Patent Application
20230351343
The present inventive concepts relate generally to health care systems and services and, more particularly, management of claims for health care services processed by payor entities.
Health care services are delivered to patients through health care providers, e.g., one or more medical practitioners. Payment for these services is usually made by one or more payors, which may include the patient and another entity, such as an insurance company. Both private companies and public organizations, such as the Medicare and Medicaid programs run by the federal government, and public employee programs run by the federal government or states, may act as payors. Payors may be penalized for improperly denying payment for health care service claims, but may also be harmed financially for approving payment for claims that cannot be justified. To improve the accuracy in determining which claims to pay, which claims to pay in part, and which claims to deny, payors may use an auditing system that provides recommendations on the payment process. The auditing system may be designed with various packages of rules that can be applied to the claims to make the recommendations on payment. A payor, however, may not have licensed all of the various rules because they are not frequently used or because of the costs associated with licensing certain rules packages. In addition, a payor may upgrade the auditing system rules on a fixed schedule, which may be infrequent. This may delay a payor gaining access to new rules that have been developed based on regulatory standards and best practices.
According to some embodiments of the inventive concept, a method comprises receiving information associated with a health care service provided to a patient; distributing a plurality of rules for determining responsibility for payment for the health care service across a plurality of hierarchical auditing systems including a primary auditing system and a secondary auditing system; generating, using the primary auditing system, a first payment recommendation for the health care service based on a first subset of the plurality of rules and the information associated with the health care service; communicating the information associated with the health care service to the secondary auditing system; generating, using the secondary auditing system, a second payment recommendation for the health care service based on a second subset of the plurality of rules and the information associated with the health care service; and merging the first payment recommendation with the second payment recommendation to generate a final payment recommendation for the health care service.
In other embodiments, the first payment recommendation is a recommendation not to pay for the health care service. Merging the first payment recommendation with the second payment recommendation to generate the final payment recommendation for the health care service comprises generating the final payment recommendation as the first payment recommendation.
In still other embodiments, the method further comprises associating a tag with the information associated with the health care service. The tag provides instructions for processing information associated with the health care service in the secondary auditing system.
In still other embodiments, the information is first information, the health care service is a first health care service, and the tag is a first tag. The method further comprises receiving second information associated with a second health care service provided to the patient; associating a second tag with the second information associated with the second health care service, the second tag providing instructions for processing the second information associated with the second health care service in the secondary auditing system; generating, using the primary auditing system, a first payment recommendation for the second health care service based on the first subset of the plurality of rules and the second information associated with the second health care service; generating, using the secondary auditing system, a second payment recommendation for the second health care service based on the second subset of the plurality of rules, the second information associated with the second health care service, the second tag, the first information associated with the first health care service, and the first tag; and merging the first payment recommendation for the second health care service with the second payment recommendation for the second health care service to generate a final payment recommendation for the second health care service.
In still other embodiments, the first payment recommendation is a recommendation not to pay for the health care service.
In still other embodiments, the information associated with the health care service corresponds to a line item in a health care claim for payment; and communicating the information associated with the health care service to the secondary auditing system comprises communicating the health care claim for payment to the secondary auditing system.
In still other embodiments, the information associated with the health care service corresponds to a line item in a health care claim for payment; and communicating the information associated with the health care service to the secondary auditing system comprises communicating the line item to the secondary auditing system without communicating other line items of the health care claim for payment to the secondary auditing system
In still other embodiments, the first payment recommendation is a recommendation to pay for the health care service in whole or in part. The second payment recommendation is not to pay in whole or in part for the health care service. Merging the first payment recommendation with the second payment recommendation to generate the final payment recommendation for the health care service comprises generating the final payment recommendation as the second payment recommendation when the second payment recommendation is an amount less than the first payment recommendation.
In still other embodiments, the first payment recommendation is a recommendation to pay for the health care service in whole or in part based on the first subset of the plurality of rules, the information associated with the health care service and historical information associated with the health care service, which is unavailable to the secondary auditing system. The second payment recommendation is not to pay in whole or in part for the health care service. Merging the first payment recommendation with the second payment recommendation to generate the final payment recommendation for the health care service comprises generating the final payment recommendation as the first payment recommendation.
