U.S. patent application number 10/628538 was filed with the patent office on 2004-02-05 for credentialer/medical malpractice insurance collaboration.
This patent application is currently assigned to The Premium Group, Inc.. Invention is credited to Martin, David A., Montgomery, David R..
Application Number | 20040024618 10/628538 |
Document ID | / |
Family ID | 23329185 |
Filed Date | 2004-02-05 |
United States Patent
Application |
20040024618 |
Kind Code |
A1 |
Martin, David A. ; et
al. |
February 5, 2004 |
Credentialer/medical malpractice insurance collaboration
Abstract
An inventive process is disclosed for linking credentialing
information with a medical malpractice insurance application. The
credentialing information is automatically transferred from the
credentialing questionnaire to an insurance application, and this
credentialing information is then used to generate a medical
malpractice insurance policy. The medical malpractice insurance
policy is a two year policy, in order to coincide with the required
re-credentialing of the healthcare provider. The inventive process
also includes linking an information database, not created for
insurance purposes, with an insurance application.
Inventors: |
Martin, David A.;
(Bentleyville, OH) ; Montgomery, David R.;
(Hudson, OH) |
Correspondence
Address: |
Daniel A. Thomson
4421 Ranchwood Spur
Akron
OH
44333-1343
US
|
Assignee: |
The Premium Group, Inc.
|
Family ID: |
23329185 |
Appl. No.: |
10/628538 |
Filed: |
July 28, 2003 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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10628538 |
Jul 28, 2003 |
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09339479 |
Jun 24, 1999 |
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Current U.S.
Class: |
705/2 ;
705/4 |
Current CPC
Class: |
G06Q 40/02 20130101;
G16H 10/20 20180101; G06Q 10/10 20130101; G06Q 40/08 20130101 |
Class at
Publication: |
705/2 ;
705/4 |
International
Class: |
G06F 017/60 |
Claims
I claim:
1. A process of linking credentialing information with a medical
malpractice insurance application, the process comprising the steps
of: providing a physician, a credentialing entity, and a medical
malpractice insurance participant; providing a questionnaire for
use in compiling credentialing information concerning the physician
to create a first credentialing application, the questionnaire
including means for obtaining the physician's permission for
release of the credentialing information to the medical malpractice
insurance participant; forwarding the questionnaire from the
credentialing entity to the medical malpractice insurance
participant if the physician gave permission for release of the
credentialing information; providing the physician with at least
one insurance premium quote generated by the medical malpractice
insurance participant for use in generating a medical malpractice
insurance policy for the physician based at least in part on the
credentialing information; preparing a medical malpractice
insurance application for the physician; transferring at least a
portion of the credentialing information from the questionnaire to
the medical malpractice insurance application; completing the
formation of the medical malpractice insurance application;
delivering the medical malpractice insurance application to the
physician for the physician's review and approval; generating the
medical malpractice insurance policy to coincide with subsequent
credentialing applications for the physician; transferring the
credentialing information from the medical malpractice insurance
policy to the subsequent credentialing application; generating a
subsequent credentialing application; and, sending the subsequent
credentialing application to a healthcare organization to which the
physician must provide the credentialing information.
2. A process of linking credentialing information with a medical
malpractice insurance application, the process comprising the steps
of: providing a healthcare provider, a credentialing entity and a
medical malpractice insurance participant; providing credentialing
information concerning the healthcare provider to the credentialing
entity; forwarding at least a portion of the credentialing
information from the credentialing entity to the medical
malpractice insurance participant; and, transferring the at least a
portion of the credentialing information to a medical malpractice
insurance application.
3. The process of claim 2, wherein after forwarding at least a
portion of the credentialing information from the credentialing
entity to the medical malpractice insurance participant, the
process comprises the step of: providing the healthcare provider
with at least one insurance premium quote for a medical malpractice
insurance policy generated by the medical malpractice insurance
participant.
4. The process of claim 2, wherein the process further comprises
the step of: delivering the medical malpractice insurance
application to the healthcare provider for the healthcare
provider's review and approval.
