公开(公告)号：WO2006023308A2

公开(公告)日：2006-03-02

申请号：PCT/US2005028073

申请日：2005-08-05

Applicant: HUMANA INC ,  SLEN BENJAMIN E ,  REED CULLEN L ,  BIERBOWER ELIZABETH D ,  KINSER MAUREEN M ,  BARTEL SANDRA L ,  LORD JONATHAN T

Inventor： SLEN BENJAMIN E ,  REED CULLEN L ,  BIERBOWER ELIZABETH D ,  KINSER MAUREEN M ,  BARTEL SANDRA L ,  LORD JONATHAN T

CPC classification number: G06Q40/08 ,  G06Q50/22 ,  G06Q50/24

Abstract: A method for providing insurance coverage to a subscriber comprises offering an insurance policy to said subscriber wherein said insurance policy comprises providing allowances to pay for one or more expenses covered by said insurance policy and providing monetary credits to said subscriber for any unused portion of a given allowance where said monetary credits can be used to cover the cost of a subsequent allowed expense. The insurance policy may be a pharmacy benefits plan. The covered expenses may be pharmacy expenses. The allowed expenses may be medical expenses which qualify under section 213 of the US Internal Revenue code for payment by an employer without said subscriber having to declare said payment as taxable income.

Abstract translation: 向用户提供保险的方法包括向所述用户提供保险单，其中所述保险单包括提供津贴以支付由所述保险单涵盖的一个或多个费用，并向所述用户提供任何给定的未使用部分的货币信用 可以使用所述货币信用额度来支付后续允许费用的费用的津贴。 保险单可能是药房福利计划。 所涉费用可能是药学费用。 允许的费用可以是医疗费用，符合“美国国税局”第213条规定，由雇主支付，而没有所述用户必须将所述付款作为应纳税所得。

公开(公告)号：WO2005109279A2

公开(公告)日：2005-11-17

申请号：PCT/US2005/014723

申请日：2005-05-02

Applicant: HUMANA, INC. ,  WARREN, Elizabeth, M. ,  SANDMAN, Timothy, B. ,  HUTTI, Jacob, M. ,  LORD, Jonathan, T. ,  WHITWORTH, Julie, E. ,  SHAW, Elizabeth, M. ,  FLEMING, William, K. ,  WATSON, HEIDARI, Teresa, L.

Inventor： WARREN, Elizabeth, M. ,  SANDMAN, Timothy, B. ,  HUTTI, Jacob, M. ,  LORD, Jonathan, T. ,  WHITWORTH, Julie, E. ,  SHAW, Elizabeth, M. ,  FLEMING, William, K. ,  WATSON, HEIDARI, Teresa, L.

IPC: G06F17/60

CPC classification number: G06Q10/06 ,  G06Q40/02

Abstract: A pharmacy benefits plan is designed such that covered that covered scripts are placed into Groups and allowances are provided for the purchase of scripts within each Group. Each Group comprises scripts for pharmaceuticals that provided medical benefits within a given time frame. A first Major Group is assigned to scripts for drugs that are prescribed for conditions that would otherwise result in further medical treatment and expense if said drugs were not taken by an insured. A second Major Group is assigned to scripts for drugs that are prescribed for conditions that would not normally result in subsequent medical costs if the drugs were not taken. Relatively high allowances are provided for scripts in said first Major Group such that the out-of-pocket costs of a given scrip will not be a barrier to said insured obtaining and taking said scripts. Relatively low allowances are provided for scripts in said second Major Group such that an insured will be further motivated to ask their doctor about low cost alternative drugs for a given treatment.

Abstract translation: 设计了一个药店福利计划，以便涵盖所涵盖的脚本被放置在组中，并为每个组中的脚本购买提供了许可。 每个组包括在给定时间范围内提供医疗益处的药物的脚本。 第一个主要集团被指定为为另外导致进一步治疗和费用的药物规定的药物的脚本，如果所述药物未被被保险人采取。 第二个主要集团被指定为药物的脚本，这些药物的规定条件通常不会导致随后的医疗费用，如果不服用药物。 为第一主要群组的脚本提供相对较高的津贴，使得给定小费的自付费用不会成为所有被保险人获取和使用所述脚本的障碍。 为第二主要小组的脚本提供相对较低的津贴，使被保险人有进一步的动机，要求他们的医生关于给定治疗的低成本替代药物。

公开(公告)号：ZA200609782B

公开(公告)日：2008-08-27

申请号：ZA200609782

申请日：2006-11-23

Applicant: HUMANA INC

Inventor： KIL DAVID H ,  POTTSCHMIDT DAVID B

IPC: A61K9/22 ,  G06F17/00 ,  G06F19/00 ,  G06N5/00 ,  G06Q20090101 ,  G06Q10/00 ,  G06Q40/00 ,  G06Q50/00

Abstract: A system and method that generates a hierarchical tree network and uses linear-plus-nonlinear learning algorithms to form a consensus view on a member's future health status. Each leaf in the hierarchical tree network is homogeneous in clinical characteristics, experience period, and available data assets. Optimization is performed on each leaf so that features and learning algorithms can be tailored to local characteristics specific to each leaf.

