Point of service third party financial management vehicle for the healthcare industry

• US 6,208,973 B1
• Filed: 02/27/1998
• Issued: 03/27/2001
• Est. Priority Date: 02/27/1998
• Status: Expired due to Term

• Current Assignee: Realmed Corporation (Availity LLC)
• Original Assignee: Onehealthbank.Com Co.
• Inventors: Hammersla, W. Edward III, Boyer, Dean F.
• Primary Examiner(s): Voeltz, Emanuel Todd
• Assistant Examiner(s): CHOI, KYLE JAEHUN
• Application Number:
  US09/031,968
• Time in Patent Office: 1,124 Days
• Field of Search: 705/2, 705/4
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/02 involving a neutral party, e.g. certification authority, notary or trusted third party [TTP]
• CPC Class Codes: G06Q 20/04 Payment circuits
• CPC Class Codes: G06Q 20/10 specially adapted for electronic funds transfer [EFT] systems; specially adapted for home banking systems
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 20/18 involving self-service terminals [SST], vending machines, kiosks or multimedia terminals
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A point of service third party adjudicated payment system and method which provides for the creation of an adjudicated settlement transaction at a point of service which designates the portion of the service to be paid by the third party payor and the portion to be paid by the customer. The system includes a point of service terminal which accepts a payment system access card, such as a credit card, debit card, or purchase card, for payment for a purchase of a service and/or product by a customer, where at least part of the purchase is reimbursable by a third party payor. The point of service terminal creates a purchase transaction which is adjudicated by an adjudication engine substantially in real-time (at the time of service or in a purchase transaction processing batch) to determine a first portion of the purchase which is to be paid by the third party payor and a second portion of the purchase which is to be paid by the customer. An adjudicated settlement transaction is returned to the point of service terminal designating at least the first portion and the second portion for payment. The payment system access card provides access to a payment system which transfers funds in accordance with the adjudicated settlement transaction whereby the third party payor is debited by the first portion and the point of service provider is paid the first portion and a payment account accessible by the payment system access card is charged at least the second portion and the point of service provider is paid the second portion as with typical payment card transactions.

Claims

1. A point of service third party adjudicated payment system, comprising:

a point of service terminal which accepts a payment system access card for payment for a purchase of at least one of a service and product by a customer, at least part of said purchase being reimbursable by a third party payor, and which creates a purchase transaction;

an adjudication engine which processes said purchase transaction so as to adjudicate substantially in real-time a first portion of said purchase which is to be paid by the third party payor and a second portion of said purchase which is to be paid by the customer and returns an adjudicated settlement transaction to said point of service terminal designating obligations for payment of at least said first portion and said second portion; and

a payment system which transfers funds in accordance with said obligations for payment of said adjudicated settlement transaction whereby the third party payor is debited by said first portion and the point of service provider is paid said first portion and a payment account accessible by said payment system access card is charged at least said second portion and the point of service provider is paid said second portion.

2. A system as in claim 1, wherein said adjudication engine is connected to a node on the Internet and said point of service terminal accesses said adjudication engine via an Internet connection to said node.

3. A system as in claim 1, wherein said adjudication engine includes a data driven rules engine which processes data from the customer, the point of service provider, the third party payor, and the payment system to determine the first portion of the payment to be paid by the third party payor.

4. A system as in claim 1, wherein said payment system access card is one of a credit card, debit card, and purchase card, said payment system includes a credit card network, and said adjudicated settlement transaction is formatted as a credit card transaction for said credit card network.

5. A system as in claim 4, wherein said purchase transaction includes at least one of product and service codes which said adjudication engine compares to payment parameters and conditions from the third party payor to determine the value of said first portion of said purchase to be paid by the third party payor.

6. A system as in claim 5, wherein the point of service provider is a healthcare provider and said payment parameters and conditions are determined by a healthcare policy between an employer of the customer and the third party payor.

7. A system as in claim 6, wherein said payment system access card is cobranded so as to include an account number for said credit card network and said healthcare policy.

8. A method of providing third party adjudicated payment at a point of service, comprising the steps of:

providing a payment system access card to a point of service provider for payment for a purchase of at least one of a service and product by a customer, at least part of said purchase being reimbursable by a third party payor;

transmitting a purchase transaction to an adjudication engine for processing;

said adjudication engine adjudicating said purchase transaction substantially in real-time so as to determine a first portion of said purchase which is to be paid by the third party payor and a second portion of said purchase which is to be paid by the customer;

receiving from said adjudication engine an adjudicated settlement transaction at said point of service designating obligations for payment of at least said first portion and said second portion;

and transferring funds in accordance with said obligations for payment of said adjudicated settlement transaction whereby the third party payor is debited by said first portion and the point of service provider is paid said first portion and a payment account accessible by said payment system access card is charged at least said second portion and the point of service provider is paid said second portion.