5. The process of claim 4, wherein the step of generating an
insurance premium quote for a medical malpractice insurance policy
comprises the steps of: quoting the insurance premium to the
healthcare provider; and, selling the medical malpractice insurance
policy to the healthcare provider.
6. The process of claim 5, wherein the process further comprises
the step of: generating the medical malpractice insurance policy,
the policy being a two-year policy, in order to coincide with a
required re-credentialing procedure for the healthcare
provider.
7. The process of claim 6, wherein the step of forwarding the
credentialing information to a medical malpractice insurance
participant comprises the steps of: inserting means for obtaining
the healthcare providers permission for release of the
credentialing information to a medical malpractice insurance
provider into the questionnaire, and, forwarding all of the
credentialing questionnaires with an affirmative response to the
medical malpractice insurance participant.
8. The process of claim 7, wherein the process further comprises
the steps of: generating a second credentialing application;
transferring the credentialing information from the medical
malpractice insurance application to the second credentialing
application; and, sending the second credentialing application to
another health organization to which the physician must provide the
credentialing information.
9. The process of claim 8, wherein the process further comprises
the step of: repeating the preceding three steps as often as
necessary.
10. A process of linking an information database with an insurance
application, the process comprising the steps of: generating the
information database for any non-insurance purpose; forwarding at
least a portion of the information from the information database to
an insurance participant; and, transferring the at least a portion
of the information from the information database to an insurance
application.
11. The process of claim 10, wherein after forwarding at least a
portion of the information from the information database to an
insurance participant, the process comprises the step of: providing
at least one insurance premium quote generated by the insurance
participant.
12. The process of claim 10, wherein the process further comprises
the step of: delivering the insurance application to the customer
for the customer's review and approval.
13. The process of claim 12, wherein the step of generating at
least one insurance premium quote comprises the steps of: quoting
the insurance premium to a customer; and, selling insurance to the
customer.
14. The process of claim 10, wherein the step of generating the
information database, the information database not being created
for insurance purposes, comprises the step of: providing a
questionnaire for gathering information for the database.
15. The process of claim 14, wherein the step of forwarding
information from the database to an insurance participant comprises
the steps of: inserting a first question into the questionnaire,
the first question asking a customer's permission for release of
the information to the insurance participant; inserting at least
one more question into the questionnaire, the at least one more
question for gathering further information related to a particular
insurance product; and, forwarding all of the questionnaires with
an affirmative response to the first question to the insurance
participant.
16. The process of claim 15, wherein the step of inserting at least
one more question into the questionnaire, the at least one more
question for gathering further information related to a particular
insurance product comprises the step of: inserting at least one
more question into the questionnaire, the at least one more
question for gathering further information related to a particular
insurance product, the particular insurance product chosen from any
a line of insurance.
17. The process of claim 10, wherein the step of generating the
information database, the information database not being created
for insurance purposes comprises the step of: generating
credentialing information, the credentialing information being
compiled by a credentialing entity, the information being compiled
onto a credentialing database.
18. An apparatus for linking credentialing information with a
medical malpractice insurance application, the apparatus
comprising: means for compiling credentialing information regarding
a healthcare provider from a credentialing questionnaire; means for
forwarding the credentialing information to a medical malpractice
insurance participant; means for generating at least one insurance
premium quote for a medical malpractice insurance policy; and,
means for transferring the credentialing information from the
credentialing questionnaire to the medical malpractice insurance
application.
19. The apparatus of claim 18, wherein the apparatus further
comprises means for generating the medical malpractice insurance
policy, the policy being of a duration, in order to coincide with a
required re-credentialing procedure for the healthcare
provider.
20. An apparatus for linking an information database with an
insurance application, the apparatus comprising: means for
generating the information database for any non-insurance purpose;
means for forwarding at least a portion of the information from the
information database to an insurance participant; means for
generating an insurance premium quote; and, means for transferring
the at least a portion of the information from the information
database to an insurance application.
21. The apparatus of claim 20, wherein the means for generating the
information database comprises: a means for providing a
questionnaire for gathering information for the database.
