USRE43904E1 - Medical benefits payment system - Google Patents
Medical benefits payment system Download PDFInfo
- Publication number
- USRE43904E1 USRE43904E1 US13/358,620 US201213358620A USRE43904E US RE43904 E1 USRE43904 E1 US RE43904E1 US 201213358620 A US201213358620 A US 201213358620A US RE43904 E USRE43904 E US RE43904E
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- US
- United States
- Prior art keywords
- payment
- health care
- benefits
- card account
- care provider
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related, expires
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/08—Insurance
-
- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q10/00—Administration; Management
- G06Q10/10—Office automation; Time management
Definitions
- This invention relates to facilitating payments for medical benefits, and more specifically to streamline the payment of health care providers by administrators and insurance carriers that handle claims adjudication and payment to these providers.
- Payers Third party administrators, insurance companies, and large self-funded corporations (herein “Payers”) adjudicate claims, compare them to the benefit plan and make the decision to write checks in payment for the claims.
- Payers are required to print checks and explanation of benefit (EOB) forms for delivery to the health care providers.
- EOB benefits
- the EOB lists the amount the health care provider billed the Payer's company and the amount the Payer's company paid on the claim. It may also list the contractual discount amount and the patient responsibility. If the claim is denied, the EOB will explain the reason for denial. It has been estimated that the check and EOB forms cost Payers approximately $4.50 each.
- TheThis creates inefficiencies tofor all Payers that must coordinate payment for medical services. This includes, including, but is not limited to, insurance carriers, government entities, and non-profit organizations.
- a long-felt but unfulfilled need in the art is a system to reduce the transactional costs incurred by the payers and speed up the delivery and funding of payments by weeks.
- the present invention is a method of facilitating payment of health care benefits to a health care provider on behalf of a Payer, often an insurance company, government organization or self-insured entity.
- An embodiment of the invention includes the step of electronically transmitting a stored-value card account payment of the authorized benefit amount concurrently with an explanation of benefits.
- stored-value cards and stored-value card accounts shall also include financial instruments known as credit cards, debit cards and EFT cards.
- a credit card system is a type of retail transaction settlement and credit system, named after the small plastic card issued to users of the system.
- a credit card is different from a debit card in that it does not remove money from the user's account after every transaction. In the case of credit cards, the issuer lends money to the consumer (or the user).
- a debit card account provides an alternative payment method to cash when making purchases.
- the card When issued in physical form, the card is a ISO 7810 card like a credit card, however its functionality is more similar to writing a check as the funds are withdrawn directly from the cardholder's bank account; some cards are referred to as check cards.
- a stored-value card represents money on deposit with the issuer, and is similar to a debit card.
- One major difference between stored value cards and debit cards is that debit cards are usually issued in the name of individual account holders, while stored value cards are usually anonymous.
- the stored-value card account payment generally includes a card number with the pre-funded amount, a card verification value code and an expiration date.
- the payment and explanation of benefits may be transmitted by a number of methods including, but not limited to, fax, SMTP, SMS, MMS, HTTP, HTTPS, and FTP.
- the electronic transmission may include an electronically computer-generated image of a physical debit card and the unique debit card number is associated with a single benefit payment.
- Paid benefits charged to the associated debit card transaction may be reconciled via the unique card number generated and assigned to a single payment.
- the debit card is pre-funded only to the authorized benefit amount. Thus is it is not possible to charge more than the authorized benefit amount.
- the stored-value card account payment may only be charged through a medical services terminal.
- the terminal may be coupled to a computer-implemented communications network as is known in the art for credit and debit card transactions.
- Another embodiment includes a method of facilitating payment of health care benefits to a health care provider including the steps of identifying the health care provider that renders medical services in anticipation of payment; identifying a payer that has agreed to pay the health care provider on behalf of a patient subject to preselected conditions; identifying an administrator that determines whether the medical services conducted by the service provider meet the preselected conditions by the payer, generates an explanation of benefits, and arranges for payment of the service provider if appropriate; intercepting the explanation of benefits and payment information transmitted from the administrator to the health care provider; acquiring a stored-value card account number for the amount of the check; merging the stored-value card account number with the explanation of benefits into an image file; and transmitting the image file to the health care provider.
- the image file may be transmitted by a number of methods including, but not limited to, fax, SMTP, SMS, MMS, HTTP, HTTPS, and FTP.
- the transmission may be implemented using a computer coupled to a network connection such as known in the art and required for transmissions such as FTP, HTTP, and the like.