In some embodiments of the inventive concept, a system comprises a processor and a memory coupled to the processor and comprising computer readable program code embodied in the memory that is executable by the processor to perform operations comprising: receiving information associated with a health care service provided to a patient; distributing a plurality of rules for determining responsibility for payment for the health care service across a plurality of hierarchical auditing systems including a primary auditing system and a secondary auditing system; generating, using the primary auditing system, a first payment recommendation for the health care service based on a first subset of the plurality of rules and the information associated with the health care service; communicating the information associated with the health care service to the secondary auditing system; generating, using the secondary auditing system, a second payment recommendation for the health care service based on a second subset of the plurality of rules and the information associated with the health care service; and merging the first payment recommendation with the second payment recommendation to generate a final payment recommendation for the health care service.
In further embodiments, the first payment recommendation is a recommendation not to pay for the health care service. Merging the first payment recommendation with the second payment recommendation to generate the final payment recommendation for the health care service comprises generating the final payment recommendation as the first payment recommendation.
In still further embodiments, the operations further comprise associating a tag with the information associated with the health care service, the tag providing instructions for processing the information associated with the health care service in the secondary auditing system.
In still further embodiments, the information is first information, the health care service is a first health care service, and the tag is a first tag, the operations further comprising: receiving second information associated with a second health care service provided to the patient; associating a second tag with the second information associated with the second health care service, the second tag providing instructions for processing the second information associated with the second health care service in the secondary auditing system; generating, using the primary auditing system, a first payment recommendation for the second health care service based on the first subset of the plurality of rules and the second information associated with the second health care service; generating, using the secondary auditing system, a second payment recommendation for the second health care service based on the second subset of the plurality of rules, the second information associated with the second health care service, the second tag, the first information associated with the first health care service, and the first tag; and merging the first payment recommendation for the second health care service with the second payment recommendation for the second health care service to generate a final payment recommendation for the second health care service.
In still further embodiments, the first payment recommendation is a recommendation not to pay for the health care service.
In still further embodiments, the information associated with the health care service corresponds to a line item in a health care claim for payment; and communicating the information associated with the health care service to the secondary auditing system comprises communicating the health care claim for payment to the secondary auditing system.
In some embodiments of the inventive concept, a computer program product, comprises a non-transitory computer readable storage medium comprising computer readable program code embodied in the medium that is executable by a processor to perform operations comprising: receiving information associated with a health care service provided to a patient; distributing a plurality of rules for determining responsibility for payment for the health care service across a plurality of hierarchical auditing systems including a primary auditing system and a secondary auditing system; generating, using the primary auditing system, a first payment recommendation for the health care service based on a first subset of the plurality of rules and the information associated with the health care service; communicating the information associated with the health care service to the secondary auditing system; generating, using the secondary auditing system, a second payment recommendation for the health care service based on a second subset of the plurality of rules and the information associated with the health care service; and merging the first payment recommendation with the second payment recommendation to generate a final payment recommendation for the health care service.
In other embodiments, the first payment recommendation is a recommendation not to pay for the health care service. Merging the first payment recommendation with the second payment recommendation to generate the final payment recommendation for the health care service comprises generating the final payment recommendation as the first payment recommendation.
In still other embodiments, the operations further associating a tag with the information associated with the health care service, the tag providing instructions for processing the information associated with the health care service in the secondary auditing system.
In still other embodiments, the information is first information, the health care service is a first health care service, and the tag is a first tag, the operations further comprising: receiving second information associated with a second health care service provided to the patient; associating a second tag with the second information associated with the second health care service, the second tag providing instructions for processing the second information associated with the second health care service in the second auditing system; generating, using the primary auditing system, a first payment recommendation for the second health care service based on the first subset of the plurality of rules and the second information associated with the second health care service; generating, using the secondary auditing system, a second payment recommendation for the second health care service based on the second subset of the plurality of rules, the second information associated with the second health care service, the second gat, the first information associated with the first health care service, and the first tag; and merging the first payment recommendation for the second health care service with the second payment recommendation for the second health care service to generate a final payment recommendation for the second health care service.
