Accelerated Payments for Health Care Plans

• US 20090006135A1
• Filed: 06/26/2007
• Published: 01/01/2009
• Est. Priority Date: 06/26/2007
• Status: Abandoned Application

• Current Assignee: Liberty Peak Ventures, LLC (Dominion Harbor Enterprises, LLC)
• Original Assignee: American Express Travel Related Services Company, Inc. (American Express Company)
• Inventors: Joshi, Sachin, Harrison, Sarah, Miller, Margaret A., Kalappa, Ahana, KECK, Mark, Sachdev, Sunil
• Application Number:
  US11/768,708
• Publication Number:
  US 20090006135A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A method for accelerating a payment to a merchant for a healthcare related claim. The method comprises submitting a healthcare related claim for payment from the merchant to a payer; determining at the payer whether the member is eligible for services covered as a part of his or her healthcare plan. If the member is determined to be eligible for payment of claim(s) submitted, then a financial institution is notified of an estimated amount of liability for the claim. At least a portion of the estimated amount of liability for the claim is paid to the merchant by the financial institution. The financial institution thereafter receives a reimbursement/payment from a healthcare finding source for the adjudicated amount of liability for the claim. Once the claim is adjudicated, a healthcare management system reconciles with the merchant for any under or over payment.

Claims

1-7. -7. (canceled)

8. A method for accelerating a payment to a provider for a healthcare related claim, comprising:

(a) receiving the healthcare related claim for payment submitted by the provider;

(b) determining an estimated total amount of liability for the healthcare related claim;

(c) paying at least a portion of the estimated total amount of liability for the healthcare related claim to the provider by a financial institution; and

(d) receiving at the financial institution a reimbursement from a funding source for the estimated total amount of liability for the healthcare related claim.

9. The method of claim 8, wherein the healthcare related claim is submitted by the provider to a payer;

and further comprising;

(e) determining at the payer whether the healthcare related claim is eligible for the payment.

10. The method of claim 8, wherein step (a) further comprises:

receiving the healthcare related claim in at least one of a real time and a batch mode.

11. The method of claim 8, further comprising:

(e) receiving the healthcare related claim for an item received by a patient at a payer from a Switch.

12. The method of claim 11, further comprising performing an eligibility check by the Switch, prior to step (b).

13. The method of claim 8, further comprising:

(e) computing an actual amount to be paid to the provider based on at least one of Medicare tables, a percentage of retail and history data of the provider.

14. The method of claim 8, wherein step (c) further comprises:

receiving at the financial institution an estimate of respective payer and patient liabilities for the claim from a Switch; and

paying a percentage of the estimated payer and/or patient liabilities for the healthcare related claim to the provider.

15. The method of claim 8, further comprising:

(f) receiving an Explanation of Payment (EOP) at a healthcare management system.

16. The method of claim 15 further comprising receiving the EOP from a payer via a Switch.

17. The method of claim 15, further comprising:

(g) receiving a second payment for at least one of the patient'"'"'s liability and the payer'"'"'s liability.

18. The method of claim 8, wherein step (c) comprises:

depositing the portion of the estimated amount of liability for the healthcare related claim into an account held by the provider at the financial institution.

19. A method for accelerating a payment to a provider for a healthcare related claim, comprising:

(a) a financial institution receiving at least one of (i) a first estimate of a patient liability for the healthcare related claim and (ii) a second estimate of a payer liability for the healthcare related claim; and

(b) the financial institution paying the provider at least a portion of an amount corresponding to a sum of the first and the second estimates of the patient and the payer liability, respectively.

20. The method of claim 19, further comprising:

(c) billing the patient and the payer for respective liabilities; and

(d) receiving reimbursement from at least one of the payer and the patient for the payment of the healthcare related claim to the provider.

21. The method of claim 19 further comprising:

(c) the financial institution reconciling with the provider for an under or an over-payment made by comparing the sum to an actual amount to be paid to the provider for the healthcare related claim.

22. The method of claim 19, wherein step (a) comprises receiving the first and second estimates from at least one of the payer and a Switch.

23. The method of claim 22, further comprising sending an acknowledgement about the payment related to the healthcare related claim to the payer.

24. A method for accelerating payment to a provider for a healthcare related claim, comprising:

a financial institution receiving a negotiated estimate of at least one of patient and payer liabilities from a third party negotiator when the patient is an out of network patient;

the financial institution paying the provider for at least a portion of the negotiated estimate of the patient and payer liabilities; and

the financial institution receiving reimbursement from at least one of the payer and the patient for the negotiated estimate.

25. The method of claim 24, further comprising:

the financial institution reconciling with the provider for an under or an over-payment made by comparing the negotiated estimate to an actual amount from the third party negotiator to be paid to the provider for the healthcare related claim.

26. A method for accelerating payment for a healthcare related purchase, comprising:

a financial institution receiving at least one of (i) an estimate of a payer'"'"'s liability for the healthcare related purchase, computed by the payer and (ii) an estimate of a patient'"'"'s liability, computed by the payer;

the financial institution paying at least a portion of the estimate of the payer'"'"'s liability and the estimate of the patient'"'"'s liability to a provider; and

the financial institution comparing whether or not the portion of the estimate paid to the provider matches an adjudicated amount computed by the payer and accordingly reconciling with the provider.

27. A method for accelerating a payment to a provider for a healthcare related claim, comprising:

(a) a healthcare management system (HMS) receiving at least one of (i) a first estimate of a payer liability for the healthcare related claim and (ii) a second estimate of a patient liability for the healthcare related claim; and

(b) the HMS instructing a financial institution to pay the provider at least a portion of an amount corresponding to at least the first estimate of the payer liability.

28. The method of claim 27, wherein step (b) further comprises:

the HMS instructing the financial institution to pay the provider an amount corresponding to a sum of the first and the second estimates of the payer and the patient liability.

29. The method of claim 28, further comprising:

(c) billing the patient and the payer for respective liabilities; and

(d) the financial institution receiving reimbursement from at least one of the payer and the patient for the payment of the healthcare related claim to the provider.

30. The method of claim 28 further comprising:

(c) the HMS reconciling with the provider for an under or over-payment made by comparing the sum to an actual amount to be paid to the provider for the healthcare related claim.

31. The method of claim 28, wherein step (a) comprises receiving the first and second estimates from at least one of the payer and a Switch.

32. The method of claim 28, further comprising:

(c) sending an acknowledgement about the payment related to the healthcare related claim to the payer.