System for Processing Retail Clinic Claims
First Claim
1. A method for dispensing a medical treatment to a patient while determining patient medical treatment coverage, eligibility, copayment amount and insurer cost, comprising the steps of(a) a patient requesting a medical treatment at a retail clinic;
- (b) the patient presenting a health insurance card at the retail clinic;
(c) the retail clinic transmitting health insurance card information to a centralized adjudication facility;
(d) the retail clinic transmitting patient medical treatment information to the centralized adjudication facility;
(e) the centralized adjudication facility determining patient medical treatment coverage, eligibility and copayment amount;
(f) transmitting the patient medical treatment coverage, eligibility and copayment amount from the centralized adjudication facility to the retail clinic;
(g) the patient purchasing the medical treatment by paying the retail clinic the copayment amount;
(h) transmitting a bill to the health care insurance provider; and
(i) thereby informing the retail clinic clinician to sell the medical treatment to the patient.
7 Assignments
0 Petitions
Accused Products
Abstract
A method for electronically determining patient medical treatment eligibility, coverage, copayment amount and insurer billing, by: (a) a patient requesting medical treatment at a retail clinic; (b) the patient presenting a health insurance card at the retail clinic; (c) the retail clinic transmitting patient health insurance card information to a centralized adjudication facility; (d) the retail clinic transmitting medical treatment information to the centralized adjudication facility; (e) the centralized adjudication facility determining patient medical treatment coverage, eligibility and copayment amount (f) transmitting the patient medical treatment coverage, eligibility and copayment amount from the centralized adjudication facility to the retail clinic; (g) the patient purchasing the medical treatment by paying the retail clinic the copayment amount, (h) transmitting a bill to the health care insurance provider; and (i) thereby informing the retail clinic clinician to sell the medical treatment to the patient. By simultaneously billing the patient and the insurer, the present invention provides a system that processes the sale of the medical treatment as a sales transaction.
94 Citations
34 Claims
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1. A method for dispensing a medical treatment to a patient while determining patient medical treatment coverage, eligibility, copayment amount and insurer cost, comprising the steps of
(a) a patient requesting a medical treatment at a retail clinic; -
(b) the patient presenting a health insurance card at the retail clinic; (c) the retail clinic transmitting health insurance card information to a centralized adjudication facility; (d) the retail clinic transmitting patient medical treatment information to the centralized adjudication facility; (e) the centralized adjudication facility determining patient medical treatment coverage, eligibility and copayment amount; (f) transmitting the patient medical treatment coverage, eligibility and copayment amount from the centralized adjudication facility to the retail clinic; (g) the patient purchasing the medical treatment by paying the retail clinic the copayment amount; (h) transmitting a bill to the health care insurance provider; and (i) thereby informing the retail clinic clinician to sell the medical treatment to the patient. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23)
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24. The method of step 1, wherein the patient purchasing the medical treatment further comprises:
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(i) the centralized adjudication facility recommending a substitute medical treatment for the patient; and (ii) the patient purchasing the substitute medical treatment.
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25. A system for dispensing a medical treatment to a patient while determining patient medical treatment coverage, eligibility, copayment amount and insurer cost, comprising:
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(a) a retail clinic; (b) a centralized adjudication facility; (c) a communication system for transmitting health insurance card information and patient medical treatment information from the retail clinic to the centralized adjudication facility; (d) a computerized benefits analysis system in the centralized adjudication facility for determining patient medical treatment coverage, eligibility and copayment amount; (e) a communication system for transmitting the patient medical treatment coverage, eligibility and copayment amount from the centralized adjudication facility to the retail clinic; and (g) a computerized purchasing system in the retail outlet for selling the medical treatment to the patient. - View Dependent Claims (26, 27, 28, 29, 30, 31, 32, 33, 34)
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Specification