Health care eligibility verification and settlement systems and methods

• US 20050288964A1
• Filed: 06/14/2005
• Published: 12/29/2005
• Est. Priority Date: 08/09/1999
• Status: Active Grant

• Current Assignee: First Data Corporation (Fiserv Incorporated)
• Original Assignee: First Data Corporation (Fiserv Incorporated)
• Inventors: Lutzen, Renee Elahi, Weis, David G., Nauman, George
• Granted Patent: US 8,751,250 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G07G 1/0018 Constructional details, e.g. of drawer, printing means, input means
• CPC Class Codes: G07G 1/12 electronically operated digital data processing aspects G06Q20/00
• CPC Class Codes: G16H 10/65 stored on portable record carriers, e.g. on smartcards, RFID tags or CD
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 50/00 ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics

Abstract

Devices, systems, and methods for processing healthcare and financial transactions are provided. A point-of-care terminal for processing a healthcare transaction by a healthcare provider includes a reader configured to read information from a healthcare eligibility and settlement presentation instrument associated with a patient, and a processor configured to process a healthcare transaction based on the information, wherein the healthcare transaction includes at least one of a healthcare eligibility verification transaction and a healthcare settlement transaction.

Claims

1. A point-of-care device comprising:

a base unit adapted for performing healthcare functions at a point-of-care, wherein the base unit includes;

a base unit housing; and

a processor disposed within the base unit housing and configured to process a plurality of transaction types, wherein one of the plurality of transaction types is a healthcare insurance verification transaction.

2. The point-of-care of claim 1, the point-of-sale device further comprising a printer.

3. The point-of-care device of claim 1, wherein the base unit further includes a display on the base unit housing and in communication with the processor.

4. The point-of-care device of claim 1, wherein the base unit further comprises a touch-screen.

5. The point-of-care device of claim 1, wherein the base unit further includes a keypad on the base unit housing and in communication with the processor.

6. The point-of-care device of claim 1, wherein the base unit housing further includes a card slot for receiving a patient card and wherein the base unit further includes a magnetic strip reader affixed with the base unit housing at the card slot and in communication with the processor.

7. The point-of-care device recited in claim 1, the point-of-care device further comprising a modem located within the base unit housing and in communication with the processor.

8. The point-of-care device of claim 1, the point-of-sale device further comprising an external communications interface in communication with the processor.

9. The point-of-care device of claim 8, wherein the processor is further configured to receive and process Internet communications over the external communications interface.

10. A point-of-care terminal for processing a healthcare transaction by a healthcare provider, the terminal comprising:

a reader configured to read information from an information encoding region of a healthcare eligibility and settlement presentation instrument associated with a patient;

a processor configured to process a healthcare transaction based on the information, wherein the healthcare transaction comprises a member selected from the group consisting of a healthcare eligibility verification transaction and a healthcare settlement transaction.

11. The point-of-care terminal according to claim 10, wherein the healthcare transaction comprises a healthcare eligibility transaction, and the processor is configured to transmit a healthcare eligibility request to a communication network and to receive a healthcare eligibility response from the communication network.

12. The point-of-care terminal according to claim 10, wherein the healthcare transaction comprises a healthcare settlement transaction, the healthcare settlement transaction comprising a member selected from the group consisting of a credit card settlement, a debit card settlement, a flexible spending account settlement, a health savings account settlement, a health reimbursement account settlement, a medical savings account settlement, a transportation account settlement, a parking settlement, a dependent care settlement, and a claim settlement.

13. The point-of-care terminal according to claim 10, wherein the processor is configured to transmit a request for an eligibility and coverage information packet to a communication network and to receive an eligibility and coverage information packet from the communication network.

14. The point-of-care terminal according to claim 13, wherein the terminal further comprises an external network interface, and the processor is configured to send the request and receive the packet via the external network interface.

15. A system for effectuating a healthcare transaction from one or more point-of-care devices, the system comprising a plurality of point-of-care devices in communication with a point-of-care control system, wherein at least one of the plurality of point-of-care devices is in communication with a first transaction system and a second transaction system.

16. The system of claim 15, wherein each of the point-of-care control system, the first transaction system, and the second transaction system are capable of configuring one or more of the plurality of point-of-care devices.

17. The system of claim 15, wherein the first transaction system is a healthcare eligibility verification system.

18. The system of claim 15, wherein the second transaction system is a healthcare settlement system.

19. A computer program product for processing a healthcare transaction by a healthcare provider, the program product comprising:

code for retrieving patient data from a healthcare presentation instrument, the healthcare presentation instrument associated with a patient;

code for generating a request for a healthcare information packet based on the patient data from the healthcare presentation instrument;

code for transmitting the request for a healthcare information packet to a communication network;

code for receiving a healthcare information packet from the communication network;

code for presenting at least part of the content of the healthcare information packet to the healthcare provider; and

a computer-readable medium for storing the codes.

20. The computer program product according to claim 19, wherein the healthcare presentation instrument comprises a healthcare insurance eligibility and coverage instrument and the healthcare information packet comprises a healthcare eligibility and coverage information packet.

21. The computer program product according to claim 19, further comprising code for maintaining a record of healthcare information packet requests.