Healthcare Payment Platform Standardizing Bills and EOBs
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Solution Overview
Problem
The healthcare industry faces challenges in timely and accurate payment processing due to synchronization issues between healthcare provider bills and explanation of benefits (EOB) forms, leading to confusion for patients who must verify the correctness of payments without standardized data aggregation and validation tools.
Innovation Solution
A mobile app and cloud-based platform that uses OCR technology to standardize and validate healthcare provider bills by matching them with adjudicated claims data, providing patients with a secure and user-friendly interface for payment processing, including geolocation and multiple payment options.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If traditional payment processing is used without standardized data aggregation, then payment processing can be performed, but patient confusion increases and verification accuracy decreases
Solution Approach 1:
The patent introduces an intermediary system that acts as a mediator between healthcare providers and patients. This intermediary aggregates and standardizes payment data from multiple sources, including provider bills and EOB forms, presenting unified payment information to patients. The intermediary layer resolves the complexity of data synchronization while maintaining accurate verification by centralizing and standardizing the data flow.
Solution Approach 2:
The patent transforms the data presentation parameters by standardizing payment information into a consistent format. By changing the data parameters from their original varied formats (different provider billing systems, EOB formats) into a standardized representation, the system enables accurate verification while reducing the complexity of handling multiple data formats.
2Ease of operation
If patients manually verify payment correctness without standardized tools, then payment processing can occur, but interaction complexity increases and time consumption increases
Solution Approach 1:
The patent enables self-service payment verification by providing patients with direct access to standardized payment information through a user-friendly interface. Patients can independently verify payment correctness without requiring manual intervention from providers or insurance companies. The system automatically performs the verification function, allowing patients to check payment status and details at their own convenience.
Solution Approach 2:
The system performs preliminary action by pre-standardizing and pre-aggregating payment data before patients need to verify it. By preparing the data in advance in a standardized format and making it readily accessible through the patient portal, the system eliminates the need for patients to manually gather and verify information from multiple sources, significantly reducing verification time.
3Reliability
If healthcare providers bill patients without synchronized EOB data, then billing can be processed, but data accuracy decreases and patient confusion increases
Solution Approach 1:
The patent implements feedback mechanisms that continuously monitor and validate billing data against EOB information. The system provides feedback loops where payment information is verified against the original claim data, and discrepancies are automatically detected and reported. This feedback process ensures billing accuracy by cross-checking data from multiple sources and alerting users to any inconsistencies.
Solution Approach 2:
The patent creates a universal data aggregation system that handles multiple data types and formats from different sources (provider billing systems, insurance EOB forms, payment processing systems). By building a universal framework that can process and standardize various data formats, the system achieves reliable billing accuracy without requiring separate specialized systems for each data source.
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
Facilitates timely and confident payments by patients, reduces interaction complexity, and ensures accurate billing by synchronizing and standardizing data, thus enhancing the efficiency of healthcare transactions.
Implementation Method 1
A mobile app and cloud-based platform that uses OCR technology to standardize and validate healthcare provider bills
Data Source
AI summary
The Healthcare Transaction Facilitation Platform Apparatuses, Methods and Systems (“HTFP”) transforms payment file, EOP data, EOB file message, claim verification input inputs via HTFP components into receipt confirmation message, claim details output, ACH request, card generation request, card payment request, ACH CCD+ payment request, EOP file outputs. Statement interaction interface mechanisms, each associated with a statement linked to a member, are generated. A statement detail interaction interface mechanism with EOB data associated with a member selected statement is generated. A member payment method details datastructure for a member responsibility payment to a provider associated with the selected statement is obtained. A TRN corresponding to the member responsibility payment is determined. A payment card datastructure corresponding to the member responsibility payment is generated. A Level 3 card payment request datastructure is generated and sent. An ACH CCD+ payment request datastructure corresponding to the member responsibility payment is generated and sent.