22. The apparatus of claim 21, wherein the means for generating a
questionnaire for gathering information for the database comprises:
means for inserting a means for obtaining a customer's permission
for release of the information to the insurance participant into
the questionnaire; means for inserting at least one more question
into the questionnaire, the at least one more question for
gathering further information related to a particular insurance
product; and, means for forwarding all of the questionnaires with
an affirmative response to the first question to the insurance
participant.
23. A process of linking a medical malpractice insurance policy
with a credentialing questionnaire, the process comprising the
steps of: providing a medical malpractice insurance participant;
providing a credentialing entity; providing a healthcare provider;
providing a medical malpractice insurance policy; and, transferring
information from the medical malpractice insurance policy to the
credentialing questionnaire.
24. The process of claim 23, wherein transferring information from
the medical malpractice insurance policy to the credentialing
questionnaire comprises the steps of: electronically transferring
information from the medical malpractice insurance policy to the
credentialing questionnaire; and, forwarding the credentialing
questionnaire to the healthcare provider for review and
approval.
25. A process for linking credentialing information with a medical
malpractice insurance policy, the process comprising the steps of:
providing a healthcare provider, a credentialing entity,
credentialing information, and a medical malpractice insurance
participant; providing means for obtaining the healthcare
provider's permission to release the credentialing information to
the medical malpractice insurance participant; receiving permission
from the healthcare provider to release the credentialing
information; forwarding at least a portion of the credentialing
information from the credentialing entity to the medical
malpractice insurance participant; and, providing the healthcare
provider with at least one insurance premium quote for a medical
malpractice insurance policy generated by the medical malpractice
insurance participant.
26. The process of claim 25, wherein the process further comprises
the steps of: receiving the healthcare provider's approval of the
at least one insurance premium quote; and, creating a medical
malpractice insurance policy.
27. The process of claim 26, wherein providing the healthcare
provider with at least one insurance premium quote for a medical
malpractice insurance policy generated by the medical malpractice
insurance participant comprises the steps of: providing the
healthcare provider with at least one insurance premium quote for a
medical malpractice insurance policy generated by the medical
malpractice insurance participant; and, transferring the
credentialing information to a medical malpractice insurance
application.
Description
BACKGROUND OF THE INVENTION
[0001] 1. Field of Invention
[0002] This invention pertains to the art of processes for linking
an information database with an insurance application, and more
particularly to the process of linking credentialing information
with a medical malpractice insurance application.
[0003] 2. Description of the Related Art
[0004] It is well known that regulatory agencies in the United
States require health professionals to have their credentials
verified every two years. Verification is a time consuming process
that typically includes the assembly of various documents,
including proof of the physician's license, a valid Drug
Enforcement Agency certificate, proof of completion of medical
school, proof of board certification, proof of appropriate work
history, etc. Thus, the verification process often takes many days
and sometimes weeks to complete. Unfortunately, this time consuming
process is the only known way that the regulatory agencies can
ensure the public that it is receiving care from a qualified
medical professional.
[0005] It is also well known that the National Committee for
Quality Assurance (NCQA) sets the standard for credentialing in
managed care organizations. Defined as "the process by which a
managed care organization authorizes, contracts, or employs,
practitioners, who are licensed to practice independently, to
provide services to its members," credentialing simply means making
sure that a practitioner is qualified to render care to
patients.
[0006] Although there is likely to be some variation on the
specific criteria used, the basic elements required in establishing
proper credentialing information for a physician are likely to
include the following: a valid and current license, clinical
privileges in a hospital, valid Drug Enforcement Agency (DEA) or
Controlled Dangerous Substance certificate (CDS), appropriate
education and training (i.e. graduation from an approved medical
school and completion of an appropriate residency or specialty
program), board certification, appropriate work history,
malpractice insurance, and a history of any liability claims.
Managed care organizations also credential nonphysician
practitioners, such as dentists, chiropractors, and podiatrists.
The primary differences between physician and non-physician
practitioners for purposes of credentialing, lie in the
requirements, and therefore, in the verification of select data.
