Account Tracking System for Health Resource Encounters

• US 20140006038A1
• Filed: 06/27/2012
• Published: 01/02/2014
• Est. Priority Date: 06/27/2012
• Status: Abandoned Application

• Current Assignee: Primewest Health
• Original Assignee: Prime West Health
• Inventors: HARRIS, JERAMIE, RONNING, TROY, MAGNUSON, MATT, PRZYBILLA, JIM
• Application Number:
  US13/534,198
• Publication Number:
  US 20140006038A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

Systems and methods for tracking accounts associated with health resource encounters are disclosed. In one aspect, a system for tracking accounts associated with health resource encounters is disclosed. The system includes a plurality of portable identification devices, such as smart cards, each associated with a user and a benefit account, and configured to store identification data of a user with whom the portable identification device is associated, insurance benefit information, and medical records of the user. Devices each affiliated with a health resource provider are configured to interact with a health resource encounter tracking server, which is configured to access a healthcare information database including data affiliated with a plurality of users, a plurality of benefit providers, and a plurality of heath resource providers. The health resource providers include medical providers and pharmacy providers.

Claims

1. A system for tracking accounts associated with health resource encounters, the system comprising:

a plurality of portable identification devices, each of the portable identification devices associated with a user and a benefit account, the user comprising a healthcare consumer and the benefit account defining coverage available to the user, each of the plurality of portable identification devices including a memory configured to store identification data of a user with whom the portable identification device is associated;

a plurality of computing devices each affiliated with a health resource provider at which a health resource encounter takes place, each of the plurality of computing devices configured to;

prior to each health resource encounter between a user and the health resource provider, receive information from a portable identification device associated with the user from among the plurality of portable identification devices,

receive validation information from the user;

transmit the validation information to a heath resource encounter tracking server;

receive authorization information and benefit information associated with the user from the health resource encounter tracking server;

record a log of the health resource encounter; and

transmit the log of the health resource encounter to the heath resource encounter tracking server; and

a health resource encounter tracking server remotely connected to each of the plurality of computing devices via a network, the health resource encounter tracking server configured to access a healthcare information database including data affiliated with a plurality of users, a plurality of benefit providers, and a plurality of heath resource providers, the health resource providers including at least medical providers and pharmacy providers.

2. The system of claim 1, wherein the plurality of portable identification devices comprises one or more smart cards.

3. The system of claim 2, wherein each of the computing devices includes a smart card reader.

4. The system of claim 2, wherein each of the one or more smart cards includes a programmable circuit and a memory, and wherein the memory is configured to store at least an identifier of the user associated with the smart card.

5. The system of claim 4, wherein the memory is further configured to store insurance benefit information and medical records of the user.

6. The system of claim 1, wherein the health resource providers are selected from a list of providers consisting of:

medical providers;

pharmacy providers;

dental providers;

vision care providers;

chiropractors; and

clinical services providers.

7. The system of claim 1, wherein the health resource encounter tracking server is configured to integrate records from one or more governmental health organizations.

8. The system of claim 1, wherein each of the plurality of computing devices is configured to record a log of each attempted health resource encounter.

9. The system of claim 1, wherein the data affiliated with a plurality of users stored in the healthcare information database includes user data selected from the group consisting of:

authentication data;

medical history data;

pharmacy data;

eligibility information;

cost sharing or apportionment data;

authorization requests; and

program benefit data.

10. The system of claim 1, wherein the data affiliated with the plurality of health resource providers includes provider data selected from the group consisting of:

entity information;

authorized services;

prescription information;

healthcare provider service records;

claim processing tools;

claim price estimation tools; and

cost records.

11. The system of claim 1, wherein the data affiliated with the plurality of benefit providers includes benefit data selected from the group consisting of:

associated medical provider identifications;

associated pharmacy provider identifications; and

benefit program definitions.

12. The system of claim 1, wherein the healthcare information database further includes third party program information.

13. The system of claim 1, wherein the health resource encounter tracking server is further configured to exchange healthcare information regarding one or more of the plurality of users with a third party system.

14. The system of claim 1, wherein the health resource encounter tracking server is configured to provide to a user, in response to a request from a remote computing system, one or more reports regarding health resource encounters associated with that user.

15. The system of claim 1, wherein the health resource encounter tracking server is configured to provide, in response to a request from a remote computing system, one or more aggregated reports regarding health resource encounters associated with a plurality of users.

16. The system of claim 15, wherein the one or more aggregated reports are provided in response to a request from a health resource provider.

17. The system of claim 15, wherein the one or more aggregated reports are provided in response to a request from a benefit provider.

18. A method of managing healthcare users affiliated with a plurality of different, unaffiliated healthcare resource providers, the method comprising:

prior to a health resource encounter between a user and a health resource provider, receiving, at a heath resource encounter tracking server, information from a computing device affiliated with the health resource provider, the information including data stored on a portable identification device associated with a user, validation information entered by the user, and an identity of the health resource provider;

based on the data stored on the portable identification device, the validation information, and the identity of the health resource provider, determining a set of benefit information based on data stored in a healthcare information database, the healthcare information database including data affiliated with a plurality of users, a plurality of benefit providers, and a plurality of heath resource providers, the health resource providers including at least medical providers and pharmacy providers;

receiving, at the heath resource encounter tracking server, a log of the health resource encounter; and

storing the log of the health resource encounter in the healthcare information database.

19. The method of claim 18, wherein the log of the health resource encounter comprises an access attempt in which the validation information entered by the user does not correspond with the data stored on the portable identification device, thereby indicating an unauthorized access attempt.

20. The method of claim 18, wherein the health resource encounter comprises a medical resource encounter.

21. The method of claim 20, wherein the log of the medical resource encounter includes one or more preapproved treatments associated with a medical resource provider.

22. The method of claim 18, further comprising:

receiving, at the health resource encounter tracking server, an indication of a proposed healthcare treatment; and

based at least in part on the proposed healthcare treatment and the benefit information, transmitting an approval of the proposed healthcare treatment to the computing device.

23. The method of claim 18, further comprising generating one or more reports in response to a user request.

24. A system for tracking accounts associated with health resource encounters, the system comprising:

a plurality of smart cards, each of the smart cards associated with a user and a benefit account defining coverage available to the user, each of smart cards including a programmable circuit and a memory configured to store identification data of a user with whom the smart card is associated; and

a plurality of computing devices each affiliated with a health resource provider at which a health resource encounter takes place, each of the plurality of computing devices configured to;

prior to each health resource encounter between a user and the health resource provider, read information from a smart card associated with the user from among the plurality of smart cards,

receive validation information from the smart card;

transmit the validation information and information from the smart card to a heath resource encounter tracking server;

receive authorization information and benefit information associated with the user from the health resource encounter tracking server;

record a log of the health resource encounter; and

transmit the log of the health resource encounter to the heath resource encounter tracking server; and

a health resource encounter tracking server remotely connected to each of the plurality of computing devices via a network, the health resource encounter tracking server configured to access a healthcare information database including data affiliated with a plurality of users, a plurality of benefit providers, and a plurality of health resource providers, the health resource providers including at least medical providers and pharmacy providers,

wherein the health resource encounter tracking server is further configured to;

generate one or more reports in response to requests from remote computing systems; and

exchange healthcare information regarding one or more of the plurality of users with a third party system, the healthcare information including the one or more reports.