Interactive electronic bill payment system

• US 8,108,274 B2
• Filed: 10/22/2002
• Issued: 01/31/2012
• Est. Priority Date: 09/06/2002
• Status: Expired due to Fees

• Current Assignee: Emergis Incorporated (Telus Corporation)
• Original Assignee: Emergis Incorporated (Telus Corporation)
• Inventors: Johnston, David, Schmidt, Mike, Grosman, Ilan, Ransom, Bob
• Primary Examiner(s): Ade, Garcia
• Application Number:
  US10/277,205
• Publication Number:
  US 20040049439A1
• Time in Patent Office: 3,388 Days
• Field of Search: 705/2, 705/4, 705/40, 705 26- 34
• US Class Current: 705/34
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03

Abstract

A system for coordinating the submission and processing of a bill according to predictive payment data of a plan. The system comprises a provider interface and an integrated database for receiving a predictive payment plan submitted from the provider interface. The system also has a predictive payment request of the plan storable in the database, the request including a plurality of predictive payment parameters. An adjudication engine is coupled to the integrated database, and an insertion function is used for inserting the predictive payment parameters, when stored in the database, into an adjudication rule set of the adjudication engine. The adjudication rule set is used for eventual adjudication of the predictive payment data, wherein adjudication of the predictive payment data results in the generation of the bill. The system also has a workflow engine coupled to the integrated database for coordinating the processing of the electronic bill and for updating the bill information in response to the bill processing. A management system is coupled to the integrated database for monitoring the contents of the integrated database accessible by the provider interface, wherein the provider can coordinate real-time retrieval of submission and status details for bill information contained in the integrated database.

Claims

1. An electronic invoice processing system configured for coordinating processing of electronic invoices submitted by a plurality of providers of insurance services, the insurance services predefined in insurance plans pertaining to a plurality of respective insurance service recipients, the electronic invoices for requesting payment for the insurance services, the system comprising;

a) a provider interface configured for receiving an update invoice request including a search parameter from a respective provider of the plurality of providers, the search parameter for identifying from the plurality of electronic invoices an invoice matching the search parameter, said invoice corresponding to the insurance services provided by the respective provider, said invoice awaiting adjudication and being both read and write accessible via the provider interface;

b) a storage for storing said invoice including processing status pertaining to said invoice as awaiting adjudication;

c) a workflow engine coupled to the storage and configured for coordinating the processing of each of the electronic invoices according to processing rules based on contents of the insurance plans and for updating invoice information of said invoice including the processing status for said invoice in response to the invoice processing, the contents of each of the insurance plans including definitions for a plurality of valid insurance services pertaining to an insurance service recipient of the plurality of respective insurance service recipients and including corresponding valid expenses for performing each of the plurality of valid insurance services; and

d) a search system coupled to the storage for using the search parameter to access the invoice information of said invoice, said invoice representing a portion of the contents of a respective insurance plan of the insurance plans, and for providing the invoice information including the processing status as unadjudicated for use in generating a response to the update invoice request.

2. The system according to claim 1 further comprising a search function of the search system for accessing the invoice information in the storage, the search function for retrieving the invoice information using a number of search options selected from the group comprising:

an insurance claim number pertaining to the portion of the contents of the respective insurance plan;

identification of said insurance service recipient;

a date range; and

a selected status including pending or processed.

53. The system according to claim 1, wherein the update invoice request consists of a void request.

54. The system according to claim 1, wherein access via the provider interface permits sequential rather than parallel editing of the invoice information.

55. The system according to claim 54, further comprising the storage including an invoice queue for coordinating the processing of said invoice, the invoice queue containing the invoice information including said invoice and corresponding details of said invoice.

3. A method for coordinating the submission and processing of an electronic invoice according to predictive payment data of an insurance plan, the electronic invoice for requesting payment for insurance services defined in the insurance plan, the method comprising the steps of:

a) storing the predictive payment data corresponding to the insurance plan in a storage coupled to an adjudication engine, the contents of the insurance plan including definitions for a plurality of valid insurance services and including corresponding valid expenses for performing each of the plurality of valid insurance services;

b) inserting a predictive payment parameter into a rule set of the adjudication engine for facilitating eventual adjudication of the electronic invoice at a predefined interval, the predictive payment data corresponding to a portion of the contents of the insurance plan;

c) triggering generation of the electronic invoice at the predefined interval according to the predictive payment parameter, the electronic invoice including the predictive payment data represented in the portion of the contents of the insurance plan;

d) providing the electronic invoice to the adjudication engine for processing;

e) updating the predictive payment parameter in the storage for recognizing submission of the electronic invoice to the adjudication engine at the predefined interval; and

f) generating a processing result of the electronic invoice as defined by the predictive payment data once adjudicated.

