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System and method for managing payments for health care services

  • US 7,813,943 B1
  • Filed: 02/13/2007
  • Issued: 10/12/2010
  • Est. Priority Date: 10/06/2006
  • Status: Active Grant
First Claim
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1. A computer system comprising machine-readable media having stored therein instructions that when executed cause the computer system to implement a method, the method comprising:

  • receiving adjudicated claim information relating to health care services provided to a participant by a health care provider, the adjudicated claim information being received a first plurality of days after the health care services were provided to the participant, the adjudicated claim information including a third party payor portion and a participant portion;

    notifying a third party payor of the third party payor portion of the adjudicated claim information to be funded within a second plurality of days of the notifying step, the notifying step occurring after the receiving step;

    causing payment of the third party payor portion and the participant portion to the health care provider in a single payment in a third plurality of days after the health care services were provided to the participant, the third plurality of days including the first plurality of days followed by the second plurality of days;

    combining, by a bill generation program logic implemented by the instructions stored in the machine-readable media, adjudicated claim information from the health care provider and a plurality of additional health care providers into a master bill to be sent to the participant, the master bill containing adjudicated claim information for the health care provider and the plurality of additional health care providers;

    itemizing, by the bill generation program logic, adjudicated claim information for each of the health care services provided to the participant by the health care provider and wherein the plurality of additional health care providers do not directly interact with the patient; and

    tracking, by a bill tracking program logic implemented by the instructions stored in the machine-readable media, payment of the master bill by the participant.

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