Payment of health care insurance claims using short-term loans

• US 7,962,350 B1
• Filed: 04/18/2005
• Issued: 06/14/2011
• Est. Priority Date: 01/08/2001
• Status: Expired due to Fees

• Current Assignee: PPS Data LLC (Zions Bancorporation, N.A.)
• Original Assignee: PPS Data LLC (Zions Bancorporation, N.A.)
• Inventors: Provost, Wayne A., Peterson, Brian E.
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): PHONGSVIRAJATI, POONSIN
• Application Number:
  US11/108,221
• Time in Patent Office: 2,248 Days
• Field of Search: 705 2- 4, 705/35
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/03 Credit; Loans; Processing thereof
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

Methods and systems for promptly paying health care providers for rendered health care services. A medical technician operating a client computer establishes communication with a remote server. Using a claim form, the technician enters patient, insurance, and treatment information which is transmitted to the server to determine whether the claim is eligible for advance payment. If the claim is eligible, the server transmits claim information to an appropriate carrier for claim processing. The remote server also transmits claim information to a payment entity which requests from a financial entity that funds be credited to an operational account and a reserve account. The funds of the operational account are immediately accessible to the health care provider. The funds of the reserve account are debited for expenses. When the carrier finally processes the claim, any payment for the claim is deposited into the reserve account.

Claims

1. In a financial entity system that is capable of communicating with a payment entity that is in communication with a server system that receives insurance claims from a health care provider, a method of advancing a carrier'"'"'s portion of payment for health care services rendered by the health care provider prior to the carrier making payment on the insurance claim for the rendered health care services, the method comprising:

at the financial entity system including computer systems and/or servers comprising one or more processors and one or more memory storage devices, configured for

receiving from the payment entity a single fund distribution request via an electronic medium, wherein the payment entity has pre-adjudicated one or more insurance claims to determine how much money of the carrier'"'"'s expected payment is eligible to be advanced in an advanced payment for rendered health care services, the single fund distribution request specifying how that advanced payment should be distributed between an operational account and a reserve account both located at the financial entity system, wherein the payment entity pre-adjudicates the one or more insurance claims prior to the carrier adjudicating the one or more insurance claims, and wherein the advanced payment is advanced by the financial entity system and corresponds to the carrier'"'"'s expected payment as distinct from the patient'"'"'s expected payment;

crediting a first portion of the advance payment to the operational account according to the single fund distribution request, such that a data structure representing the operational account is updated to indicate that the first portion of the advance payment has been advanced, wherein the first portion of the advanced payment corresponds to a portion of the carrier'"'"'s expected payment and wherein the first portion of the advanced payment is immediately accessible to the health care provider;

crediting a second portion of the advanced payment to the reserve account according to the single fund distribution request, such that a data structure representing the reserve account is updated to indicate that the second portion of the advanced payment has been advanced, wherein the second portion of the advanced payment corresponds to another portion of the carrier'"'"'s expected payment and wherein the second portion of the advanced payment is not immediately accessible to the health care provider; and

after the carrier processes the insurance claim, subsequently receiving payment for the insurance claim from the carrier.

2. A method as defined in claim 1, wherein money in the reserve account is debited to pay for interest on unpaid balances, to pay off unpaid balances, and to pay for service fees associated with the advanced payment.

3. A method as defined in claim 1, further comprising crediting the reserve account with the payment received from the carrier.

4. A method as defined in claim 1, wherein receiving payment from the carrier includes receiving from the carrier an electronic fund transfer to pay for the insurance claim.

5. A method as defined in claim 1, wherein receiving payment from the carrier includes receiving from the carrier a check to pay for the insurance claim.

6. A method as defined in claim 1, wherein the carrier makes payment for the insurance claim after first processing the insurance claim, and wherein the carrier first processes the insurance claim upon receiving insurance claim information from the server system that is generated after the health care provider submits an insurance claim to the server system.

7. In a financial entity system that is capable of communicating with a payment entity that is in communication with a server system that receives insurance claims from a health care provider, a method of advancing a carrier'"'"'s portion of payment for health care services rendered by the health care provider prior to the carrier making payment on the insurance claim for the rendered health care services, the method comprising:

at the financial entity system including computer system and/or servers comprising one or more processors and one or more memory storage devices, configured for

receiving from the payment entity a single fund distribution request via an electronic medium, wherein the payment entity has pre-adjudicated one or more insurance claims to determine how much money of the carrier'"'"'s expected payment is eligible to be advanced in an advanced payment for rendered health care services, the single fund distribution request specifying how that advanced payment should be distributed between an operational account and a reserve account both located at the financial entity system, wherein the payment entity pre-adjudicates the one or more insurance claims prior to the carrier adjudicating the one or more insurance claims, and wherein the advanced payment is advanced by the financial entity system and corresponds to the carrier'"'"'s expected payment as distinct from the patient'"'"'s expected payment;

crediting a first portion of the advanced payment to the operational account according to the single fund distribution request, such that a data structure representing the operational account is updated to indicate that the first portion of the advanced payment has been advanced, wherein the first portion of the advanced payment corresponds to a portion of the carrier'"'"'s expected payment and wherein the first portion of the advanced payment is immediately accessible to the health care provider;

crediting a second portion of the advanced payment to the reserve account according to the single fund distribution request, such that a data structure representing the reserve account is updated to indicate that the second portion of the advanced payment has been advanced, wherein the second portion of the advanced payment corresponds to another portion of the carrier'"'"'s expected payment and wherein the second portion of the advanced payment is not immediately accessible to the health care provider;

debiting at least part of the second portion of the advanced payment in the reserve account at least for service fees; and

crediting a remaining part of the second portion of the advanced payment in the reserve account to the operational account after the claim is adjudicated by the carrier.