- the charge incurred against the stored-value card account number may be reconciled to confirm the health care provider has been paid for the services approved by the administrator.
- the stored-value card account number is chargeable only through a medical services terminal.
- FIG. 1 (prior art) is an illustration of the current state-of-the-art.
- FIG. 2 is a flow-chart illustration of an embodiment of the invention.
- FIG. 3 is a diagrammatic view of an embodiment of the invention.
- FIG. 4 is an image of a merged EOB and stored-value card account payment according to an embodiment of the invention.
- insured patient 20 consumes services from health care provider 30 .
- Health care provider 30 submits a benefit claim to administrator 40 in order to receive payment.
- Administrator 40 may be a third party administrator, insurance company government entity, non-profit organization or the like.
- administrator 40 is considered any entity that adjudicates claims, compares them to the benefit plan and makes the decision to make payment for the services.
- Administrator 40 evaluates the claim made by health care provider 30 to determine whether all or a portion of the benefit claim is payable under the terms of the relevant policy issued by payer or plan sponsor (herein “payer”). 50 .
- Payer 50 funds funding account 70 in anticipation of benefit claims. If administrator 40 finds that a benefit claim is payable, it draws the money from funding account 70 .
- Administrator 40 then generates an explanation of benefits and a check for the benefit payment.
- the explanation of benefits and check are then sent concurrently to health care provider 30 .
- Drawbacks associated with the prior art include the cost and time associated with generating hardcopy checks and sending them by mail to health care provider 30 .
- claim 80 is received. Claim 80 is then evaluated to determine whether it is payable under the terms of an applicable policy. If claim 80 is not even partially payable, then non-payment EOB 90 is generated and transmitted to health care provider 30 without payment. However, if claim 80 is at least partially payable, then stored-value card account 100 is loaded with funds equal to the amount of the payable benefit. Payment EOB 110 is merged with stored-value card account 100 to generate image file 120 .
- Image file 120 includes payment EOB 110 and a computer-generated facsimile of a physical stored-value card complete with the card number, expiration date and security verification code. Image file 120 is transmitted to health care provider 30 by a suitable transmission medium including, but not limited to, fax, SMTP, SMS, MMS, HTTP, HTTPS, and FTP.
- insured 20 having coverage provided by payer 50 consumes services by health care provider 30 .
- Health care provider 30 then submits a benefit claim to administrator 40 which adjudicates the benefit claim in accordance with preexisting guidelines. If payment is appropriate on the benefit claim, a transfer of funds is made between payer's account 60 and its funding account 70 (to which administrator 40 has access).
- Stored-value card processor 130 then loads funds from funding account 70 onto a stored-value card account.
- the stored-value card account is chargeable only on a medical services terminal and it cannot be charged over the amount loaded onto it.
- the card number, the security verification code and the expiration date of the debit card account are merged with the explanation of benefits generated by administrator 40 into image file 140 which is then transmitted back to health care provider 30 .
- FIG. 4 illustrates an exemplary embodiment of a merged EOB and stored-value card account payment.
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- Engineering & Computer Science (AREA)
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- General Business, Economics & Management (AREA)
- Entrepreneurship & Innovation (AREA)
- Economics (AREA)
- Marketing (AREA)
- Finance (AREA)
- Human Resources & Organizations (AREA)
- Physics & Mathematics (AREA)
- Accounting & Taxation (AREA)
- General Physics & Mathematics (AREA)
- Theoretical Computer Science (AREA)
- Technology Law (AREA)
- Data Mining & Analysis (AREA)
- Development Economics (AREA)
- Operations Research (AREA)
- Quality & Reliability (AREA)
- Tourism & Hospitality (AREA)
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Abstract
Description
Claims (26)
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US13/358,620 USRE43904E1 (en) | 2006-12-05 | 2012-01-26 | Medical benefits payment system |
US13/715,053 USRE44748E1 (en) | 2006-12-05 | 2012-12-14 | Medical benefits payment system |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/566,930 US7792686B2 (en) | 2006-12-05 | 2006-12-05 | Medical benefits payment system |