公开(公告)号：MX2007006604A

公开(公告)日：2007-10-04

申请号：MX2007006604

申请日：2005-11-23

Applicant: HUMANA INC

Inventor： REED CULLEN L ,  STEPHENSON RICHARD L ,  BROWN STEVEN T ,  GRUCHALSKI JOANNE E ,  WIDENSKI HENRY A JR ,  ERDMANN JEFFREY JAY

IPC: G06K15/00 ,  G06Q20/00 ,  G06Q30/00 ,  G07F19/00

Abstract: La presente invencion se relaciona con un metodo y sistema de control de cuenta en tiempo real que permite comprar solamente articulos elegibles y autorizados con el uso de la cuenta. La presente invencion, se relaciona en particular con cuentas de gastos medicos, tales como cuentas de gastos flexibles y cuentas de reembolsos medicos. El metodo puede comprender los pasos de: establecer por lo menos una cuenta, cada cuenta tiene un portador de cuenta, que identifica por lo menos un articulo elegible a ser comprado, con el uso de una de las cuentas; y luego de la solicitud de compra del articulo con el uso de una de las cuentas autorizar la compra por un monto que no excede el saldo disponible en esa cuenta, solamente cuando el articulo sea un articulo identificado como elegible para compra y cuando el articulo sea autorizado para compra. El sistema incluye un sistema de punto de venta que tiene por lo menos un dispositivo de entrada y un sistema procesador. El sistema tambien incluye un sistema procesador de transacciones que tiene estructuras de datos configuradas para contener los identificadores de articulo elegible, los identificadores de articulo autorizado, los detalles de los datos de transaccion y el sistema de decision que utiliza la informacion en las estructuras de datos para procesar las transacciones y proporcionar la informacion de transaccion al sistema de punto de venta. El sistema tambien incluye por lo menos una red de comunicaciones de datos configurada para proporcionar la comunicacion entre el sistema de punto de venta, el sistema procesador de transacciones y la red de tarjetas financieras.

公开(公告)号：WO2005104733A3

公开(公告)日：2007-03-29

申请号：PCT/US2005014350

申请日：2005-04-26

Applicant: HUMANA INC ,  KIL DAVID H ,  SIGWALT MARLENE A ,  CHIU SANDY S ,  POTTSCHMIDT DAVID B

Inventor： KIL DAVID H ,  SIGWALT MARLENE A ,  CHIU SANDY S ,  POTTSCHMIDT DAVID B

IPC: G06Q10/00

CPC classification number: G06Q10/10 ,  G06Q40/08 ,  G06Q50/22 ,  G06Q50/24

Abstract: The present invention relates to a system and method for automated extraction and display of past health care use to aid in predicting future health status. A system and method that converts raw medical and pharmacy claims data into Hierarchical Major Clinical Condition (HMCC) and Place of Treatment (POT) time-series data to facilitate the health assessment of a member's total clinical conditions and aid in predicting his or her future health status. The HMCC categories are organized in body systems and likely disease progression to permit both spatio-temporal digital signal processing and the development of a dynamical learning system. Each medical and pharmacy claim of the member is mapped onto one or more HMCC/POT-time cells. At the end of mapping, multiple entries in each HMCC-time cell are accumulated with the temporal resolution determined as a function of group size and temporal fidelity required for model building. Individual HMCC/POT-time maps can be rolled up to a group level to facilitate employer-by-employer or market-by-market comparison so that clinical strategies can be tailored to each employer or geographic region. Multiple nonlinear visualization mapping algorithms are provided to cope with highly nonlinear nature of claims cost data.

Abstract translation: 本发明涉及一种用于自动提取和显示过去保健用途以帮助预测未来健康状况的系统和方法。 将原始医疗和药房索赔数据转换为分层主要临床条件（HMCC）和治疗地点（POT）时间序列数据的系统和方法，以促进对成员总临床状况的健康评估，并有助于预测他或她的未来 健康状况。 HMCC类别在身体系统中组织，并且可能发生疾病进展，以允许时空数字信号处理和动态学习系统的开发。 成员的每个医疗和药房索赔被映射到一个或多个HMCC / POT-时间单元上。 在映射结束时，每个HMCC时间单元中的多个条目被累积，其中确定的时间分辨率是模型构建所需的组大小和时间保真度的函数。 个人HMCC / POT时间地图可以卷起到一个群体层面，以便雇主或雇主逐个市场比较，以便临床策略可以针对每个雇主或地理区域。 提供了多个非线性可视化映射算法来应对索赔成本数据的非线性特性。

公开(公告)号：WO2007005623A2

公开(公告)日：2007-01-11

申请号：PCT/US2006/025606

申请日：2006-06-30

Applicant: HUMANA INC. ,  KIL, David, H. ,  SHIN, Bongjoo

Inventor： KIL, David, H. ,  SHIN, Bongjoo

IPC: G06Q50/00

CPC classification number: G06Q10/10 ,  G06F19/00 ,  G06F19/3475 ,  G06Q30/02 ,  G06Q50/22 ,  G09B19/00 ,  G16H10/20 ,  G16H50/20 ,  G16H50/30

