Transparent healthcare transaction management system

• US 20070192146A1
• Filed: 02/14/2006
• Published: 08/16/2007
• Est. Priority Date: 02/14/2006
• Status: Active Grant

• Current Assignee: Kathleen Menocal, Tomas Menocal
• Original Assignee: Kathleen Menocal, Tomas Menocal
• Inventors: Menocal, Kathleen, Menocal, Tomas
• Granted Patent: US 8,442,840 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/00 Commerce
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A healthcare payment transaction system for managing and arranging payment for a healthcare service transaction provided by a healthcare service provider to a patient, particularly where the payment is to be paid by an insurer. The system includes an electronic deposit account for the healthcare service provider whereby the healthcare service provider records information regarding healthcare service transactions performed by the healthcare service provider for patients. It also features an electronic deposit account for the insurer whereby the insurer accesses information regarding healthcare service transactions for services provided for patients for which the insurer has payment responsibility. The insurer can also use its electronic deposit account to deposit payments for healthcare service transactions performed for patients covered by a policy issued by the insurer. A central system is used as a means for electronically transferring payments from the insurer'"'"'s electronic deposit account to the healthcare service provider'"'"'s electronic deposit account. A sweep function is further provided as a means for determining whether the healthcare service provider has recorded information regarding a healthcare service transaction for a patient for whom the insurer has payment responsibility.

Claims

1. A healthcare payment transaction system for managing and arranging payment for a healthcare service transaction provided by a healthcare service provider to a patient, wherein said payment is to be paid by a payer, said healthcare payment transaction system comprising:

a. an electronic deposit account for said healthcare service provider whereby said healthcare service provider records information regarding said healthcare service transaction;

b. an electronic deposit account for said payer whereby said payer accesses said information regarding said healthcare service transaction and deposits payment for said healthcare service transaction;

c. a means for electronically transferring said payment from said electronic deposit account for said payer to said electronic deposit account for said healthcare service provider;

d. a display means for allowing said healthcare service provider to view said electronic deposit account for said healthcare service provider in order for said healthcare service provider to determine whether said healthcare service provider has been paid for said healthcare service transaction by said payer; and

e. a means for determining whether said healthcare service provider has recorded information regarding a healthcare service transaction for a patient for which said payer has payment responsibility.

2. The healthcare payment transaction system of claim 1, wherein said means for determining whether said healthcare service provider has recorded information regarding a healthcare service transaction for a patient for which said payer has payment responsibility further comprises sweeping said deposit account for said healthcare service provider to determine whether said healthcare service transaction has been recorded for said patient.

3. The healthcare payment transaction system of claim 1, wherein said information regarding said healthcare service transaction includes identifying information for said patient.

4. The healthcare payment transaction system of claim 2, wherein said information regarding said healthcare service transaction includes identifying information for said patient.

5. The healthcare payment transaction system of claim 1, wherein said information regarding said healthcare service transaction includes identifying information for said patient, diagnosis and treatment information for said healthcare service transaction, and billing information for said healthcare service transaction.

6. The healthcare payment transaction system of claim 2, wherein said information regarding said healthcare service transaction includes identifying information for said patient, diagnosis and treatment information for said healthcare service transaction, and billing information for said healthcare service transaction.

21. The healthcare payment transaction system of claim 1, further comprising a provider credential associated with said healthcare service provider configured to authenticate said healthcare service provider to said payer so that said payer may recognize said healthcare service provider as an authorized provider of services covered by said payer.

7. A healthcare payment transaction system;

a. a first plurality of deposit accounts for healthcare service providers, each of said first plurality corresponding to a healthcare service provider, each of said first plurality of deposit accounts including

i. a means for inputting a deposit into one of said plurality of deposit accounts, wherein said deposit includes information pertaining to a healthcare service transaction for a patient,

ii. a means for withdrawing a payment made for performing said healthcare service transaction;

b. a means for associating said deposit with a payer having payment responsibility for said patient for which said deposit pertains; and

c. a second plurality of deposit accounts for insurers, each of said second plurality corresponding to an insurer, each of said second plurality of deposit accounts including

i. a means for recalling deposits for which said insurer is determined to be said payer having payment responsibility.

8. The healthcare payment transaction system of claim 7, each of said second plurality of deposit accounts for said insurers including a means for depositing payment for healthcare service transactions performed for covered patients.

9. The healthcare payment transaction system of claim 7, wherein said information pertaining to said healthcare service transaction for said patient includes identifying information for said patient.

10. The healthcare payment transaction system of claim 7, wherein said information pertaining to said healthcare service transaction for said patient includes identifying information for said patient, diagnosis and treatment information for said healthcare service transaction, and billing information for said healthcare service transaction.

11. A method for arranging a payment for a healthcare service transaction provided by a healthcare service provider to a patient, wherein said payment is to be made by a payer having payment responsibility for said patient comprising the steps of:

a. accessing an electronic deposit account for said healthcare service provider, said electronic deposit account configured to receive information pertaining to said healthcare service transaction;

b. entering said information pertaining to said healthcare service transaction into said electronic deposit account for said healthcare service provider;

c. associating said healthcare service transaction with an electronic deposit account for said payer having payment responsibility for said patient; and

d. transmitting said information pertaining to said healthcare service transaction to said electronic deposit account for said payer having potential payment responsibility for said patient.

12. The method of claim 11, further comprising the step of:

a. adjudicating said information pertaining to said healthcare service transaction to determine the existence and extent of actual payment responsibility belonging to said payer.

13. The method of claim 11, further comprising the step of:

a. determining order of insurance with respect to said payer and a second party having potential payment responsibility for said patient.

14. The method of claim 12, further comprising the steps of:

a. determining order of insurance with respect to said payer and a second party having potential payment responsibility for said patient; and

b. determining coordination of benefits with respect to said payer and said second party having potential payment responsibility for said patient.

15. The method of claim 11, further comprising the step of:

a. transmitting payment for said healthcare service transaction from said electronic deposit account for said payer to said electronic deposit account for said healthcare service provider.

16. The method of claim 12, further comprising the step of:

a. transmitting payment for said healthcare service transaction from said electronic deposit account for said payer to said electronic deposit account for said healthcare service provider.

17. The method of claim 13, further comprising the step of

a. transmitting payment for said healthcare service transaction from said electronic deposit account for said payer to said electronic deposit account for said healthcare service provider.

18. The method of claim 14, further comprising the step of

a. transmitting payment for said healthcare service transaction from said electronic deposit account for said payer to said electronic deposit account for said healthcare service provider.

19. A healthcare payment transaction system for managing and arranging payment for a healthcare service transaction provided by a healthcare service provider to a patient, wherein said payment is to be paid by a payer, said healthcare payment transaction comprising:

a. an electronic deposit account for said healthcare service provider whereby said healthcare service provider records information regarding said healthcare service transaction;

b. an electronic deposit account for said payer whereby said payer accesses said information regarding said healthcare service transaction;

c. software for directing a computer to determine whether said healthcare service provider has recorded information regarding a healthcare service transaction for a patient for which said payer has payment responsibility;

d. a network communication means for providing access of said electronic deposit account for said healthcare service provider to said health care service provider and providing access of said electronic deposit account for said payer to said payer; and

e. a display means for allowing said payer to view said electronic deposit account for said payer and see whether said healthcare service provider has recorded information regarding a healthcare service transaction for a patient for which said payer has payment responsibility.

20. The healthcare payment transaction system of claim 19, further comprising software for directing a computer to electronically transfer payments made by said payer for said health care service transaction from said electronic deposit account for said payer to said electronic deposit account for said healthcare service provider.