The U.S. Patent and Trademark Office granted a patent to AccumTech in Ann Arbor for a computer system and database design that processes and matches misidentified health plan member names with misidentified health provider claims.
The firm assists health plans, pharmacy benefit managers (PBMs), and third-party administrators with translating and integrating claims data between a variety of health providers and vendors. As a key service, AccumTech tallies co-insurance, co-pays, and deductibles for individual and family members enrolled in health plans.
“Most automated claim problems do not occur with dollar figures, numbers, and math,” says Andrew Madonna, vice president of AccumTech. “Enrollment data, especially the nuanced coding that differs between systems, drives most of the problems with tracking benefit expenditures.”
For example, Blue Cross Blue Shield of Michigan and a PBM may use different member ID numbers or their records contain different derivations of the same name. AccumTech’s patented method matches the member’s personal information — even though it varies between systems — with the corresponding records in another system so that benefit costs and totals can be accurately updated and tallied.
“Our ClaimGen system and Enrollment Engine act like a universal translator,” Madonna says. “It lets us coordinate and communicate all the data into each organization’s native computer ‘language’ and member identification scheme.”
Gary Gavin, vice president of autos, national, and key accounts at Blue Cross Blue Shield of Michigan, says, “After partnering with AccumTech in 2018, our team did not have to implement time-consuming new procedures or big programing changes, which improves customer service. We quickly experienced an improvement with claims reconciliation. In addition, our members and health partners have higher satisfaction resulting from shorter lead times for vendor transitions with superior outcomes.”
Patent Number 11,217,346 covers AccumTech’s computer system design and methods of integrating health plan member eligibility and payor claims databases with both systems using their native layouts, business logic, and other processing specifications.
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