Transparent healthcare transaction management system

• US 8,442,840 B2
• Filed: 02/14/2006
• Issued: 05/14/2013
• Est. Priority Date: 02/14/2006
• Status: Active Grant

• Current Assignee: Kathleen A. Menocal, Tomas G. Menocal
• Original Assignee: Kathleen A. Menocal, Tomas G. Menocal
• Inventors: Menocal, Kathleen A., Menocal, Tomas G.
• Primary Examiner(s): O'Connor, Gerald J.
• Assistant Examiner(s): WOODS, TERESA S
• Application Number:
  US11/353,658
• Publication Number:
  US 20070192146A1
• Time in Patent Office: 2,646 Days
• Field of Search: 705/2, 705/40, 705/4, 705/35, 705/3, 705/52
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/00 Commerce
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A healthcare payment transaction system for managing and arranging payment for a healthcare service transaction provided by a healthcare service provider to a patient, particularly where the payment is to be paid by an insurer. The system includes an electronic deposit account for the healthcare service provider whereby the healthcare service provider records information regarding healthcare service transactions performed by the healthcare service provider for patients. It also features an electronic deposit account for the insurer whereby the insurer accesses information regarding healthcare service transactions for services provided for patients for which the insurer has payment responsibility. The insurer can also use its electronic deposit account to deposit payments for healthcare service transactions performed for patients covered by a policy issued by the insurer. A central system is used as a means for electronically transferring payments from the insurer'"'"'s electronic deposit account to the healthcare service provider'"'"'s electronic deposit account. A sweep function is further provided as a means for determining whether the healthcare service provider has recorded information regarding a healthcare service transaction for a patient for whom the insurer has payment responsibility.

Claims

1. A healthcare transaction system for managing and arranging payment for a healthcare service provided to a patient by a healthcare service provider, said payment being owed by one or more payers, comprising:

a. a central data system residing on a computer which is independent from said healthcare service provider and said payers, said central data system including authenticated access control for said healthcare service provider and said payers, wherein all information submitted remains centrally persistent in said central data system;

b. an electronic deposit account which is created by said healthcare service provider over the Internet, in said central data system, wherein said electronic deposit account includes information pertaining only to said individual healthcare service provided to said patient;

c. an electronic deposit account for each of said payers in said central system, into which each of said payers submits coverage information sufficient to determine whether said electronic deposit account created for said individual healthcare service is a healthcare service for which each of said payers owes a payment;

d. an sweep tool for performing a relationship sweep within said central system, wherein said relationship sweep creates a link between said electronic deposit account for said individual healthcare service and said electronic deposit account for each payer having an obligation to pay for at least part of said individual healthcare service;

e. wherein each link created by said sweep tool is limited to said deposit describing said individual healthcare service and one payer;

f. wherein a payer is provided access to said electronic deposit account for said individual healthcare service once a link is created;

g. wherein once a link is created both said healthcare service provider and a linked payer are able to submit information to said electronic deposit account for said individual healthcare service;

h. wherein once said link is created both said healthcare service provider and a linked payer are able to review all information submitted into said electronic deposit account for said individual healthcare services;

i. wherein once a payer is given access to said particular linked deposit said payer can deposit payment for said healthcare service transaction with said central data system;

j. a means for electronically transferring said payment from said payer to said healthcare service provider; and

k. an asset management tool which allows each of said payers to determine its total liability within said central system following each sweep made.

2. The healthcare transaction system of claim 1, wherein said information regarding said individual healthcare service transaction includes a set of information which is commonly supplied in a prior art insurance claim form.

3. The healthcare transaction system of claim 1, wherein said information regarding said healthcare service transaction includes identifying information for said patient, diagnosis and treatment information for said healthcare service transaction, and billing information for said healthcare service transaction.

4. The healthcare transaction system of claim 1, further comprising a provider credential associated with said healthcare service provider configured to authenticate said healthcare service provider to said at least one payer so that said at least one payer may recognize said healthcare service provider as an authorized provider of services covered by said at least one payer.

5. The healthcare transaction system of claim 1, wherein once said sweep tool retrieves said individual deposit and associates said individual deposit with said at least one payer, said individual deposit is accessible to both said account of said healthcare service provider and said account for said at least one payer.

6. The healthcare transaction system of claim 1, wherein at least one payer can order said sweep using said sweep tool.

7. A method for arranging for payment for a healthcare service provided to a patient by a healthcare service provider, said payment being owed by one or more payers, comprising the steps of:

a. providing a central data system residing on a computer which is independent from said healthcare service provider and said payers, said central data system including authenticated access control for said healthcare service provider and said payers, wherein all information submitted remains centrally persistent in said central data system;

b. said healthcare service provider creating an electronic deposit account in said central data system over the Internet, wherein said electronic deposit account includes information pertaining only to said individual healthcare service provided to said patient;

c. each of said payers creating an electronic deposit account in said central data system into which each of said payers submits coverage information sufficient to determine whether said electronic deposit account created for said individual healthcare service is a healthcare service for which each of said payers owes a payment;

d. performing a relationship sweep within said central data system, wherein said relationship sweep creates a link between said electronic deposit account for said individual healthcare service and said electronic deposit account for each payer having an obligation to pay for at least part of said individual healthcare service;

e. wherein each link created by said relationship sweep is limited to said deposit describing said individual healthcare service and one payer;

f. providing a payer access to said electronic deposit account for said individual healthcare service once a link is created;

g. wherein once a link is created both said healthcare service provider and a linked payer are able to submit information to said electronic deposit account for said individual healthcare service;

h. wherein once a link is created both said healthcare service provider and a linked payer are able to review all information submitted into said electronic deposit account for said individual healthcare services;

i. wherein once a payer is given access to said particular linked deposit said payer can deposit payment for said healthcare service transaction with said central data system;

j. transferring said payment deposited by said payer to said healthcare service provider; and

k. determining a total liability for a payer within said central data system following said sweep.

8. The method of claim 7, further comprising the step of adjudicating said information pertaining to said particular deposits to determine the existence and extent of actual payment responsibility belonging to a plurality of said payers.

9. The method of claim 8, further comprising the steps of:

a. determining order of insurance with respect to a plurality of payers having potential payment responsibility for said patient; and

b. determining coordination of benefits with respect to said plurality of payers having potential payment responsibility for said patient.

10. The method of claim 8, further comprising the step of:

a. transferring payment for said healthcare service transaction from said electronic deposit account for said payer to said electronic deposit account for said healthcare service provider.

11. The method of claim 7, further comprising the step of determining order of insurance with respect to each of a plurality of payers having potential payment responsibility for said particular deposit.

12. The method of claim 7, further comprising the step of:

a. transferring payment for said healthcare service transaction from said electronic deposit account for said plurality of payers to said electronic deposit account for said healthcare service provider; and

b. wherein said plurality of payers associated with said individual deposit have the ability to view the status of said payments made to said healthcare service provider.