4. The method according to claim 3, wherein the predictive payment parameter specifies the predefined interval and is part of a parameter set defined in the predictive payment data of the insurance plan, the parameter set including at least one further predictive payment parameter selected from the group comprising:

service codes;

expense codes;

payment amounts of the valid expenses;

payment frequency;

start and end dates for the generation of the electronic invoice;

units; and

payee information.

5. An electronic invoice processing system configured for coordinating access to updated status information on the processing of electronic invoices submitted by a plurality of providers of insurance services, the insurance services predefined in insurance plans pertaining to a plurality of respective insurance service recipients, the electronic invoices for requesting payment for the insurance services, the system comprising;

a provider interface configured for receiving an update invoice request including a search parameter from a respective provider of the plurality of providers, the search parameter for identifying from the plurality of electronic invoices an invoice matching the search parameter, said invoice corresponding to the insurance services provided by the respective provider, said invoice awaiting adjudication and being both read and write accessible via the provider interface;

a storage for storing said invoice including status information pertaining to the processing of said invoice;

a workflow engine coupled to the storage and configured for updating status information for each of the electronic invoices in response to processing rules reflecting contents of the insurance plans, the contents of each of the insurance plans including definitions for a plurality of valid insurance services pertaining to an insurance service recipient of the plurality of respective insurance service recipients and including corresponding valid expenses for performing each of the plurality of valid insurance services; and

a search system coupled to the storage for using the search parameter to access said invoice, said invoice representing a portion of the contents of a respective insurance plan of the insurance plans, and for providing the invoice information including the processing status as unadjudicated for use in generating a response to the update invoice request for said invoice.

6. The system of claim 5, wherein status information includes a status selected from the group comprising:

pending;

result; and

payment.

7. The system of claim 6, wherein the status information includes further information selected from the group comprising:

insurance claim data;

invoice payment details; and

processing details.

8. The system of claim 5, wherein the plurality of valid insurance services include services selected from the group comprising:

a service;

a treatment and a product.

9. The system of claim 5, wherein the respective insurance plan includes the definitions of the plurality of valid insurance services for two or more insurance service recipients from the plurality of insurance service recipients.

10. The system of claim 5 further comprising the storage including an invoice queue for coordinating the processing of the electronic invoices, the invoice queue containing invoice information including said invoice and corresponding details of said invoice awaiting adjudication.

11. The system of claim 10 further comprising the workflow engine configured for coordinating a scheduling of the electronic invoices for insertion into a respective position in the invoice queue for subsequent processing.

12. The system of claim 11 further comprising the workflow engine configured for generating said invoice for insertion into the invoice queue as a predictive payment request, the predictive payment request including generated invoice payment details based on the portion of the contents of the respective insurance plan.

13. The system of claim 12 further comprising the workflow engine configured for periodic insertion of said invoice into the invoice queue based on a payment frequency defined in the portion of the contents of the respective insurance plan.

14. The system of claim 12 further comprising the workflow engine configured for generating processing rules for the predictive payment request to use in processing said invoice.

15. The system of claim 14 further comprising the workflow engine configured for generating the processing rules of the predictive payment request in response to receipt of the respective insurance plan.

16. The system of claim 11 further comprising a scheduling table coupled to the workflow engine for use in coordinating the scheduling of the electronic invoices.

17. The system of claim 16, wherein the contents of the scheduling table facilitate implementation of a scheduling action selected from the group comprising:

hold said invoice for additional action before insertion into the invoice queue; and

direct insertion into the invoice queue.

18. The system of claim 5 further comprising the provider interface configured for receiving a further update invoice request including a further search parameter from a further provider different from the respective provider, the further search parameter for identifying from the plurality of electronic invoices a further invoice matching the further search parameter, said further invoice corresponding to the insurance services provided by the further provider, said further invoice representing a further portion of the contents of the respective insurance plan such that the further portion is different from said portion.

49. The method of claim 13 wherein the insurance services are related to a continuum of health care provided to the insurance service recipient, such that said invoice is one of a plurality of the electronic invoices pertaining to the respective insurance plan.

50. The method of claim 17 wherein the insurance services are related to a continuum of health care provided to the insurance service recipient, such that said invoice is one of a plurality of the electronic invoices pertaining to the respective insurance plan.

