COMPUTER IMPLEMENTED HEALTH CARE PAYMENT PROCESSING APPARATUS, SYSTEM, AND METHOD

• US 20150100329A1
• Filed: 10/04/2013
• Published: 04/09/2015
• Est. Priority Date: 10/04/2013
• Status: Abandoned Application

• Current Assignee: Daniel W. Dreyfuss, Michael T Williams
• Original Assignee: Daniel W. Dreyfuss, Michael T Williams
• Inventors: Dreyfuss, Daniel W., Williams, Michael T.
• Application Number:
  US14/046,649
• Publication Number:
  US 20150100329A1
• 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

Abstract

Systems, methodologies, media, and other embodiments associated with a health care payment processing system are described. One exemplary system embodiment includes a computer implemented method of health care payment processing including receiving health care insurance information pertaining to a patient, the information including the patient'"'"'s identity and health care insurance carrier information or health care exchange information, adding the health care insurance information to a premium assistor database, determining eligibility of the patient for health care insurance premium payment assistance based on a status of a health care insurance premium payment for verified health care insurance coverage, paying a health care insurance premium payment associated with the status of the health care insurance premium payment, verifying receipt of the health care insurance premium payment, and verifying receipt of a health care services payment from a health care insurance carrier.

Claims

1. A computer implemented method of health care payment processing including the steps of:

receiving health care insurance information pertaining to a patient, the health care insurance information including;

the patient'"'"'s identity; and

health care insurance carrier information or health care exchange information;

verifying whether the patient has valid health care insurance coverage;

if valid health care insurance coverage is verified, then determining a status of a health care insurance premium payment for the verified health care insurance coverage;

adding the health care insurance information to a premium assistor database;

determining eligibility of the patient for health care insurance premium payment assistance based on the status of the health care insurance premium payment determined based on the health care insurance information;

paying a health care insurance premium payment associated with the status of the health care insurance premium payment;

verifying receipt of the health care insurance premium payment; and

verifying receipt of a health care services payment from the health care insurance carrier.

2. A computer implemented method of health care payment processing including the steps of:

receiving health care insurance information pertaining to a patient, the health care insurance information including;

the patient'"'"'s identity; and

health care insurance carrier information or health care exchange information;

verifying the patient has valid health care insurance coverage;

determining a status of a health care insurance premium payment based on the health care insurance information; and

transmitting the health care insurance information to a premium assistor.

3. The method of health care payment processing of claim 2, further including:

determining whether the patient'"'"'s information includes an assignment of benefits.

4. The method of health care payment processing of claim 2, wherein the receiving health care insurance information includes receiving at least some patient information from the patient.

5. The method of health care payment processing of claim 2, wherein the receiving health care insurance information includes receiving at least some patient information from a health care insurance carrier.

6. The method of health care payment processing of claim 2, wherein if the verifying the patient has valid health care insurance step verifies that the patient has valid health care insurance, then determining the status of the health care insurance premium payment.

7. The method of health care payment processing of claim 2, wherein if it is determined that the patient has valid health care insurance coverage, then verifying the patient has valid health care insurance coverage.

8. The method of health care payment processing of claim 2, wherein if the determining a status of the health care insurance premium payment step determines the premium payment status is in arrears, then transmitting the health care insurance information to a premium assistor.

9. The method of health care payment processing of claim 2, further including:

receiving notification of premium due information from a premium assistor.

10. The method of health care payment processing of claim 9, further including:

adding an identifier of the patient to a screening list to indicate the patient received assistance from the premium assistor to pay a premium for the valid health care insurance coverage.

11. The method of health care payment processing of claim 2, further including:

determining whether the patient transferred coverage to another health insurance carrier.

12. A computer implemented method of health care payment processing including the steps of:

receiving health care insurance information pertaining to a patient, the information including;

the patient'"'"'s identity; and

health care insurance carrier information or health care exchange information;

adding the health care insurance information to a premium assistor database;

determining eligibility of the patient for health care insurance premium payment assistance based on a status of a health care insurance premium payment for verified health care insurance coverage;

paying a health care insurance premium payment associated with the status of the health care insurance premium payment;

verifying receipt of the health care insurance premium payment; and

verifying receipt of a health care services payment from a health care insurance carrier.

13. The method of health care payment processing of claim 12, further including:

receiving premium assistance eligibility information.

14. The method of health care payment processing of claim 13, wherein if the premium assistance eligibility information does not include an assignment of benefits, then receiving an receiving an assignment of benefits from the patient or a third party.

15. The method of health care payment processing of claim 13, further including:

transferring the health care insurance information and the premium assistance eligibility information to a health care premium work list to indicate the patient may be eligible for health care insurance premium payment assistance.

16. The method of health care payment processing of claim 15, wherein if the determining eligibility of the patient for health care insurance premium payment assistance step determines that the patient is eligible for health care insurance premium payment assistance, then transferring the health care insurance information and the premium assistance eligibility information to the health care premium work list.

17. The method of health care payment processing of claim 13, wherein the receiving premium assistance eligibility information includes receiving at least some patient information from the patient.

18. The method of health care payment processing of claim 13, wherein the receiving premium assistance eligibility information includes receiving at least some patient information from the health care insurance carrier.

19. The method of health care payment processing of claim 12, wherein if the determining eligibility of the patient for health care insurance premium payment assistance step determines that the patient is eligible for health care insurance premium payment assistance, then paying the health care insurance premium payment.

