Systems and methods for facilitating healthcare provider enrollment with one or more payers

• US 8,566,117 B1
• Filed: 06/30/2011
• Issued: 10/22/2013
• Est. Priority Date: 06/30/2011
• Status: Active Grant

• Current Assignee: Change Healthcare Holdings, LLC (UnitedHealth Group Incorporated)
• Original Assignee: Mckesson Financial Holdings Limited (McKesson Corp.)
• Inventors: Sarathi, Nikhil, Smith, Marty, Troutt, Paul
• Primary Examiner(s): PAULS, JOHN A
• Application Number:
  US13/173,985
• Time in Patent Office: 845 Days
• Field of Search: 705/2
• US Class Current: 705/2
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Systems and methods may facilitate healthcare provider enrollment with one or more payers. The systems and methods may include receiving identification of a plurality of payers; determining required enrollment information needed for the healthcare provider to enroll for one or more services of the plurality of payers; retrieving or receiving available enrollment information associated with the healthcare provider; determining missing enrollment information based upon a comparison of the required enrollment information and the available enrollment information; and delivering, by the service provider to the healthcare provider computer, a request for the missing enrollment information.

Claims

1. A method, comprising:

receiving, by at least one service provider computer associated with a service provider, from a healthcare provider computer associated with a healthcare provider, identification of a plurality of payers;

determining, by at least one of the service provider or the service provider computer, required enrollment information needed for the healthcare provider to register for using one or more services provided by one or more of the plurality of payers;

retrieving or receiving, by at least one of the service provider or the service provider computer, available enrollment information associated with the healthcare provider;

determining, by at least one of the service provider or the service provider computer, missing enrollment information based upon a comparison of the required enrollment information and the available enrollment information; and

transmitting, by the service provider computer, to the healthcare provider computer, a request for the missing enrollment information;

providing by the service provider computer, a user interface that allows the health care provider to select the one or more services provided by the one or more of the plurality of payers, wherein the one or more services comprises at least one of a claims service, an electronic remittance service, or a reports service.

2. The method of claim 1, further comprising:

receiving, by the service provider computer, from the healthcare provider computer, the missing enrollment information.

3. The method of claim 1, further comprising:

pre-populating respective enrollment forms for each of the plurality of payers.

4. The method of claim 3, further comprising:

delivering the respective enrollment forms to each of the plurality of payers.

5. The method of claim 3, further comprising:

delivering the respective enrollment forms to the healthcare provider computer.

6. The method of claim 3, wherein the enrollment of the healthcare provider enables the service provider to facilitate one or more healthcare transactions between the healthcare provider computer and respective payer computers associated with each of the plurality of payers.

7. The method of claim 1, wherein the available enrollment information is received during an initial registration session prior to receiving the identification of the plurality of payers.

8. The method of claim 1, wherein the required enrollment information is determined based upon a prior analysis of required information from respective enrollment forms of each of the plurality of payers.

9. The method of claim 1, wherein the plurality of payers comprises at least one of a pharmacy benefits manager (PBM), a government payer, a health care plan, or a discount plan.

10. The method of claim 1, further comprising:

providing by the service provider computer, a user interface that allows the health care provider to select one or more of payers from a listing of payers for transmitting the identification of the plurality of payers to the healthcare provider computer.

11. A system, comprising:

at least one memory for storing computer-executable instructions; and

at least one processor in communication with the at least one memory, wherein the at least one processor is configured to execute the computer-executable instructions to;

receive, from a healthcare provider computer associated with a healthcare provider, identification of a plurality of payers;

determine required enrollment information needed for the healthcare provider to register to use one or more services provided by one or more of the plurality of payers;

retrieve or receive available enrollment information associated with the healthcare provider;

determine missing enrollment information based upon a comparison of the required enrollment information and the available enrollment information; and

transmit to the healthcare provider computer, a request for the missing enrollment information;

provide a user interface that allows the health care provider to select the one or more services provided by the one or more of the plurality of payers, wherein the one or more services comprises at least one of a claims service, an electronic remittance service, or a reports service.

12. The system of claim 11, wherein the at least one processor is further configured to execute the computer-executable instructions to:

receive, from the healthcare provider computer, the missing enrollment information.

13. The system of claim 11, wherein the at least one processor is further configured to execute the computer-executable instructions to:

facilitate enrollment of the health care provider by pre-populating respective enrollment forms for each of the plurality of payers.

14. The system of claim 13, wherein the enrollment is further facilitated by automatically delivering the respective enrollment forms to each of the plurality of payers.

15. The system of claim 13, wherein the enrollment is facilitated by delivering the respective enrollment forms to the healthcare provider computer.

16. The system of claim 11, wherein the enrollment of the healthcare provider for one or more services of the plurality of payers enables the service provider to facilitate one or more healthcare transactions between the healthcare provider computer and respective payer computers associated with each of the plurality of payers.

17. The system of claim 16, wherein the one or more healthcare transactions include one or more types of healthcare claim transactions.

18. The system of claim 11, wherein the available enrollment information is received during an initial registration session prior to receiving the identification of the plurality of payers.