In still other embodiments, the first payment recommendation is a recommendation not to pay for the health care service.
It is noted that aspects described with respect to one embodiment may be incorporated in different embodiments although not specifically described relative thereto. That is, all embodiments and/or features of any embodiments can be combined in any way and/or combination. Moreover, other methods, systems, articles of manufacture, and/or computer program products according to embodiments of the inventive concept will be or become apparent to one with skill in the art upon review of the following drawings and detailed description. It is intended that all such additional systems, methods, articles of manufacture, and/or computer program products be included within this description, be within the scope of the present inventive subject matter, and be protected by the accompanying claims. It is further intended that all embodiments disclosed herein can be implemented separately or combined in any way and/or combination.
Other features of embodiments will be more readily understood from the following detailed description of specific embodiments thereof when read in conjunction with the accompanying drawings, in which:
In the following detailed description, numerous specific details are set forth to provide a thorough understanding of embodiments of the present inventive concept. However, it will be understood by those skilled in the art that the present invention may be practiced without these specific details. In some instances, well-known methods, procedures, components and circuits have not been described in detail so as not to obscure the present inventive concept. It is intended that all embodiments disclosed herein can be implemented separately or combined in any way and/or combination. Aspects described with respect to one embodiment may be incorporated in different embodiments although not specifically described relative thereto. That is, all embodiments and/or features of any embodiments can be combined in any way and/or combination.
As used herein, the term “provider” may mean any person or entity involved in providing health care services to a patient.
Some embodiments of the inventive concept are described with reference to a payor determining whether to make payment for a claim for services or products. In the context of a health care environment, a payor may be, for example, an entity that provides health or medical insurance, such as private insurance companies and government insurance agencies, both at the federal and state levels (e.g., Medicare, Medicaid, public employee insurance agencies, and the like). Health care providers may submit claims for medical services rendered, products prescribed (e.g., medications, medical devices, etc.), administrative fees, and/or other fees or expenses to a payor for payment. Upon receiving a claim, the payor may then determine whether to pay the claim in whole, in part, or deny the claim. A claim may include both header and line information. The header may be information that applies to the entire claim, e.g., patient details (name, date of birth, address, etc.). The line information may identify the various services, products, fees, expenses, and/or other items for which payment is sought and may be referred to as line item(s). Thus, a payor may evaluate each line in the claim to determine whether to pay the invoiced amount in full, in part, or to deny payment for that line.
A payor, such as an insurance company operating in the health care field, may make use of a claims auditing system to assist them in determining whether to pay and how much to pay for the various lines listed in claims submitted for payment. As described above, payors may be penalized for improperly denying payment of a claim. But a payor may suffer economically if payment is made for fraudulent claims or claims for which reimbursement has not been authorized or contracted for. Some embodiments of the inventive concept stem from a realization that the claims auditing system used by a payor may only contain a subset of all the rules that may be available for evaluating claims for payment. For example, the rules may be packaged together in groups, which are sometimes referred to as knowledge packs, and a payor may only license or purchase a portion of the rules. In some circumstances, the payor may wish to have access to more rules, but schedules updates to the claim auditing system on a fixed schedule, which may result in an extended time period before new rules can be introduced into the system. According to some embodiments of the inventive concept, a secondary auditing system may be provided that includes additional rules for evaluating claims for payment that are not available to the payor by way of the primary auditing system. The secondary auditing system may be provided, for example, remotely through a cloud service. A remote connection system may provide an interface between the primary auditing system and the secondary auditing system. The remote connection system may act as a filter at the claim level for determining whether to forward a claim including the line items therein to a secondary auditing system. The remote connection system may not forward a claim to the secondary auditing system based on one or more claim level fields that may be indicative of whether a secondary auditing system may provide value. For example, a claim level field may be defined that provides an identification for the claims processing system used by a payor. If the claims processing system is not configured to accept a recommendation from a secondary auditing system, then the remote connection system need not forward the claim to the secondary auditing system. Similarly, a field may be defined indicating whether a patient is self-insured or non-self-insured. The remote connection system may not forward claims associated with patients who are self-insured. In some embodiments, when the primary auditing system makes a determination to assign a do not pay status to one or more line items in a claim, then the secondary auditing system will not be tasked with making a further recommendation. Nevertheless, line items in a claim that have been assigned a do not pay status by the primary auditing system may be useful to the secondary auditing system in evaluating line items in the same claim or other claims for payment.