56. The system according to claim 5, wherein the update invoice request consists of a void request.

57. The system according to claim 5, wherein access via the provider interface permits sequential rather than parallel editing of the invoice information.

19. An electronic invoice processing method executed within an electronic bill processing network for coordinating access to updated status information on the processing of electronic invoices submitted by a plurality of providers of insurance services, the insurance services predefined in insurance plans pertaining to a plurality of respective insurance service recipients, the electronic invoices for requesting payment for the insurance services, the method comprising;

receiving, at a display user interface of a service provider, an update invoice request including a search parameter from a respective provider of the plurality of providers, the search parameter for identifying from the plurality of electronic invoices an invoice matching the search parameter, said invoice corresponding to the insurance services provided by the respective provider, said invoice awaiting adjudication and being both read and write accessible via the provider interface;

storing, in a memory of a storage database, said invoice including the status information pertaining to the processing of said invoice in a storage;

updating, at a memory of a workflow engine, the status information for each of the electronic invoices in response to processing rules reflecting contents of the insurance plans, the contents of each of the insurance plans including definitions for a plurality of valid insurance services pertaining to an insurance service recipient of the plurality of respective insurance service recipients and including corresponding valid expenses for performing each of the plurality of valid insurance services; and

applying, at a memory of a database search system, the search parameter to access the invoice information of said invoice, said invoice representing a portion of the contents of a respective insurance plan of the insurance plans, and for providing the accessed invoice information including the processing status as unadjudicated for use in generating a response to the update invoice request.

20. The method of claim 19 further comprising the step of storing the electronic invoices in an invoice queue of the storage for coordinating the processing of the electronic invoices.

21. The method of claim 20 further comprising the step of coordinating a scheduling of the electronic invoices for insertion into a respective position in the invoice queue for subsequent processing.

22. The method of claim 21 further comprising the step of generating said invoice for insertion into the invoice queue as a predictive payment request, the predictive payment request including generated invoice payment details based on the portion of the contents of the respective insurance plan.

23. The method of claim 22 further comprising the step of periodically inserting of said invoice into the invoice queue based on a payment frequency defined in the portion of the contents of the respective insurance plan.

24. The method of claim 22 further comprising the step of generating processing rules for the predictive payment request to use in processing said invoice.

25. The method of claim 24 further comprising the step of generating the processing rules of the predictive payment request in response to receipt of the respective insurance plan.

26. The method of claim 21 further comprising the step of using a scheduling table in coordinating the scheduling of the electronic invoices.

27. The method of claim 26, wherein the contents of the scheduling table facilitate implementation of a scheduling action selected from the group comprising:

hold said invoice for additional action before insertion into the invoice queue; and

direct insertion into the invoice queue.

28. The method of claim 19 further comprising step of receiving a further update invoice request including a further search parameter from a further provider different from the respective provider, the further search parameter for identifying from the plurality of electronic invoices a further invoice matching the further search parameter, said further invoice corresponding to the insurance services provided by the further provider, said further invoice representing a further portion of the contents of the respective insurance plan such that the further portion is different from said portion.

51. The method of claim 23 wherein the insurance services are related to a continuum of health care provided to the insurance service recipient, such that said invoice is one of a plurality of the electronic invoices pertaining to the respective insurance plan.

52. The method of claim 27 wherein the insurance services are related to a continuum of health care provided to the insurance service recipient, such that said invoice is one of a plurality of the electronic invoices pertaining to the respective insurance plan.

58. The method according to claim 19, wherein the update invoice request consists of a void request.

59. The method according to claim 19, wherein access via the provider interface permits sequential rather than parallel editing of the invoice information.

60. The method according to claim 59, further comprising the storage including an invoice queue for coordinating the processing of said invoice, the invoice queue containing the invoice information including said invoice and corresponding details of said invoice.

29. A method executed within an electronic bill processing network for coordinating the submission and processing of an electronic invoice according to predictive payment data of an insurance plan, the electronic invoice for requesting payment for insurance services defined in the insurance plan, the method comprising the steps of:

storing, in a memory of a storage database coupled to an adjudication engine, the predictive payment data corresponding to the insurance plan, the contents of the insurance plan including definitions for a plurality of valid insurance services and including corresponding valid expenses for performing each of the plurality of valid insurance services;

inserting, at a memory of a queue database, a predictive payment parameter into a rule set of the adjudication engine for facilitating eventual adjudication of the electronic invoice at a predefined interval, the predictive payment data corresponding to the contents of the insurance plan;

triggering generation of the electronic invoice at the predefined interval a memory of the storage database, the electronic invoice including the predictive payment data represented in the contents of the insurance plan;

providing, from the memory of the storage database, the electronic invoice to the adjudication engine for processing; and

upon recognizing completion of processing of the electronic invoice at the predefined interval, generating, at a processor of the adjudication engine, a processing result of the electronic invoice as defined by the predictive payment data once adjudicated.

