System And Method For Payment Of Medical Claims

Abstract

A system allows a health care provider to arrange payment at the time of service for a patient responsibility portion of a health care claim amount, even though the provider may not know what the patient responsibility portion will be until after adjudication. A health care debit card is associated with an account of the patient. At the time of service, the patient presents the card to the provider. The provider uses the card to authorize the system to hold an estimate of the patient responsibility amount in suspense in the patient's account. After adjudication, when the actual patient responsibility amount is known, a transaction set is sent to the system. The system then automatically transfers the actual patient responsibility amount from the patent's account and into the provider's bank account. Any remainder of the suspended funds is left in the patient's account. A trace number is provided so that the provider can reconcile bank statement deposits with transaction set information.

Description

CROSS-REFERENCE TO RELATED APPLICATION[0001]This application claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Application No. 60 / 373,903, filed Apr. 19, 2002. The entirety of the subject matter of U.S. Provisional Application No. 60 / 373,903 is incorporated herein by reference.BACKGROUND INFORMATION[0002]Currently a health care provider (for example, a doctor) does not know at the time of service what portion of the doctor's bill for services will be the patient's responsibility and what portion will be paid by a payer (for example, an insurance company). Only after the patient's visit is the patient responsibility amount determined. This patient responsibility amount is determined by the doctor and the payer in what is called an “adjudication”. This means that the doctor typically cannot bill the patient at the time of service, but rather must wait until the amount is known to bill the patient for the patient responsibility amount. The result is paperwork, administrati...

AI Technical Summary

Benefits of technology

[0009]For each amount deposited into the provider's bank account, the system also supplies to the provider's bank an associated trace number. The provider's bank in turn forwards this trace number to the provider along with a record of the associated deposit amount. The provider can then use the trace number to associate transaction set information received for a given claim with a record from the provider's bank of a particular deposited amount. In this way, a provider can confirm that a particular payment amount indicated by the transaction set information to have been paid was in fact paid as evidenced by a particular deposit amount appearing on a deposit statement from the provider's bank.

Problems solved by technology

This means that the doctor typically cannot bill the patient at the time of service, but rather must wait until the amount is known to bill the patient for the patient responsibility amount.

The result is paperwork, administrative expense, and a delay in collection.

If the patient later chooses not to pay, the expense to the doctor of collecting payment from the patient may be so great that the doctor elects just to write off the uncollected amount.

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