System And Method For Payment Of Medical Claims
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Abstract
A system allows a health care provider to arrange payment at the time of service for a patient responsibility portion of a health care claim amount, even though the provider may not know what the patient responsibility portion will be until after adjudication. A health care debit card is associated with an account of the patient. At the time of service, the patient presents the card to the provider. The provider uses the card to authorize the system to hold an estimate of the patient responsibility amount in suspense in the patient'"'"'s account. After adjudication, when the actual patient responsibility amount is known, a transaction set is sent to the system. The system then automatically transfers the actual patient responsibility amount from the patent'"'"'s account and into the provider'"'"'s bank account. Any remainder of the suspended funds is left in the patient'"'"'s account. A trace number is provided so that the provider can reconcile bank statement deposits with transaction set information.
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Citations
40 Claims
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1-14. -14. (canceled)
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15. A health care claim adjudication computer-implemented method, comprising:
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receiving, at a payment processing center, an estimated payment amount for a health care service provided to a patient by a health care provider, the estimated payment amount corresponding to a patient payment portion payable by the patient; receiving, at the payment processing center, account information corresponding to an account of the patient; and suspending, by the payment processing center, the estimated payment amount at the account of the patient prior to adjudication of a claim payment for the provided health care service. - View Dependent Claims (16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26)
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27. A health care claim adjudication method, comprising:
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sending, from a health care provider, a claim payment to a health care payer; sending, from the health care provider to a payment processing center, account information corresponding to an account of a patient; sending, from the health care provider to the payment processing center, an estimated payment amount for a health care service provided to the patient by the health care provider, wherein the estimated payment amount corresponds to a patient payment portion payable by the patient; and suspending, by the payment processing center, the estimated payment amount at the account of the patient prior to adjudication of the claim payment by the health care payer. - View Dependent Claims (28, 29, 30, 31, 32, 33, 34, 35, 36)
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37. A health care claim adjudication system, comprising:
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a memory; and a processor disposed in communication with the memory and configured to issue processing instructions stored in the memory to; receive an estimated payment amount for a health care service provided to a patient by a health care provider, the estimated payment amount corresponding to a patient payment portion payable by the patient; receive account information corresponding to an account of the patient; and suspend the estimated payment amount at the account of the patient prior to adjudication of a claim payment for the provided health care service.
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38. A processor-readable tangible medium storing processor-issuable health care claim adjudication instructions to:
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receive an estimated payment amount for a health care service provided to a patient by a health care provider, the estimated payment amount corresponding to a patient payment portion payable by the patient; receive account information corresponding to an account of the patient; and suspend the estimated payment amount at the account of the patient prior to adjudication of a claim payment for the provided health care service.
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39. A health care claim adjudication system, comprising:
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a memory; and a processor disposed in communication with the memory and configured to issue processing instructions stored in the memory to; send, from a health care provider, a claim payment to a health care payer; send, from the health care provider to a payment processing center, account information corresponding to an account of a patient; send, from the health care provider to the payment processing center, an estimated payment amount for a health care service provided to the patient by the health care provider, wherein the estimated payment amount corresponds to a patient payment portion payable by the patient; and suspend, by the payment processing center, the estimated payment amount at the account of the patient prior to adjudication of the claim payment by the health care payer.
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40. A processor-readable tangible medium storing processor-issuable health care claim adjudication instructions to:
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send, from a health care provider, a claim payment to a health care payer; send, from the health care provider to a payment processing center, account information corresponding to an account of a patient; send, from the health care provider to the payment processing center, an estimated payment amount for a health care service provided to the patient by the health care provider, wherein the estimated payment amount corresponds to a patient payment portion payable by the patient; and suspend, by the payment processing center, the estimated payment amount at the account of the patient prior to adjudication of the claim payment by the health care payer.
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Specification