30. The method according to claim 29, wherein the predictive payment parameter specifies the predefined interval.

31. The method according to claim 29, wherein the predictive payment parameter is part of a parameter set defined in the predictive payment data of the insurance plan, the parameter set including at least one parameter selected from the group comprising:

the predefined interval;

service codes;

expense codes;

payment amounts of the valid expenses;

payment frequency;

start and end dates for the generation of the electronic invoice;

units; and

payee information.

32. The method of claim 29, wherein the plurality of valid insurance services include services selected from the group comprising:

a service;

a treatment and a product.

33. The method of claim 29, wherein the insurance plan includes the definitions of the plurality of valid insurance services for two or more individual insurance service recipients.

36. The method of claim 29 further comprising the step of generating processing rules of the rule set for use in processing said invoice.

37. The method of claim 36 further comprising the step of generating the processing rules in response to receipt of the insurance plan.

38. The method of claim 29 further comprising the step of using a scheduling table in coordinating scheduling of the electronic invoice with respect to other electronic invoices for processing by the adjudication engine, wherein the contents of the scheduling table facilitate implementation of a scheduling action selected from the group comprising:

hold said invoice for additional action before insertion into an invoice queue; and

direct insertion into an invoice queue.

34. The method of clam 29 further comprising the step of selecting the predictive payment data as a subset of the contents of the insurance plan.

35. The method of claim 34 further comprising the step of including invoice payment details in the processing result of the electronic invoice based on the subset of the contents of the insurance plan.

39. A system for coordinating the submission and processing of an electronic invoice according to predictive payment data of an insurance plan, the electronic invoice for requesting payment for insurance services defined in the insurance plan, the system comprising:

a storage for storing the predictive payment data corresponding to the insurance plan for processing, the contents of the insurance plan including definitions for a plurality of valid insurance services and including corresponding valid expenses for performing each of the plurality of valid insurance services;

a workflow engine configured for inserting a predictive payment parameter into a rule set for facilitating eventual adjudication of the electronic invoice at a predefined interval, the predictive payment data corresponding the contents of the insurance plan;

a scheduling module configured for use in triggering generation of the electronic invoice at the predefined interval and configured for recording completion of the processing of the electronic invoice at the predefined interval, the electronic invoice including the predictive payment data represented in the contents of the insurance plan; and

an adjudication engine for receiving the electronic invoice for processing based on the rule set and for generating a processing result of the electronic invoice once adjudicated.

40. The system according to claim 39, wherein the predictive payment parameter specifies the predefined interval.

41. The system according to claim 39, wherein the predictive payment parameter is part of a parameter set defined in the predictive payment data of the insurance plan, the parameter set including at least one parameter selected from the group comprising:

the predefined interval;

service codes;

expense codes;

payment amounts of the valid expenses;

payment frequency;

start and end dates for the generation of the electronic invoice;

units; and

payee information.

42. The system of claim 39, wherein the plurality of valid insurance services include services selected from the group comprising:

a service;

a treatment and a product.

43. The system of claim 39, wherein the insurance plan includes the definitions of the plurality of valid insurance services for two or more individual insurance service recipients.

46. The system of claim 39 further comprising the workflow engine configured for generating processing rules of the rule set for use in processing said invoice.

47. The system of claim 46 further comprising the workflow engine configured for generating the processing rules in response to receipt of the insurance plan.

48. The system of claim 39 further comprising a scheduling table for use in coordinating scheduling of the electronic invoice with respect to other electronic invoices for processing by the adjudication engine, wherein the contents of the scheduling table facilitate implementation of a scheduling action selected from the group comprising:

hold said invoice for additional action before insertion into an invoice queue; and

direct insertion into an invoice queue.

44. The system of clam 39 further comprising the predictive payment data represents a subset of the contents of the insurance plan.

45. The system of claim 44 further comprising the adjudication engine configured for including invoice payment details in the processing result of the electronic invoice based on the subset of the contents of the insurance plan.