HEALTHCARE SYSTEM AND METHOD FOR RIGHT-TIME CLAIMS ADJUDICATION AND PAYMENT
First Claim
1. A system for providing right-time claim adjudication and payment for patient healthcare services, where payment may be made by multiple payer sources, the system comprising:
- a point of sale (POS) device for use by a provider in entering patient information, including at least patient ID information and a healthcare treatment code for the patient healthcare services; and
a host for receiving the patient information from the POS device for submission as a healthcare claim to a first payer source, the host for also providing estimated explanation of benefits (EOB) information in response to the patient information, the estimated EOB information including at least information on any patient portion of a provider charge that is not to be paid by the first payer source;
whereby the patient may authorize payment of the patient portion on a real-time basis to the provider in response to the estimated EOB information.
8 Assignments
0 Petitions
Accused Products
Abstract
A system and method for permitting real-time payment of healthcare charges from multiple sources of payment. A POS terminal is used to enter a patient ID and treatment code. A health insurance network receives the patient ID and treatment code and returns an estimated explanation of benefits (EOB) data packet that is used to display an EOB statement at the POS terminal, the display including information on a patient portion not covered by the health insurance plan. The EOB data packet is used to electronically process payment for the patient portion from a second payment source, such as an medical savings account (MSA), credit card account or banking account.
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Citations
26 Claims
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1. A system for providing right-time claim adjudication and payment for patient healthcare services, where payment may be made by multiple payer sources, the system comprising:
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a point of sale (POS) device for use by a provider in entering patient information, including at least patient ID information and a healthcare treatment code for the patient healthcare services; and
a host for receiving the patient information from the POS device for submission as a healthcare claim to a first payer source, the host for also providing estimated explanation of benefits (EOB) information in response to the patient information, the estimated EOB information including at least information on any patient portion of a provider charge that is not to be paid by the first payer source;
whereby the patient may authorize payment of the patient portion on a real-time basis to the provider in response to the estimated EOB information. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16)
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17. A method for making payment on a charge from a provider of healthcare services, wherein the services are subject to a healthcare plan administered by a first payer, and wherein a patient portion of the charge may not be covered by the healthcare plan, and wherein a second payer may be used for the patient portion, the method comprising:
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providing a healthcare provider system at the provider location for healthcare services, the provider system for receiving a patient ID and a treatment code identifying healthcare services provided to the patient, and the provider system for identifying the first payer;
electronically preparing a claim at the provider system for the first payer system, the claim including the patient ID and the treatment code;
generating estimated EOB data in response to the claim, and transmitting the estimated EOB data to the provider system, the estimated EOB data representing at least the patient portion;
displaying the estimated EOB data at the provider system so that the patient may authorize payment from the second payer for the patient portion; and
electronically submitting an authorization for payment from the provider system to a second payer system, in order to process real-time payment from the second payer at the time that healthcare services are provided to the patient. - View Dependent Claims (18, 19, 20, 21)
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22. A system for making payment for patient healthcare services to a provider of such services, where payment may be made by multiple payer sources, including a first payer to whom a health care claim is submitted and a second payer maintaining an account on behalf of the patient that may be used for amounts not paid by the first payer, the system comprising:
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a point of sale (POS) device for use by the provider in entering data, including at least a patient identification and a treatment code; and
a healthcare network linked to the POS terminal and to the second payer, the healthcare network for;
receiving data entered at the POS terminal and in response to the received data electronically transmitting a healthcare claim to the first payer source and to an estimating system;
receiving from the estimating system an estimated explanation of benefits (EOB) message in response to the healthcare claim, the estimated EOB message including at least (a) information on a permitted charge corresponding to the treatment code and (b) information relating to any patient portion of such permitted charge that is not to be paid by the first payer; and
posting an electronic transaction against the second payer account in response to receipt of the patient portion information, so that real-time payment of the patient portion to the provider may be made after the estimated EOB message is received by the healthcare network. - View Dependent Claims (23, 24, 25, 26)
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Specification