20. The method of health care payment processing of claim 12, further including:

receiving premium due information from the healthcare insurance carrier.

21. The method of health care payment processing of claim 20, further including:

transmitting notification of premium due information to a health care provider.

22. The method of health care payment processing of claim 12, further including:

verifying a health care service date of the patient is within a health care coverage period paid for with the health care insurance premium payment.

23. The method of health care payment processing of claim 22, further including:

transmitting a request for at least a portion of a health care service charge associated with the patient to the health care insurance carrier.

24. The method of health care payment processing of claim 23, wherein if the request for at least a portion of a health care service charge associated with the patient denied or the health care insurance carrier requires additional information, then transmitting the additional information to the health care insurance carrier.

25. The method of health care payment processing of claim 12, further including:

transmitting a request for payment of premium assistor charges to the health care provider.

26. The method of health care payment processing of claim 25, wherein if verifying receipt of the services payment from the health care insurance carrier step verifies the receipt of the services payment, then transmitting the request for payment of premium assistor charges to the health care provider.

27. The method of health care payment processing of claim 12, further including:

adding an identifier of the patient to a follow up alert list to indicate the patient received assistance from a premium assistor to pay a premium for valid health care insurance coverage.

28. The method of health care payment processing of claim 12, wherein if the patient transferred coverage to another health care insurance carrier, then receiving benefit verification and retroactive authorization of treatment and billing the another health care insurance carrier.

29. The method of health care payment processing of claim 12, further including:

verifying a request for at least a portion of a health care service charge associated with the patient is processing in the ordinary course of business;

30. The method of health care payment processing of claim 12, wherein if incomplete health care insurance information is received from a health care provider, then receiving health care insurance information pertaining to the patient from other than the health care provider.

31. The method of health care payment processing of claim 12, further including:

scanning hospital database to identify at risk claims.

32. The method of health care payment processing of claim 12, further including:

verifying that the health care provider has a signed assignment of benefits.

33. A computer implemented method of health care payment processing including the steps of:

receiving health care insurance information pertaining to a patient, the health care insurance information including;

the patient'"'"'s identity; and

health care insurance carrier information or health care exchange information;

responding to an inquiry regarding whether the patient has health care insurance;

responding to an inquiry associated with a status of a health care insurance premium payment triggering addition of the health care insurance information to a database;

receiving the health care insurance premium payment from a premium assistor for a health care insurance premium the patient owes;

responding to a verification request regarding payment of the health care insurance premium; and

if the health care insurance premium payment is received, then paying a health care insurance claim in response to receiving payment for the health care insurance premiums.

34. A health care payment processing system, including:

a health care provider database configured to store health care information pertaining to a patient and configured to store received health care insurance information pertaining to the patient;

a health care provider server electronically communicable with the health care provider database and configured to receive health care insurance information pertaining to the patient including;

a receiver electronically communicable with a health care provider server and configured to receive health care insurance information pertaining to the patient, the health care information including;

the patient'"'"'s identity; and

health care insurance carrier information or health care exchange information;

a verifier configured to verify the patient has valid health care insurance coverage;

a determiner configured to determine a status of a health care insurance premium payment for the verified health care insurance coverage; and

a transmitter configured to transmit the health care insurance information to a premium assistor.

35. The health care payment processing system of claim 34, wherein the health care provider server is electronically communicable with a premium assistor database and configured to add the health care information to the premium assistor database.

36. A health care payment processing system, including:

a premium assistor database configured to store health care information pertaining to a patient;

a premium assistor server electronically communicable with the premium assistor database and including;

a receiver electronically communicable with a health care provider server and configured to receive health care insurance information pertaining to the patient, the health care information including;

the patient'"'"'s identity; and

health care insurance carrier information or health care exchange information;

an adder configured to add the health care insurance information to a premium assistor database;

a determiner configured to determine premium assistance eligibility of the patient for health care insurance premium payment assistance based on a status of a health care insurance premium payment determined based on the health care insurance information;

a payer configured to pay a health care insurance premium payment associated with the status of the health care insurance premium payment; and

at least one verifier configured to verify receipt of the health care insurance premium payment;

wherein the at least one verifier or another verifier is configured to verify receipt of a health care services payment in response to the receipt of the health care insurance premium payment.

37. A health care payment processing system, including:

a receiver configured to receive a patient'"'"'s health care insurance information;

at least one responder configured to respond to an inquiry regarding whether the patient has health care insurance;

the at least one responder configured to respond to an inquiry associated with a status of a health care insurance premium payment triggering addition of the health care insurance information to a database;

a receiver configured to receive a health care insurance premium payment for a health care insurance premium the patient owes;

the at least one responder configured to respond to a verification request regarding payment of the health care insurance premium; and

a payer configured to pay a health care insurance claim in response to receiving payment for the health care insurance premiums.

38. A computer program product including a non-transitory computer-readable storage medium having encoded thereon:

instructions that, when executed by a processor, cause the processor to;

record the health care information pertaining to the patient to the premium assistor database;

request premium payment assistance eligibility information from the patient, health care provider server, or health care insurance server by providing at least one parameter for selecting the requested premium payment assistance eligibility information, wherein the requested premium payment assistance eligibility information received from the patient, health care provider server, or health care insurance server is selected based on a premium assistance eligibility parameter; and

output the premium payment assistance eligibility information.