ELECTRONIC HEALTHCARE IDENTIFICATION GENERATION AND RECONCILIATION

• US 20090164243A1
• Filed: 01/29/2009
• Published: 06/25/2009
• Est. Priority Date: 09/30/2005
• Status: Abandoned Application

• Current Assignee: VIIAD Systems, LLC
• Original Assignee: J&H Enterprises LLC
• Inventors: Zubak, John A., Mitgang, Harvey
• Application Number:
  US12/362,092
• Publication Number:
  US 20090164243A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

A system and method for generating healthcare identification and reconciliation information are provided. In an illustrative implementation, a computer-implemented healthcare information and reconciliation platform (HIRP) maintains a HIR engine which is operable on various data including but not limited to patient data, network data, plan data, insurance carrier/payor data, and healthcare provider data. In an illustrative operation, the HIR engine can receive input data representative of a participating user'"'"'s benefit plan. The HIR engine can process the inputted data and correlate the inputted data against healthcare provider data, benefit plan data, healthcare related data, healthcare network data and insurance carrier/payor data to generate and/or store an electronic healthcare card/document representative of the most up-to-date contractual obligations between the cooperating parties (e.g., healthcare provider, benefit plan administrator, healthcare network, insurance carrier, and the covered person/patient).

Claims

1. A system for generating healthcare information and reconciliation comprising:

a data store comprising patient data, healthcare provider data, insurance carrier data, healthcare network data, and benefit plan data;

a computing processor communicatively coupled with the data store; and

computing memory communicatively coupled with the computing processor, the computing memory having instructions stored therein which when executed by the computing processor cause the processor to perform the following method;

receiving data representative of a subscriber'"'"'s benefit plan information via an electronic communication mechanism;

correlating the received data against one or more of healthcare provider data, healthcare network data, benefit plan data and insurance carrier data; and

generating an electronic healthcare card having information thereon that is representative of current contractual obligations existing between cooperating parties of a healthcare system.

2. The system as recited in claim 1 wherein the cooperating parties of a healthcare system comprise any of a patient, a healthcare provider, an insurance carrier, and employer, a claims adjustor, a case manager, a healthcare network, and a payor.

3. The system as recited in claim 1 wherein the electronic healthcare card information comprises managed network healthcare information specific to a selected healthcare provider.

4. The system as recited in claim 3 wherein the healthcare card information comprises one or more selected logos to satisfy one or more contractual obligations existing between a healthcare provider and an insurance carrier or payor.

5. The system as recited in claim 1, wherein receiving data representative of a subscriber'"'"'s benefit plan information via an electronic communication mechanism comprises receiving data via one or more of the Internet, a wireless telephonic network, a wireless communication network, fixed-wire communications network, and fixed-wire telephonic network.

6. The system as recited in claim 1, wherein receiving data representative of a subscriber'"'"'s benefit plan information via an electronic communication mechanism comprises receiving data communicated by the subscriber.

7. The system as recited in claim 1, wherein receiving data representative of a subscriber'"'"'s benefit plan information via an electronic communication mechanism comprises receiving data communicated by healthcare service provider personnel.

8. The system as recited in claim 7 further comprising communicating the electronic healthcare card to healthcare service provider personnel.

9. The system as recited in claim 1 wherein receiving data representative of a subscriber'"'"'s benefit plan information comprises receiving any of user benefit plan data, healthcare provider data, employer data, claims adjustor data, case manager data, healthcare network data, and insurance carrier/payor data.

10. The system as recited in claim 7 wherein communicating the electronic healthcare card comprises communicating information via at least one of phone, facsimile, e-mail, or short messaging service.

11. A computer-implemented interactive method for generating current healthcare identification and reconciliation information, comprising:

receiving data representative of a subscriber'"'"'s benefit plan information via an electronic communication mechanism;

correlating the received data against one or more of healthcare provider data, healthcare network data, benefit plan data and insurance carrier/payor data to produce verified healthcare information for the participating user;

generating an electronic healthcare card/document having verified healthcare information representative of one or more current relationships between cooperating parties comprising any of healthcare providers, benefit plan administrators, healthcare networks, insurance carriers/payors, and participating users.