Thus, some embodiments of the inventive concept provide a tagging mechanism in which a tag can be associated with a line item in a claim. The tag can assume multiple states and can be used to provide more nuance to the general rule that denied line items are not forwarded to the secondary auditing system for evaluation. A tag may be viewed as an instruction or a mechanism for conveying information that may be used by a rules engine running on the secondary auditing system for evaluating the line item with the tag or for using the tagged line item to evaluate another line item in the same claim or another claim. For example, if the primary auditing system recommends denying payment for a line item of a claim with high certainty, then this line item may be useful to the secondary auditing system in evaluating line items in the present claim or other claims even though the secondary auditing system would not be tasked with making a payment recommendation on that tagged line item because of the primary auditing system recommendation of denying payment. Conversely, if the primary system recommends denying payment for a line item of a claim with less certainty, including those instances where the primary auditing system recommends a person perform a manual review of the line item, then the tag state may be set to prohibit or limit the secondary auditing system's use of the line item in evaluating other claims and other line items due to the uncertainty surrounding present line item. Thus, some embodiment of the inventive concept provide for sending claims to a secondary auditing system in whole or not at all based on claim level field information. By sending or not sending entire claims, the primary system need not split apart claims by line with some lines being sent to a secondary auditing system and others filtered and not sent to the secondary auditing system. This reduces the processing power needed to divided the claims into individual lines and re-assemble the claims once a secondary auditing system has completed making recommendations on the lines that were sent to it. Other embodiments, however, may allow for the division of claims into lines with decisions being made at the claim line level of which lines to send to a secondary auditing system for evaluation.
The remote connection system may also be used to merge the recommendations between the primary auditing system and the secondary auditing system including resolving any conflicts that may occur due to the primary auditing system having access to more or different historical claim data than may be available to the secondary auditing system. A primary or secondary auditing system may access claim history from an Operational Data Store (ODS) database and/or from their claims processing system. Moreover, a primary auditing system may pass claim history information on to a secondary auditing system. A payor may control how much or how little claim history is passed to a secondary auditing system. As a result, a primary auditing system and a secondary auditing system may have different history information. In some embodiments, the payor may elect to only communicate historical claim information associated with paid claims because a paid claim is typically a final decision making the most accurate. Although described herein in the context of a primary auditing system and a secondary auditing system for evaluating claims for payment, the system architecture may be viewed as a hierarchical auditing system including a primary auditing system and one or more secondary auditing system. Multiple secondary auditing systems may be connected in series in a daisy-chain manner with a remote connection system supporting the addition of each new secondary auditing system to the chain. Rules may be developed including the use of tags to determine which line items are forwarded to each successive secondary auditing system. According to some embodiments described herein, the rules used for evaluating claims for payment may be distributed over a hierarchy of auditing systems beginning with a primary auditing system and one or more secondary auditing systems. The rules applied to claim line items via a secondary auditing system may result in the denial of payment or a reduction in payment amount for one or more line items that otherwise would have been approved by the primary auditing system thereby providing savings to the payor. The payor may subscribe or license the rules provided in a secondary auditing system on a contingency basis where the payor is charged a percentage of the savings that are obtained through use of the secondary auditing system. Because the secondary auditing system may be provided as a service, such as a cloud service, for example, a payor may gain access to new rules on an expedited basis without having to wait to update the rules in the primary auditing system.