For example, chiropractors are not board certified and do not
require DEA or CDS certificates.
[0007] Credentialing is a necessary and critical step in securing
qualified practitioners to render and manage the care of managed
care organization subscribers or members. The managed care
organizations oftentimes delegate certain activities in the
credentialing process. A Credentials Verification Organization
(CVO), which may be certified by NCQA, will verify a practitioner's
credentials for a set price. Contracting with a NCQA-certified CVO
exempts the hospital, healthcare entity, or managed care
organization from the due diligence oversight requirements,
specified by NCQA and the Joint Commission for Accreditation of
Healthcare Organizations (JCAHO), for all the verification
services. By contracting out the necessary credentialing to a
NCQA-certrified CVO, the managed care organizations have met their
due diligence requirements.
[0008] CompHealth, a licensed CVO in the United States, has
developed a new web-based credentialing service, moving as much of
the process online as possible. One of the keys to the
credentialing service is an Internet application called Apply.net.
Medical professionals can use the Apply.net application to submit
their information to CompHealth via the Internet. However, there is
currently in the art no known connection between the credentialing
services, the credentialing information, and the insurance
industry.
[0009] The Federal government has attempted to alleviate some of
the problems of credential sharing among separate government
entities. The Federal Credentialing Program was created to attempt
to electronically link credentialing databases among the federal
agencies and departments. However, this credentialing information
sharing is limited to the federal government and does not involve
the insurance industry.
[0010] The present invention provides a process for quickly and
efficiently linking credentialing information with a medical
malpractice insurance policy. Difficulties inherent in the related
art are therefore overcome in a way that is simple and efficient
while providing better and more advantageous results.
SUMMARY OF THE INVENTION
[0011] In accordance with one aspect of the current invention, the
credentialing information is automatically transferred to an
insurance application.
[0012] In accordance with another aspect of the present invention,
at least one medical malpractice insurance premium quote can be
generated without the physician having to fill out an
application.
[0013] Yet another aspect of the current invention includes
generating a two year medical malpractice insurance policy in order
to coincide with the required recredentialing of the physician.
[0014] In accordance with still another aspect of the current
invention, the process includes means for generating the
information database for any non-insurance purpose, means for
forwarding at least a portion of the information from the
information database to an insurance participant, means for
generating an insurance premium quote, and means for transferring
the at least a portion of the information from the information
database to an insurance application.
[0015] In accordance with another aspect of the current invention,
the process includes a means for providing a questionnaire for
gathering information for the database, means for inserting a means
for obtaining a customer's permission for release of the
information to the insurance participant into the questionnaire,
means for inserting at least one more question into the
questionnaire, the at least one more question for gathering further
information related to a particular insurance product, and means
for forwarding all of the questionnaires with an affirmative
response to the first question to the insurance participant.
[0016] One advantage of the present invention is that the physician
will not have to fill out a separate application form for medical
malpractice insurance.
[0017] Another advantage of the present invention is that the
medical malpractice insurance policy is of a duration that
corresponds to the recredentialing process, thus eliminating the
long term need for physicians to recomplete insurance applications
or insurance renewal applications.
[0018] Yet another advantage of the current invention is that the
entire process can be automated, thereby, creating a quick and
efficient process.
[0019] Still another advantage of the current invention is that the
process increases competition among malpractice insurers by giving
them easier access to potential insureds.
[0020] One more advantage of the current invention is that the
process will drive down the healthcare provider's processing costs,
thereby lowering costs of one of physicians' largest line item
expenses, thereby lowering the costs of healthcare to
consumers.
[0021] Still other benefits and advantages of the invention will
become apparent to those skilled in the art to which it pertains
upon a reading and understanding of the following detailed
specification.
