Healthcare Payment Pre-authorization and Deduction System
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Solution Overview
Problem
The current process for healthcare service providers to collect funds from both healthcare payer entities and responsible parties is time-consuming and inefficient, requiring manual submission of claims and billing, which can lead to delays and inaccuracies.
Innovation Solution
A method that estimates the amount the individual is responsible for, acquires pre-authorization to deduct from their financial account, submits claims to payer entities, and deducts the unpaid balance from the account, ensuring timely and accurate payment to the healthcare provider, utilizing financial networks for routing and processing information according to the Standard Financial Network Authorization Process.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If manual claim submission and billing processes are used, then healthcare providers can collect funds from payer entities and responsible parties, but the process becomes time-consuming and inefficient
Solution Approach 1:
The system performs preliminary actions by estimating the patient responsibility amount before service delivery and obtaining pre-authorization from the patient's financial account. This advance preparation eliminates the need for manual claim submission and billing processes afterward, directly resolving the contradiction by performing necessary actions before they are needed, thus improving productivity while reducing time loss.
Solution Approach 2:
The system enables self-service by automatically determining patient responsibility amounts and deducting funds from pre-authorized financial accounts without requiring manual intervention from healthcare providers. The automated estimation and deduction processes eliminate time-consuming manual claim submission and billing activities, improving both productivity and reducing time loss simultaneously.
2Reliability
If manual billing processes are used, then healthcare providers can bill responsible parties for remaining balances, but the process leads to delays and inaccuracies
Solution Approach 1:
The system replaces manual mechanical billing processes with automated electronic estimation and deduction mechanisms. The automated system calculates patient responsibility amounts and executes deductions from financial accounts without human intervention, eliminating delays and inaccuracies associated with manual processing. This substitution directly improves reliability while reducing processing time.
Solution Approach 2:
The system incorporates feedback mechanisms where the estimated patient responsibility amount is dynamically adjusted based on actual payer entity responses and financial account balances. This continuous feedback loop ensures accurate determination of patient obligations and timely execution of deductions, improving both reliability and reducing processing delays.
3Productivity
If automated estimation and pre-authorization processes are implemented, then payment collection is streamlined and accuracy is improved, but system complexity increases
Solution Approach 1:
The system achieves universality by implementing a multi-functional platform that handles eligibility verification, benefit determination, estimated amount calculation, pre-authorization, and automated deduction all within a single integrated system. This consolidation improves productivity while managing complexity through functional integration rather than separate systems, as the multi-functional design eliminates the need for multiple discrete processes.
Solution Approach 2:
The system introduces intermediary components such as financial networks and standardized authorization processes that simplify the complexity of automated estimation and pre-authorization. These intermediaries act as mediators between the healthcare provider system and financial institutions, enabling automated fund collection while managing system complexity through established external protocols rather than requiring complex internal infrastructure.
Data Source
AI summary
Methods and systems for acquiring a pre-approval from a responsible party and receiving funds from a financial account related to the pre-approval in the healthcare field are described herein. A method for collecting payment from an individual for services rendered by a provider is disclosed. The method includes verifying an individual's eligibility for benefits, estimating an individual responsibility amount, acquiring authority from the individual for up to the individual responsibility amount on at least one financial account held by the individual, submitting one or more claims to one or more payer entities requesting compensation for the services rendered by the provider, deducting an amount from the at least one financial account held by the individual, and transferring the deducted amount to the provider.