US13/358,620 USRE43904E1 (en) | 2006-12-05 | 2012-01-26 | Medical benefits payment system |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US11/566,930 Reissue US7792686B2 (en) | 2006-12-05 | 2006-12-05 | Medical benefits payment system |
Related Child Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US11/566,930 Continuation US7792686B2 (en) | 2006-12-05 | 2006-12-05 | Medical benefits payment system |
Publications (1)
Publication Number | Publication Date |
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USRE43904E1 true USRE43904E1 (en) | 2013-01-01 |
Family
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Family Applications (3)
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US11/566,930 Ceased US7792686B2 (en) | 2006-12-05 | 2006-12-05 | Medical benefits payment system |
US13/358,620 Expired - Fee Related USRE43904E1 (en) | 2006-12-05 | 2012-01-26 | Medical benefits payment system |
US13/715,053 Active 2029-07-07 USRE44748E1 (en) | 2006-12-05 | 2012-12-14 | Medical benefits payment system |
Family Applications Before (1)
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US11/566,930 Ceased US7792686B2 (en) | 2006-12-05 | 2006-12-05 | Medical benefits payment system |
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US13/715,053 Active 2029-07-07 USRE44748E1 (en) | 2006-12-05 | 2012-12-14 | Medical benefits payment system |
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Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9799026B1 (en) | 2014-12-17 | 2017-10-24 | Supersede Solutions, LLC | Direct payment method using gateway exception handling |
US11468442B1 (en) | 2014-09-02 | 2022-10-11 | Vpay, Inc. | Payment card reconciliation by authorization code |
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MXPA01004945A (en) * | 1998-11-17 | 2003-03-10 | Prenet Corp | Electronic payment system utilizing intermediary account. |
US8234214B2 (en) * | 2004-01-07 | 2012-07-31 | Precash, Inc. | System and method for facilitating large scale payment transactions |
US20070150414A1 (en) * | 2004-01-07 | 2007-06-28 | Precash, Inc. | System and method for facilitating payment transactions |
US8626536B2 (en) * | 2004-08-31 | 2014-01-07 | Electronic Commerce for Healthcare Organizations, Inc. | Intelligent router for medical payments |
US7792686B2 (en) | 2006-12-05 | 2010-09-07 | Stoneeagle Services, Inc. | Medical benefits payment system |
US8566240B2 (en) * | 2007-01-16 | 2013-10-22 | E2Interactive, Inc. | Systems and methods for the payment of customer bills utilizing payment platform of biller |
US10614458B2 (en) * | 2009-08-14 | 2020-04-07 | Visa U.S.A. Inc. | Influenza vaccine administration payment device processing |
US11978031B2 (en) | 2010-12-14 | 2024-05-07 | E2Interactive, Inc. | Systems and methods that create a pseudo prescription from transaction data generated during a point of sale purchase at a front of a store |
US20120253989A1 (en) * | 2011-03-30 | 2012-10-04 | CPS Holdings, LLC | System and method for payment by virtual credit card |
US8249893B1 (en) * | 2012-04-05 | 2012-08-21 | Stoneeagle Services, Inc. | Automated service provider payment method |
US10068295B1 (en) | 2012-05-30 | 2018-09-04 | Vpay, Inc. | Merchant portal system with explanation of benefits |
US8332238B1 (en) | 2012-05-30 | 2012-12-11 | Stoneeagle Services, Inc. | Integrated payment and explanation of benefits presentation method for healthcare providers |
US9613183B2 (en) | 2013-02-11 | 2017-04-04 | Datavi, LLC | Post-authorization transaction bundling control |
AU2014269934A1 (en) | 2013-05-23 | 2015-12-10 | Davidshield L.I.A. (2000) Ltd. | Automated reimbursement interactions |
US10062075B2 (en) | 2013-11-04 | 2018-08-28 | E2Interactive, Inc. | Systems and methods for using a dual function medical benefits card |
US11599885B1 (en) | 2014-08-30 | 2023-03-07 | Vpay, Inc. | System and method for virtual payment card fraud detection |
US11354753B1 (en) * | 2019-01-03 | 2022-06-07 | INMAR Rx SOLUTIONS, INC. | System for reconciling pharmacy payments based upon predicted claims and related methods |
US11494752B1 (en) * | 2019-11-01 | 2022-11-08 | Chandra Bondugula | System and method for pre-paid services |
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Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US11468442B1 (en) | 2014-09-02 | 2022-10-11 | Vpay, Inc. | Payment card reconciliation by authorization code |
US9799026B1 (en) | 2014-12-17 | 2017-10-24 | Supersede Solutions, LLC | Direct payment method using gateway exception handling |
Also Published As
Publication number | Publication date |
---|---|
US7792686B2 (en) | 2010-09-07 |
US20080133266A1 (en) | 2008-06-05 |
USRE44748E1 (en) | 2014-02-04 |
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