DESCRIPTION OF THE PREFERRED EMBODIMENT
[0022] The inventive process is designed to link credentialing
information with a medical malpractice insurance application. The
credentialing information, which the regulatory agencies require of
health professionals, can be compiled for each physician by a
credentials verification organization (CVO). The credentialing
information, however, can be gathered by any entity licensed to do
so. The CVO typically obtains and/or verifies required information
about each physician, including, a valid and current license,
clinical privileges at a hospital, valid DEA or CDS certificates,
appropriate education and training (i.e., graduation from an
approved medical school and completion of an appropriate residency
or specialty program), board certification, appropriate work
history, malpractice insurance, and a history of liability claims.
This information is used by healthcare entities to ensure the
public that it is receiving adequate care from a qualified medical
professional. What is to be especially noted is that the
information gathered by the CVO is virtually identical to the
information required to underwrite a medical malpractice insurance
policy.
[0023] The inventive process begins by having the CVO include means
for obtaining the physician's permission for release of the
credentialing information to the medical malpractice insurance
participant. This means for obtaining the physician's permission
could be in the form of a question added to the questionnaire,
requesting the physician's permission. An example of what the
question might be is, "May we release this information for the
purpose of obtaining competitive malpractice insurance quotes for
you?" The means for obtaining permission could also include a
statement above the signature line stating that by signing the
questionnaire the doctor is giving the CVO permission to release
the information to the medical malpractice insurance participant.
All of the credentialing questionnaires in which such permission is
granted are then automatically forwarded by the CVO to the medical
malpractice insurance participant. What is meant by the term
"medical malpractice insurance participant" is any one, or more, of
the following: insurance companies, brokers, agents, third party
administrators, risk bearers, claims managers, risk managers,
insurance marketers, and the like.
[0024] Using the credentialing information, at least one insurance
premium quote is generated for the medical malpractice insurance
policy. The medical malpractice insurance participant can provide
multiple quotes from various insurance companies to the physician.
The insurance participant then contacts the physician with the
premium quotes and policy terms and conditions. By "quote" it is
meant either a non-binding or binding quote of the cost of the
insurance policy premium.
[0025] If the physician orders the medical malpractice insurance,
the credentialing information is transferred from the credentialing
questionnaire to a medical malpractice insurance application. An
application for medical malpractice insurance is then generated by
a computer for the physician.
[0026] The insurance participant then delivers the completed
application to the physician for the physician's review and
approval.
[0027] Once the medical malpractice insurance policy has been
approved by the physician, a two year policy is generated by the
insurance participant. This two year policy coincides with the
required re-credentialing procedure for the physician. The
physician will no longer be required to fill out a new application
for medical malpractice insurance each time the medical malpractice
policy comes up for renewal. Each time the re-credentialing is
done, which, in the preferred embodiment, occurs every two years,
the updated credentialing information can then be sent again to the
insurance participant, and the medical malpractice insurance policy
can be renewed with expediency and efficiency.
[0028] The two year medical malpractice insurance policy is a
preferred embodiment of the invention, and is not intended to limit
the invention in any way. The current inventive process also
encompasses any length of policy term that coincides with the
re-credentialing process. For example, if the re-credentialing
occurs every three years, instead of every two years, a three year
medical malpractice insurance policy can be issued.
[0029] Also, the information on the medical malpractice insurance
application, since it is almost identical to the credentialing
information, can be transferred back to a credentialing
questionnaire for any subsequent health organizations that require
credentialing of the subject physician. The medical malpractice
insurance participant can transfer this information, and send
copies of the credentialing questionnaires to the various health
organizations, thereby saving the physician a great deal of time
and effort. The physician will no longer be required to fill out
multiple credentialing questionnaires for multiple health
organizations. In the past, a physician had to fill out a
credentialing questionnaire for each and every health organization
from which they desired approval. With the inventive process, the
physician need only fill out one credentialing questionnaire, and
from that, the process transfers the information to a medical
malpractice insurance application. From the insurance application,
the credentialing information can be transferred to multiple
questionnaires to send out to multiple health organizations. All
that the physician needs to do is to contact the medical
malpractice insurance participant and request that the insurance
participant complete a credentialing application for whichever
health organization the physician wishes. The medical malpractice
insurance participant can then transfer the information from the
insurance application to the credentialing questionnaire and
provide the completed questionnaire to the physician. The physician
then reviews the credentialing questionnaire, signs it, and submits
it to the credentialing entity, or health organization. The
inventive process encompasses all of the subsequent applications
and questionnaires that the physician would need for any subsequent
health organizations that require the credentialing
information.
