System and method for managing payments for health care services
First Claim
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.
2 Assignments
0 Petitions
Accused Products
Abstract
A health care claim payment system and method receives a claim for a health care service provided to a participant in a benefits plan. The claim is received by a payment services system, and a portion of the claim is payable by the participant. The payment services system remits the portion of the claim payable by the participant on behalf of the participant so that payment can be remitted to the provider in a single payment and accepts risk of delinquency and/or non-payment by the participant. In one example, the health care provider receives payment for the participant portion and employer portion of the claim within 30 days of issuing a health care service.
29 Citations
24 Claims
-
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. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20)
-
-
21. 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; generating, by a bill generation program logic implemented by the instructions stored in the machine-readable media, a statement including; an itemized explanation of benefits, wherein the itemized explanation of benefits includes a listing of the participant portion and the third party payor portion of the adjudicated claim information for the health care services provided by the health care provider; and at least one payment coupon including a participant identification number and the participant portion owed for the health care services. - View Dependent Claims (22, 23, 24)
-
Specification