公开(公告)号：CA2589769A1

公开(公告)日：2006-06-08

申请号：CA2589769

申请日：2005-11-23

Applicant: METAVANTE CORP ,  HUMANA INC

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

IPC: G06K15/00 ,  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.

公开(公告)号：AU2005237604A1

公开(公告)日：2005-11-10

申请号：AU2005237604

申请日：2005-04-27

Applicant: HUMANA INC

Inventor： KIL DAVID H ,  POTTSCHMIDT DAVID B

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

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：CA2455970A1

公开(公告)日：2003-02-27

申请号：CA2455970

申请日：2002-08-12

Applicant: HUMANA INC

Inventor： WEBER LEIGH S ,  KEINSLEY BRIAN E ,  SMITHSON MARK A ,  LATIMER ELEANOR W ,  ROSENBERG SIDDY ,  LIGHT ERIC P ,  HARRIS SHARON A ,  TOWNSEND DAVID L ,  EDWARDS BRETT T ,  BURCHARD WILLIAM ,  LAWHEAD AARON L ,  STANLEY CRAIG

IPC: G06F21/20 ,  G06F21/00 ,  G06Q50/00 ,  H04L29/06 ,  G06F9/445 ,  G06F7/00 ,  G06F17/00 ,  H04L9/00 ,  G06F17/60

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) contro l of access to secured information (2) enabling access to users having indirec t 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 acce ss 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 giv en 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.

公开(公告)号：ZA200609781B

公开(公告)日：2007-11-28

申请号：ZA200609781

申请日：2006-11-23

Applicant: HUMANA INC

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

IPC: G06Q20090101 ,  G06Q10/00

公开(公告)号：AU2005237562A1

公开(公告)日：2005-11-10

申请号：AU2005237562

申请日：2005-04-26

Applicant: HUMANA INC

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

IPC: G06Q10/00

公开(公告)号：WO2005104768A3

公开(公告)日：2007-05-24

申请号：PCT/US2005014522

申请日：2005-04-27

Applicant: HUMANA INC ,  KIL DAVID H ,  POTTSCHMIDT DAVID B

Inventor： KIL DAVID H ,  POTTSCHMIDT DAVID B

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

CPC classification number: G06Q50/24 ,  G06Q10/10 ,  G06Q40/08 ,  G06Q50/22 ,  G16H50/20 ,  G16H50/30 ,  G16H50/70

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 least 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.

Abstract translation: 一种生成层次树网络并使用线性加非线性学习算法来形成对成员未来健康状况的共识视图的系统和方法。 分层树网络中的每一个在临床特征，经验期和可用数据资产中是同质的。 在每个叶子上进行优化，使得特征和学习算法可以针对每个叶子特定的局部特征进行定制。

公开(公告)号：WO2005109279A3

公开(公告)日：2007-05-18

申请号：PCT/US2005014723

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: G06Q10/00 ,  G06Q40/00

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：WO2006060286A3

公开(公告)日：2007-03-29

申请号：PCT/US2005042811

申请日：2005-11-23

Applicant: HUMANA INC ,  METAVANTE CORP ,  REED CULLEN L ,  STEPHENSON RICHARD L ,  BROWN STEVEN T ,  GRUCHALSKI JOANNE E ,  WIDENSKI HENRY A JR ,  ERDMANN JEFFREY JAY

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

CPC classification number: G06Q30/06 ,  G06Q20/04 ,  G06Q20/20 ,  G06Q20/204 ,  G06Q20/208 ,  G06Q20/40 ,  G06Q50/22

Abstract: The present invention relates to a real time account control method and system that allows only eligible and authorized item to be purchased using the account. The system includes a point of sale system (20) having at least one input device (22) and a process system (26). The system also includes a transaction processor system (30) having data structures configured to contain eligible item identifiers (32), authorized item identifiers (34), transaction data detail (36) and a decision system (38) which use the information in the data structures to process transactions and provide transaction information to the point of sale system (20). The system further include at least one data communications network (42, 44) configured to provide communication between the point of sale system (20), the transaction processor system (30), and a financial card network (40).

Abstract translation: 本发明涉及一种实时账户控制方法和系统，其仅允许使用该账户购买符合资格和授权的项目。 该系统包括具有至少一个输入装置（22）和处理系统（26）的销售点系统（20）。 该系统还包括具有数据结构的交易处理器系统（30），该数据结构被配置为包含符合条件的项目标识符（32），授权项目标识符（34），交易数据细节（36）和决策系统（38） 数据结构来处理交易并向销售点系统（20）提供交易信息。 该系统还包括被配置为提供销售点系统（20），交易处理器系统（30）和金融卡网络（40）之间的通信的至少一个数据通信网络（42,44）。

公开(公告)号：WO2006023308A3

公开(公告)日：2006-03-02

申请号：PCT/US2005/028073

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.

IPC: G06Q50/00 ,  G06Q40/00

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.

公开(公告)号：WO2005104733A2

公开(公告)日：2005-11-10

申请号：PCT/US2005/014350

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 ,  G06F19/00 ,  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。