Referring to
To allow the payor to access additional rules for evaluating claim line items for payment in an expedited fashion, a remote connection system server 230 may be used to provide access to a secondary auditing system server 240. The secondary auditing system server 240 includes a secondary auditing module 245, which includes additional rules not available via the primary auditing module 225 for evaluating claim line items for payment, payment in part, or non-payment. The secondary auditing module 245 may also include some history information for claims and/or line items that have been previously evaluated and processed. The remote connection system server 230 includes a remote connection module 235 and may be configured to serve as a proxy for filtering and forwarding claims to a secondary auditing system 115a, . . . , 115n for evaluation for payment. In some embodiments, the remote connection system server 230 may provide a tagging capability to provide instructions that may be processed using the rules running on the secondary auditing system server 240. The various states associated with a tag may be interpreted by the rules running on the secondary auditing system 240 to evaluate the present tagged line for payment and/or use the present tagged line to evaluate another line for payment in the same claim and/or different claim. For example, a line item of a claim that has been recommended for non-payment by the primary auditing system server 220 may be processed by secondary auditing system server 240 based on the state of a tag associated therewith. If the certainty associated with the non-payment recommendation is high, then a tag may be associated with the line item and configured in a state that allows the secondary auditing system server 240 to use the information in the line item as support in evaluating one or more other line items in the same claim or other claims for payment. Conversely, if the non-payment recommendation generated by the primary auditing module 225 is made with less certainty, including circumstances where a manual review is recommended, then the tag state may be set to prohibit or limit the secondary auditing module's 245 use of the line item in evaluating other claims and other line items due to the uncertainty associated with the primary auditing module's 225 recommendation. The remote connection system server 240 may also be configured to merge the payment recommendation between the primary auditing system server 220 the secondary auditing system server 240.
The customer data center 200 of
A network 260 couples the primary auditing system server 220 and remote connection server 230 to the secondary auditing system server 240. The network 260 may be a global network, such as the Internet or other publicly accessible network. Various elements of the network 260 may be interconnected by a wide area network, a local area network, an Intranet, and/or other private network, which may not be accessible by the general public. Thus, the communication network 260 may represent a combination of public and private networks or a virtual private network (VPN). The network 260 may be a wireless network, a wireline network, or may be a combination of both wireless and wireline networks.
Although the primary auditing system server 220, remote connection system server 230, and the secondary auditing system server 240 are shown as separate physical servers, it will be understood that the functionality and capabilities of the various servers may be logically combined/divided among one or more physical servers.
Although
Referring to
Referring now to
As described above, the remote connection system server 230 may resolve any conflicts that may occur due to the primary auditing system having access to more historical claim data than may be available to the secondary auditing system. Thus, in general, if the secondary auditing system server 240 generates a recommendation to deny payment for a line item or pay less than an amount recommended by the primary auditing system server, then the remote connection system server 240 may accept the recommendation by the secondary auditing system server 240 as the final recommendation due to the secondary auditing system saving the payor money. But, referring now to
The remote connection system server 230 may further provide a tagging capability, which can be used to provide instructions that may be processed using the rules running on the secondary auditing system server 240. This may allow the secondary auditing module 245 and secondary auditing system server 240 to use information embedded or implicit in the tags to make payment recommendations on a particular tagged line or to use the tag and line information as support for making recommendations for other lines in the same claim and/or other claim. The tagging may be designed in a variety of ways. For example, any number of tags may be defined and each tag may take on any number of possible states. The greater the number of possible tags and the greater the number of possible states the greater the amount of information that can be conveyed to the secondary auditing module 245/secondary auditing system server 240 for interpretation by the rules running thereon. Moreover, as described above, in some embodiments, the remote connection server 230 may provide a filtering capability with respect to which claims are forwarded to the secondary auditing system server 240 based on claim level fields. In other embodiments, claims may be divided into lines and the tags associated with the individual lines may be used by the remote connection server 230 as a basis for forwarding individual lines to the secondary auditing system server 240 for evaluation. Such an approach may be more processor intensive as the remote connection server 230 would need to track which lines are sent to the secondary auditing system server 240 and reconstruct the original claim upon receiving recommendation results from the secondary auditing system server 240. But the information associated with the tags provides the remote connection system server 230 with a more complex and refined filtering capability with respect to what line items are forwarded to the secondary auditing system server 240. Referring now to
For example, the primary auditing system server may recommend that payment be denied for a line item. If the denial is made with a high certainty, then it may still be useful to forward the line item to the secondary auditing system server 240 as the secondary auditing system server 240 may be able to use that line item information along with the denial recommendation as support in evaluating another line item in the same or another claim for payment. If, however, the denial is made with less certainty, then the line item may not be communicated to the secondary auditing system server 240 as it may not be useful or reliable for use as support information in evaluating other line items for payment. Thus, the use of tagging may allow for exceptions to the general rule of not forwarding line items for which the primary auditing system server 220 has made a non-payment recommendation to the secondary auditing system server 240 to obtain a second recommendation.