12. The method as recited in claim 11 further comprising generating verified healthcare information comprising one or more selected logos representative of one or more current relationships between cooperating parties comprising any of a healthcare provider, benefit plan administrator, healthcare network and an insurance carrier/payor.

13. The method as recited in claim 12 further comprising providing an electronic healthcare card/document for delivery to healthcare provider in accordance with contractual requirements.

14. The method as recited in claim 13 further comprising reconciling payment for services rendered by a healthcare provider using the generated electronic healthcare card/document.

15. A computer-readable medium that contains instructions which, when executed by a processor, causes the processor to perform an interactive method for generating healthcare identification and reconciliation information comprising the steps of:

receiving data representative of a subscriber'"'"'s current benefit plan information via an electronic communication mechanism, the electronic communication mechanism comprising at least one of;

the Internet, a wireless telephonic network, a wireless communication network, fixed-wire communications network, or fixed-wire telephonic network;

correlating the received data against one or more data comprising any of healthcare provider data, healthcare network data, benefit plan data and insurance carrier/payor data to produce verified healthcare information for the subscriber;

generating an electronic healthcare card/document having verified healthcare information representative of one or more current relationships between cooperating parties comprising any of healthcare providers, benefit plan administrators, healthcare networks, insurance carriers/payors, and participating users.

16. A method to generate an electronic healthcare card comprising:

receiving data representative of a benefit plan;

comparing the received benefit plan data with data in a cooperating data store to determine eligibility requirements for the benefit plan;

upon satisfying eligibility requirements retrieving current data from a cooperating data store representative of healthcare providers that are covered by the benefit plan; and

generating an electronic healthcare card/document using the received data representative of the benefit plan and the retrieved healthcare provider information such that the electronic healthcare card/document has current information specific to one or more of the covered healthcare providers.

17. The method as recited in claim 16 further comprising generating an electronic healthcare card/document having information specific to one or more healthcare providers such that the electronic healthcare card/document satisfies one or more current contractual obligations that exist between the one or more healthcare providers and the benefit provider.

18. A system for generating healthcare information and reconciliation comprising:

a data store comprising patient data, healthcare provider data, insurance carrier data, healthcare network data, healthcare related data, and benefit plan data;

a computing processor communicatively coupled with the data store; and

computing memory communicatively coupled with the computing processor, the computing memory having instructions stored therein which when executed by the computing processor cause the processor to perform the following method;

receiving data identifying a covered party via an electronic communication mechanism;

in response to the request, generating an electronic healthcare card comprising;

information representative of current contractual obligations existing between cooperating parties of a healthcare system, and healthcare related data; and

communicating the electronic healthcare card.

19. The system as recited in claim 18, wherein the healthcare related data comprises deductible information.

20. The system as recited in claim 18, wherein the healthcare related data comprises data representative of healthcare spending accounts.

21. The system as recited in claim 18, wherein the healthcare related data comprises data representative of indemnity plans.

22. The system as recited in claim 18, wherein the healthcare related data comprises data representative of instructions for processing payment of healthcare services by parties comprising health maintenance organizations, benefit plan operators, and personal plan option operators.

23. The system as recited in claim 18, further comprising instructions stored in the memory which when executed by the computing processor cause the processor to perform searches for healthcare service providers satisfying particular criteria.

24. The system as recited in claim 18, wherein communicating the electronic healthcare card comprises communicating one or more electronic links to one or more forms for use as part of healthcare reconciliation processing.

25. The system as recited in claim 18, further comprising instructions stored in the memory which when executed by the computing processor cause the processor to communicate one or more links to one or more forms, the forms comprising information corresponding to information on the electronic healthcare card.

26. The system as recited in claim 18, wherein the data store comprises partner data representative of at least one vendor partner capable of offering services to a covered party, and

wherein generating an electronic healthcare card comprises highlighting the at least one vendor partner on the electronic healthcare card.

27. The system as recited in claim 18, further comprising instructions stored in the memory which when executed by the computing processor cause the processor to store a generated electronic healthcare card for subsequent use.