System and method using extended authorization hold period

• US 8,660,855 B2
• Filed: 06/08/2007
• Issued: 02/25/2014
• Est. Priority Date: 06/08/2006
• Status: Active Grant

• Current Assignee: Visa USA, Inc. (Visa, Inc.)
• Original Assignee: Visa USA, Inc. (Visa, Inc.)
• Inventors: Pourfallah, Stacy, Pruitt, Janet, Frantz, Douglas, Kayoumi, Roxanna
• Primary Examiner(s): NGUYEN, TRAN N
• Application Number:
  US11/760,244
• Publication Number:
  US 20080140447A1
• Time in Patent Office: 2,454 Days
• Field of Search: 705/2
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Embodiments of the present invention relate to methods and apparatuses serving to provide assurance that healthcare providers will receive payment for services rendered. In one embodiment, a payment card (or other portable consumer device) provides an extended authorization hold period (for example up to 21 days). This hold period allows the healthcare provider to request authorization for payment from the patient'"'"'s credit, debit, FSA, HRA, or HSA payment card, submit the insurance claim, and then upon receipt of a health insurance carrier'"'"'s Explanation of Benefits (EOB) within the hold period, submit for settlement only that amount actually due from the patient. In accordance with an alternative embodiment, pending receipt of the EOB from the insurer, the healthcare provider flags a transaction in a point-of-sale (POS) terminal device or server for storage and delayed submittal over an electronic payment network. Embodiments in accordance with the present invention are particularly applicable to payment of claims in healthcare plans following adjudication by a payer.

Claims

1. An electronic payment processing method comprising:

receiving, an authorization request data message from a point of sale terminal at a healthcare provider via an electronic payment processing network, for a first amount associated with healthcare services rendered to a patient;

determining, by the electronic payment processing network, a predetermined amount of time for holding the portion of the first amount on a payment card from a plurality of amounts of time, from the authorization request data message;

forwarding, via the electronic payment processing network the authorization request data message to an issuer of the payment card,

the authorization request data message having a requirement that at least a portion of the first amount is held by the issuer for the predetermined amount of time, the predetermined amount of time comprising at least four days;

receiving, from the point-of-sale terminal, a settlement request message, via the electronic payment processing network, requesting payment for a second amount due from the patient after an adjudication with the patient'"'"'s health insurance carrier within the predetermined amount of time,

wherein the issuer is not the health insurance carrier, and if the healthcare provider does not send the settlement request message to the issuer within the predetermined amount of time, the held amount is no longer held; and

processing, via the electronic payment processing network, a fund transfer transaction from the patient'"'"'s payment card to the health provider based on the settlement request message.

2. The method of claim 1 wherein the second amount comprises a difference between,

a value of the healthcare services, or a contracted price for services agreed upon between the health insurance carrier and healthcare provider;

and

an amount to be paid by the health insurance carrier following the adjudication decision.

3. The method of claim 2 wherein the first amount comprises a retail value of the services rendered.

4. The method of claim 1 wherein the settlement request message is sent after a predetermined period of time in which the adjudication is expected to be made.

5. The method of claim 4 wherein the point-of-sale terminal sends an alert to the healthcare provider regarding an expiration of the predetermined time period.

6. The method of claim 1 wherein the predetermined amount of time comprises 21 days.

7. The method of claim 1 wherein the hold is automatically imposed by the point-of-sale terminal based upon recognition of information present in the authorization request message.

8. The method of claim 1 wherein the hold is maintained for only a predetermined period of time in which the adjudication is expected to be completed.

9. The method of claim 1 wherein the settlement request message is transmitted at the manual instruction of the healthcare provider.

10. The method of claim 1 wherein the payment card is selected from a group consisting of Flexible Savings Account card, Health Reimbursement Arrangement card, and Health Savings Account card.

11. An apparatus comprising a host computer including a processor and a non-transitory computer readable storage medium, the non-transitory computer readable storage medium having stored thereon code for directing the processor to,

receive over an electronic payment network, a request for authorization of a payment of a transaction for healthcare services rendered to a patient the payment for a first amount,

determine, a predetermined amount of time for holding the portion of the first amount on a payment card from a plurality of amounts of time, from the request for authorization;

recognize in the request for authorization, information indicating that a delay for the predetermined amount of time in settlement of the transaction is appropriate,

generate a message delaying settlement of the transaction for a predetermined amount of time, wherein delaying comprises imposing a hold of at least a portion of the first amount for authorization, the hold comprising at least four days,

receive over the electronic payment network, a settlement request for a payment of the transaction for healthcare services for a second amount due from the patient, and if the settlement request is not received within the predetermined amount of time, release the held amount, and

process a fund transfer transaction of the second amount from the patient'"'"'s payment card to a health provider based on the settlement request.

12. The apparatus of claim 11 wherein the host computer is controlled by an issuer of a payment card of the patient.

13. The apparatus of claim 11 wherein the computer readable storage medium has code thereon to further direct the processor to recognize a subsequent message requesting settlement of the transaction.

14. The apparatus of claim 11 wherein the request for authorization and the settlement request are received from an acquirer.

15. The apparatus of claim 11 wherein the information indicating that a delay in settlement of the transaction is appropriate comprises the predetermined amount of time.

16. The apparatus of claim 11 wherein the computer readable storage medium has code thereon to further direct the processor to send an alert regarding an expiration of the predetermined amount of time.

17. The apparatus of claim 11 wherein the payment of a transaction for healthcare services comprises a credit card transaction.

18. The apparatus of claim 11 wherein the predetermined amount of time comprises 21 days.

19. The apparatus of claim 11 further comprising an interchange engine configured to calculate interchange fees.