9. A method as in claim 8, wherein said transferring step comprises the steps of charging said payment account by said first and second portions and crediting said payment account by said first portion.

10. A method as in claim 8, wherein said transferring step comprises the steps of debiting the third party payor by said first portion, paying the point of service provider said first portion, charging said payment account by at least said second portion, and paying the point of service provider said second portion.

11. A method as in claim 8, wherein said adjudication engine is connected to a node on the Internet and said transmitting step comprises the step of providing an Internet connection to said node.

12. A method as in claim 8, wherein said payment system access card is one of a credit card, a debit card, and a purchase card, and said funds transferring step comprises the steps of formatting said adjudicated settlement transaction as a credit card transaction and processing said adjudicated settlement transaction in a credit card network.

13. A method as in claim 8, wherein said adjudicating step comprises the step of comparing at least one of product and service codes in said purchase transaction to payment parameters and conditions from the third party payor to determine the value of said first portion of said purchase to be paid by the third party payor.

14. A method of providing adjudicated payment of reimbursable healthcare costs to a healthcare provider at a point of service of a patient, comprising the steps of:

providing a payment system access card to the healthcare provider at said point of service for payment for a purchase of at least one of healthcare products and services by the patient, at least part of said purchase being reimbursable by a third party payor;

transmitting a purchase transaction to an adjudication engine for processing;

said adjudication engine adjudicating said purchase transaction substantially in real-time so as to determine a first portion of said purchase which is to be paid by the third party payor and a second portion of said purchase which is to be paid by the patient;

receiving from said adjudication engine an adjudicated settlement transaction at said point of service designating obligations for payment of at least said first portion and said second portion; and

transferring funds in accordance with said obligations for payment of said adjudicated settlement transaction whereby the third party payor is debited by said first portion and the healthcare provider is paid said first portion and a payment account accessible by said payment system access card is charged at least said second portion and the healthcare provider is paid said second portion.

15. A method as in claim 14, wherein said adjudication engine is connected to a node on the Internet and said transmitting step comprises the step of providing an Internet connection to said node.

16. A method as in claim 14, wherein said payment system access card is cobranded so as to include an account number for a credit card network and a healthcare policy between an employer of the patient and the third party payor, and said funds transferring step comprises the steps of formatting said adjudicated settlement transaction as a credit card transaction and processing said adjudicated settlement transaction in said credit card network.

17. A method as in claim 16, wherein said adjudicating step comprises the step of comparing at least one of product and service codes in said purchase transaction to payment parameters and conditions from the third party payor to determine the value of said first portion of said purchase to be paid by the third party payor, whereby said payment parameters and conditions are determined by said healthcare policy.

18. A method as in claim 14, wherein said funds transferring step comprises the steps of charging said payment account by said first and second portions and crediting said payment account by said first portion.

19. A method as in claim 14, wherein said funds transferring step comprises the steps of debiting the third party payor by said first portion, paying the healthcare provider said first portion, charging said payment account by at least said second portion, and paying the healthcare provider said second portion.

20. A method as in claim 14, wherein said payment system access card is provided to the healthcare provider in said providing step prior to provision of healthcare services, comprising the additional step of accessing said adjudication engine to verify patient eligibility for payment for services by the third party payor prior to provision of healthcare services by the healthcare provider.

21. A method as in claim 20, comprising the additional steps of providing a coverage profile for the patient to the healthcare provider and comparing a preliminary diagnosis for healthcare services to be provided to the patient to said coverage profile prior to providing healthcare services to the patient.

22. A method of converting a healthcare transaction into a credit card transaction for payment by a patient, comprising the steps of:

transmitting at least one of healthcare product and service codes for healthcare products and services purchased by the patient from a healthcare provider at a point of service to an adjudication engine for processing;

said adjudication engine adjudicating said product and service codes substantially in real-time so as to determine a first portion of said purchased healthcare products and services which is to be paid by a third party payor and a second portion of said purchased healthcare services which is to be paid by the patient;

receiving from said adjudication engine an adjudicated settlement transaction at said point of service designating obligations for payment of at least said first portion and said second portion;

formatting said adjudicated settlement transaction as a credit card transaction at said point of service; and

processing said formatted adjudicated settlement transaction in a credit card network for payment of said payment obligations.

23. A method as in claim 22, wherein said credit card network is accessed in said processing step using a payment system access card including one of a credit card, a debit card, and a purchase card, and said payment system access card is cobranded so as to include an account number for said credit card network and a healthcare policy between an employer of the patient and said third party payor, whereby said processing step comprises the step of using said account number to access said credit card network.