[0030] If a physician has already obtained medical malpractice
insurance coverage, the medical malpractice insurance participant
will have all, or most, of the information necessary for the
credentialing process. This invention also encompasses the initial
step of the process being the medical malpractice participant
transferring the information from the medical malpractice insurance
application to the credentialing questionnaire. In this manner, the
credentialing process can be efficiently and quickly completed even
after the physician has a medical malpractice insurance policy.
[0031] In either of the situations where the information is going
from the insurance application to the credentialing questionnaire,
or vice versa, it is possible that some of the questions will not
match up. If one of the questions on either the credentialing
questionnaire or the insurance application is left blank due to the
questions not matching up, these questions will be highlighted, and
when the physician receives the application or questionnaire, the
physician will fill in the highlighted blank spaces.
[0032] In the preferred embodiment, the inventive process occurs
automatically via electronic transmission and computer data
manipulation. The required computer hardware, and the necessary
computer code, would be obvious to one skilled in the computer
art.
[0033] However, this invention is not limited to the preferred
embodiment, and can be accomplished without the use of computers or
electronic means. The methods of transferring information manually,
or by way of a hybrid combination of manual and electronic
transference, are both encompassed by this invention. In the
manual, or hybrid of manual and electronic, transference
embodiments, the steps taken to link the insurance application with
the credentialing information are identical to the steps taken in
the preferred embodiment, and those steps are incorporated herein
by reference.
[0034] The present invention is also not limited to the medical
malpractice field, but includes the entire range of insurance
participants. The present invention can be used to link any
information database, not created for insurance purposes, to any
type of insurance application. The only information databases not
encompassed within this invention would be databases created for
the purpose of filling out an insurance application, or for the
purpose of obtaining any type of insurance. An example of the type
of information database not encompassed within this invention would
be an Internet insurance application form. However, any other
information database, not created for insurance purposes, can be
linked by this inventive process to an insurance application. The
means by which this information is linked with the insurance
application is identical to the process described in the medical
malpractice insurance process, and the steps of the process are
incorporated herein by reference. However, when linking the
information to other forms of insurance, further questions may need
to be added in order to gather further, necessary information. An
example of some further questions, necessary for life insurance,
would be whether someone is a smoker or a nonsmoker.
[0035] The types of insurance applications that can be linked can
include, but are not limited to, the following: life insurance,
automobile insurance, medical malpractice insurance, legal
malpractice insurance, professional liability insurance, health
insurance, disability insurance, renter's insurance, homeowner's
insurance, flood insurance, fire insurance, hurricane insurance,
and earthquake insurance, or any other line of insurance.
[0036] It is to be noted that the invention encompasses the idea
that the credentialing organization, the healthcare entity, the
insurance participant, etc. can be one entity or separate entities.
For example, a hospital that does its own credentialing and
provides insurance for its physicians is encompassed within this
invention.
[0037] In another embodiment of this invention, there is no need
for a credentialing questionnaire to be provided. The CVO should
have all the data necessary for filling out an insurance
application, and all that would be needed would be the physician's
permission for use of the information. In this embodiment, the
initial step of the process would be transferring the credentialing
information from the CVO directly into either an insurance
application or an insurance policy.
[0038] The invention also encompasses the use of electronic
transmission of the information to the physician for the
physician's approval. The physician could then send approval for
the insurance policy back to the insurance participant. Under this
method of the invention, no signature is required by the physician,
only the physician's approval of the insurance policy.
[0039] The invention has been described with reference to preferred
embodiments. Obviously, modifications and alterations will occur to
others upon a reading and understanding of this specification. It
is intended to include all such modifications and alternations in
so far as they come within the scope of the appended claims or the
equivalents thereof.
[0040] Having thus described the invention, it is now claimed:
* * * * *