Humana Inc.
SYSTEM FOR GAP IN CARE ALERTS

Abstract:

A gap in care alert system and method includes a computer network which receives health insurance claims data. A database with medical treatment protocols for medical conditions is in electronic communication with one or more processors, the computer network, and an electronic storage device. The processor is configured to analyze said health insurance claims data to identify a triggering event for an insured patient, establish a date for a follow-up event based on a treatment protocol, and generate a gap in care alert if subsequently gathered health insurance claims data does not contain the follow-up event by said date. An alert delivery subsystem delivers said alert electronically to a receiver.