Abstract: A system and method for providing to an individual certain information which is relevant to that individual's health status. More specifically, the invention relates to a system and method for providing information relevant to an individual's health status and wherein the information provided is chosen on the basis of not only the individual's health status but also complex psychosocial behavioral factors related to that individual's motivational structure and likely impact

Abstract translation: 用于向个人提供与该个体的健康状况相关的某些信息的系统和方法。 更具体地说，本发明涉及一种用于提供与个人健康状况相关的信息的系统和方法，其中所提供的信息不仅基于个人的健康状况而且还涉及与该个体的动机结构相关的复杂的心理社会行为因素， 可能的影响

公开(公告)号：WO2003017096A1

公开(公告)日：2003-02-27

申请号：PCT/US2002/025272

申请日：2002-08-12

Applicant: HUMANA INC

Inventor： EDWARDS, Brett, T. ,  LAWHEAD, Aaron, L. ,  ROSENBERG, Siddy ,  KEINSLEY, Brian, E. ,  LIGHT, Eric, P. ,  TOWNSEND, David, L. ,  HARRIS, Sharon, A. ,  LATIMER, Eleanor, W. ,  WEBER, Leigh, S. ,  SMITHSON, Mark, A. ,  STANLEY, Craig ,  BURCHARD, William

IPC: G06F9/445

CPC classification number: H04L63/102 ,  G06F21/41 ,  G06F21/6218 ,  H04L63/08

Abstract: A stand-alone security system controlling access to secured information and self-service functionality for a sponsor organization, usable for Web-based and IVR-based self-service functions, having five primary facets: (1) control of access to secured information (2) enabling access to users having indirect and direct relationships with the sponsor organization (3) distribution of security administration from a central information technology resource to users of the security system, (4) support for integration into different environments, and (5) support for system integrators. Key components of access control include (1) association of a userID with one specific person, (2) identification of keys to data in back-end systems and association of those keys with the system users, (3) definition of pieces (segments) of an organization so that permissions are granted based on the pieces, (4) definition of user roles based on the functionality to which he has been given permission, (5) a single sign-on for a user with multiple reasons to use the system, and (6) support for direct and indirect assignment of business functions.

Abstract translation: 控制对赞助机构的安全信息和自助服务功能的访问的独立安全系统，可用于基于Web和基于IVR的自助服务功能，具有五个主要方面：（1）控制对安全信息的访问 2）能够访问与赞助机构间接和直接关系的用户（3）从中央信息技术资源向安全系统用户分发安全管理，（4）支持集成到不同环境中，（5）支持 用于系统集成商。 访问控制的关键组件包括（1）用户ID与一个特定人员的关联，（2）对后端系统中的数据的密钥的识别以及这些密钥与系统用户的关联，（3）段（段） 的组织，以便根据这些部分授予权限，（4）基于他被授予权限的功能来定义用户角色，（5）单个登录用户有多种原因使用系统 ，（6）支持直接和间接分配业务职能。

公开(公告)号：GB2462333A

公开(公告)日：2010-02-10

申请号：GB0819297

申请日：2008-10-21

Applicant: HUMANA INC

Inventor： DAUB RAYMOND WILLIAM ,  KANNAN RAMU SHANKARAN

IPC: G06F19/00 ,  G06Q50/00

Abstract: A settlement and invoice validation application that enables a payer to validate the charges from a healthcare services provider and to better manage contracting and performance management functions. The application supports claims adjudication and payment processing. It validates all patient activity data that is received from healthcare services providers. Patient activity data relates to episodes involving a single patient care event. The application applies to episodes rules related to clinical and financial requirements for the payee. The application tracks details related to application of the rules to episodes and identifies reasons that an episode fails. Episodes that fail are routed to appropriate staff for review and action. Following review, an episode may be accepted for payment or challenged for various reasons. The application automates a variety of manual tasks and limits manual review to only those activities that require further attention and action.

公开(公告)号：GB0819297D0

公开(公告)日：2008-11-26

申请号：GB0819297

申请日：2008-10-21

Applicant: HUMANA INC

公开(公告)号：ZA200704455B

公开(公告)日：2008-09-25

申请号：ZA200704455

申请日：2007-05-30

Applicant: HUMANA INC ,  METAVANTE CORP

Inventor： REED CULLEN L ,  STEPHENSON RICHARD L ,  BROWN STEVEN T ,  GRUCHALSKI JOANNE E ,  JR WIDENSKI HENRY A ,  JAY ERDMANN JEFFREY

IPC: G06K20090101 ,  G06Q20/00 ,  G06Q30/00

Abstract: The present invention relates to a real time account control method and system that allows only eligible and authorized items to be purchased using the account. The present invention relates particularly to healthcare spending accounts such as flexible spending accounts and health reimbursement arrangements. The method can comprise the steps of: establishing at least one account, each account having an account holder; identifying at least one item eligible for purchase using one of the accounts; identifying at least one item authorized for purchase using one of the accounts; and, upon request to purchase an item using one of the accounts, authorizing the purchase for an amount not to exceed an available balance in that account only if the item is both an item identified as eligible for purchase and an item authorized for purchase.