SYSTEM AND METHOD USING EXTENDED AUTHORIZATION HOLD PERIOD

• US 20080140447A1
• Filed: 06/08/2007
• Published: 06/12/2008
• Est. Priority Date: 06/08/2006
• Status: Active Grant

• Current Assignee: Visa USA, Inc. (Visa, Inc.)
• Original Assignee: Visa USA, Inc. (Visa, Inc.)
• Inventors: Frantz, Douglas, Kayoumi, Roxanna, Pourfallah, Stacy, Pruitt, Janet
• Granted Patent: US 8,660,855 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Embodiments of the present invention relate to methods and apparatuses serving to provide assurance that healthcare providers will receive payment for services rendered. In one embodiment, a payment card (or other portable consumer device) provides an extended authorization hold period (for example up to 21 days). This hold period allows the healthcare provider to request authorization for payment from the patient'"'"'s credit, debit, FSA, HRA, or HSA payment card, submit the insurance claim, and then upon receipt of a health insurance carrier'"'"'s Explanation of Benefits (EOB) within the hold period, submit for settlement only that amount actually due from the patient. In accordance with an alternative embodiment, pending receipt of the EOB from the insurer, the healthcare provider flags a transaction in a point-of-sale (POS) terminal device or server for storage and delayed submittal over an electronic payment network. Embodiments in accordance with the present invention are particularly applicable to payment of claims in healthcare plans following adjudication by a payer.

Claims

1. A method comprising:

sending an authorization request message from a healthcare provider to an issuer of a payment card, for a first amount associated with healthcare services rendered to a patient, wherein at least a portion of the first amount is held by the issuer for a predetermined amount of time; and

sending a settlement request message to the issuer requesting payment for a second amount due from the patient after communicating with the patient'"'"'s health insurance carrier.

2. The method of claim 1 wherein if the healthcare provider does not send the settlement request message to the issuer within the predetermined period of time, the held amount is no longer held.

3. The method of claim 1 wherein the second amount comprises a difference between,

a value of the healthcare services, or a contracted price for services agreed upon between the health insurance carrier and healthcare provider;

and

an amount to be paid by the health insurance carrier following an adjudication decision.

4. The method of claim 3 wherein the first amount comprises a retail value of the services rendered.

5. A method of obtaining payment for healthcare goods or services, the method comprising:

rendering healthcare goods or services to a patient;

submitting to a healthcare insurance carrier of the patient, a claim for a full amount of the healthcare goods or services; and

delaying a request to the patient for payment of the full amount, pending adjudication of the claim by the healthcare insurance carrier.

6. The method of claim 5 wherein the delaying comprises imposing a hold of a requested amount for authorization transmitted over an electronic payment network from an acquirer of the healthcare provider to an issuer of a payment card of the patient.

7. The method of claim 6 wherein the hold is automatically imposed by a computer based upon recognition of information present in the request for authorization.

8. The method of claim 6 wherein the hold is maintained for only a predetermined period of time in which the adjudication is expected to be completed.

9. The method of claim 5 wherein the delaying comprises:

storing a payment transaction in a memory of a point-of-sale (POS) device of the healthcare provider; and

transmitting a settlement request for the transaction from the POS device over an electronic payment network, after the adjudication has been received by the healthcare provider.

10. The method of claim 9 wherein the settlement request is transmitted at the manual instruction of the healthcare provider.

11. The method of claim 9 wherein the settlement request is transmitted after a predetermined period of time in which the adjudication is expected to be made.

12. The method of claim 11 further comprising the POS device sending an alert to the healthcare provider regarding an expiration of the predetermined time period.

13. An apparatus comprising a host computer including a processor and a computer readable storage medium, the computer readable storage medium having stored thereon code for directing the processor to,

receive over an electronic payment network, a request for authorization of a payment of a transaction for healthcare services,

recognize in the request for authorization, information indicating that a delay in settlement of the transaction is appropriate, and

generate a message delaying settlement of the transaction for a predetermined time.

14. The apparatus of claim 13 wherein the host computer is controlled by an issuer of a payment card of a recipient of the healthcare services.

15. The apparatus of claim 13 wherein the computer readable storage medium has code stored thereon to further direct the processor to recognize a subsequent message requesting settlement of the transaction.

16. An apparatus comprising a host computer including a processor and a computer readable storage medium, the computer readable storage medium having stored thereon code for directing the processor to,

at a first time, receive information regarding a transaction for healthcare services;

store the information on the computer-readable storage medium together with an identifying flag; and

at a predetermined time after the first time, send a request for authorization of payment of the transaction, over an electronic payment processing network.

17. The apparatus of claim 16 wherein the computer readable storage medium further comprises code for recognizing the transaction as appropriate for delayed transmittal of the request for authorization.

18. The apparatus of claim 16 wherein the computer readable storage medium further comprises code for directing the processor to search a plurality of healthcare transactions stored on the computer readable storage medium.

19. The apparatus of claim 16 wherein the computer readable storage medium further comprises code for generating an alert indicating passage of the predetermined time.