Referring to
Referring now to
Although
Computer program code for carrying out operations of data processing systems discussed above with respect to
Moreover, the functionality of the primary auditing system server 220 of
The data processing apparatus described herein with respect to
Some embodiments of the inventive concept may provide a hierarchical auditing system that may provide a payor responsible for making payment for claims for services or goods, such as health care insurance claims, the ability to enhance their primary auditing system, which provides rules for making payment recommendations for line items in the claims. Specifically, the primary auditing system may be supplemented with one or more secondary auditing systems that provide additional rules for evaluating claim line items for payment. These secondary auditing systems may be accessed through the cloud for convenient and expeditious access to newly developed rules. The payor may be offered access to the rules on a contingency basis where the payor is charged a percentage of the savings obtained through application of the rules in the secondary auditing system.
Further Definitions and Embodiments:
In the above-description of various embodiments of the present inventive concept, it is to be understood that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this inventive concept belongs. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of this specification and the relevant art and will not be interpreted in an idealized or overly formal sense expressly so defined herein.
The flowchart and block diagrams in the figures illustrate the architecture, functionality, and operation of possible implementations of systems, methods, and computer program products according to various aspects of the present inventive concept. In this regard, each block in the flowchart or block diagrams may represent a module, segment, or portion of code, which comprises one or more executable instructions for implementing the specified logical function(s). It should also be noted that, in some alternative implementations, the functions noted in the block may occur out of the order noted in the figures. For example, two blocks shown in succession may, in fact, be executed substantially concurrently, or the blocks may sometimes be executed in the reverse order, depending upon the functionality involved. It will also be noted that each block of the block diagrams and/or flowchart illustration, and combinations of blocks in the block diagrams and/or flowchart illustration, can be implemented by special purpose hardware-based systems that perform the specified functions or acts, or combinations of special purpose hardware and computer instructions.
The terminology used herein is for the purpose of describing particular aspects only and is not intended to be limiting of the inventive concept. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items. Like reference numbers signify like elements throughout the description of the figures.
In the above-description of various embodiments of the present inventive concept, aspects of the present inventive concept may be illustrated and described herein in any of a number of patentable classes or contexts including any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof. Accordingly, aspects of the present inventive concept may be implemented entirely hardware, entirely software (including firmware, resident software, micro-code, etc.) or combining software and hardware implementation that may all generally be referred to herein as a “circuit,” “module,” “component,” or “system.” Furthermore, aspects of the present inventive concept may take the form of a computer program product comprising one or more computer readable media having computer readable program code embodied thereon.
Any combination of one or more computer readable media may be used. The computer readable media may be a computer readable signal medium or a computer readable storage medium. A computer readable storage medium may be, for example, but not limited to, an electronic, magnetic, optical, electromagnetic, or semiconductor system, apparatus, or device, or any suitable combination of the foregoing. More specific examples (a non-exhaustive list) of the computer readable storage medium would include the following: a portable computer diskette, a hard disk, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or Flash memory), an appropriate optical fiber with a repeater, a portable compact disc read-only memory (CD-ROM), an optical storage device, a magnetic storage device, or any suitable combination of the foregoing. In the context of this document, a computer readable storage medium may be any tangible medium that can contain, or store a program for use by or in connection with an instruction execution system, apparatus, or device.
The description of the present inventive concept has been presented for purposes of illustration and description, but is not intended to be exhaustive or limited to the inventive concept in the form disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art without departing from the scope and spirit of the inventive concept. The aspects of the inventive concept herein were chosen and described to best explain the principles of the inventive concept and the practical application, and to enable others of ordinary skill in the art to understand the inventive concept with various modifications as are suited to the particular use contemplated.
| Number | Date | Country | |
|---|---|---|---|
| Parent | 17038640 | Sep 2020 | US |
| Child | 18348540 | US |
