided with a membership code
(or the PD code as shown in block 26) for storage in
the Provider Data (PD) database 20. The membership
code contains various information based upon a minimum
disclosure by the provider of name, specialty and
regional location information, preferably by zip code
of the principal office address. For example, a
representative code would appear MT88046, in which the
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term "MT" represents the specialty, massage therapy,
as chosen from the APT database 14 and resulting from
the input raw data step 32. The term 88046 is the zip
code attached to the APT code, thus forming a link in
the chain of terms forming the provider membership
code.
The zip code portion of the membership code stored
in the PD database 20 is the basis for subsequent
comparison of scope of practice codes defining the
limits of allowable fees and regulated procedures as
legislated from state to state. The state scope of
practice is identified by any suitable codes defining
such scope, and includes a zip code identifying
portion and is stored in the SOP database 63. The zip
code portion of the membership codes subsequently
encoded onto the incoming claims entered at the input
step 32 are then correlated with the zip code portions
of the scope of practice database 63 in order to
establish proper claims payment. This step of the
encoding process may occur at any point in the
processing of a claim after the membership code has
been established and correlated with the service or
procedure claimed, such as suggested by block 57.
When a participating provider accesses ACS 10, the
claim form 18 having raw information including both
the patient information and the minimum provider
information or data (including provider fee, or in the
alternative, an RW adjusted amount claimed for each
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service rendered) is input for translation (at 32)
into an encoded form. Means for inputting the raw
information is provided, which may include a keyboard
or scanning means. The cpu is programmed to store
such information in an appropriate memory file and
access the databases 14,16. The APT database 14 is
accessed and provider specialty is matched to the
appropriate APT code and retrieved 38. Likewise, the
patient treatment by procedure or prescribed apparatus
is matched to the appropriate SAPD code which is
retrieved 38 and encoded to the claim. Having
retrieved the appropriate code terms, the code terms
are sequentially linked by the central processing unit
to form an intermediate code term comprising the
portion of the ABC 34 including the SAPD and APT. In
the previously noted example and referring momentarily
to Fig. 2, the intermediate code term portion may be
"CH" 24 for the SAPD code 29 for a chiropractic spinal
manipulation. A stringed code portion of the final PD
code, including category and sub-category, is thus
generated.
The stringed code terms are input into the PD
database 20 and a PD file is created for each
combination of diagnosis and procedure for use with
the following steps. The PD database 20 contains all
PD files for retrieval and calculation of a cost
average of the total claims presented for a specific
SAPD and APT combination grouped by provider specialty
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18
and location. The cpu is programmed to group each
provider by the regional location of the provider 52,
preferably by using zip code or state and its
associated code, and by specialty 54, according to the
APT code. Thus, for example, a claim submitted for
payment may be the chiropractic spinal manipulation,
which is stored in a PD file.
The claim associated with it for payment may be, for
example, $24. As calculated in the system (step 58)
according to the appropriate formula, RW x conversion
factor = payment amount, or 4 x $6 = $24, the twenty-
four dollar charge for payment of the claim is then
compared with the remaining PD files for providers as
encoded for a predetermined region matching the claim
code. The predetermined region may be identified by
zip code or by a broader region including numerous zip
codes, or alternatively, in a sub-region by RVLT
conversion factor for the carrier. Thus, if the
conversion factor is $6 as negotiated for the New
Mexico region, the system is programmed to multiply $6
x RW. The claimed payment of $24 matches the formula
calculation and is therefore payable, which
information is stored in the PD file generated at
block 26. Using this system, claims payment
determinations by third-party payers may also be made
based upon this information.
The system at step 58 also calculates a Provider
Average Rate (PAR) , which is the average cost for a
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procedure performed by a hypothetical provider grouped
by specialty and region. The PAR is calculated by
taking a sampling of groups of at least 20 actual
providers in a predetermined profession or specialty
and geographical area and calculating an average rate
for each procedure used, as based on inputted claims
information. The highest and lowest 10% of provider
charges are eliminated before the average rate is
calculated. This information is stored in the PAR
database 61.
Upon calculation of the cost, the PD file of step 26
is now processed to combine the SAPD, and APT (from
blocks 42, 44, 46) to yield the ABC 34, a single code
that represents all the necessary elements incident to
treatment. Clearly, each portion of the alphanumeric
codes, as discussed above, may be associated into a
string having a consistently organized and standard
format, which is repeated for each SAPD and APT to
provide an intuitive and user-friendly code.
Such ABC is used to provide insurance carriers and
other third-party payers (at 50) with the PD code
portion and other encoded cost data for payment of the
provider's claim 18. However, as such insurance
- carriers are generally not familiar internally with a
method of processing alternative healthcare provider
claims, a conversion table is necessary to convert the
ABC 34 to the traditionally accepted forms of coding,
such as CPTs. The relative cost of a procedure is
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typically derived by assigning a conversion factor for
each branch of medicine, surgery, pathology, and
radiology, coded M, S, P and R respectively.
Therefore, a conversion database 40 is provided
5 containing a table of corresponding CPT and ICD-9-CM
codes to help the payer translate the information from
the ABC, shown by the "AM" designation representing an
"alternative medicine" code in Fig. 3.
The present ACS encoding system 10 is compatible
10 with such typical format. Fig. 2 is the code
conversion table 70 used in tracking individual
procedure costs used in building the ABC, shown at 34.
In the left column, each of the PD codes 26 are listed
as the standard patient treatment codes for each
15 provider type.
Entire ABC codes 34 may be listed in which the PD code
is included, shown in the right column. To convert
this information to a useful format familiar to an
insurance carrier, Fig. 3 illustrates a code
20 conversion table 74 for a particular insurance
carrier. The ABC codes 34 can be converted by means of
such conversion table 74 into a specific RW and
conversion factor codes of a given insurance carrier.
Upon review of each table, the insurance carrier can
thus correlate the right column of the conversion
table 70 (exclusively for use with alternative
medicine) with the appropriate service code numbers
CA 02308275 2000-04-26
WO 99/23589 PGT/US97/19419 ~~
21
(CPT codes) 72 of the left column of the conversion
table 74 as used by the insurance industry.
Ultimately, claims processing fees may pass along a
cost operating the ACS system plus reasonable prof its .
A set user fee may be charged to the provider to
process claims.
It is understood that the present invention is not
limited to the sole embodiment described above, but
encompasses any and all embodiments within the scope
of the following claims.
