Healthcare Payment Reconciliation System with Provider Prompt Pay
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Solution Overview
Problem
Healthcare providers face significant challenges in reconciling billing statements with explanations of benefits (EOBs) from payers, leading to underpayment by patients due to complexity and administrative costs, which contributes to overall healthcare cost inefficiencies.
Innovation Solution
A healthcare payment management system that consolidates billing information from providers and EOBs from payers into a payment reconciliation statement, providing clear payment options to patients, including electronic payments, to facilitate timely and accurate payments.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If patients manually reconcile billing statements with EOBs, then payment accuracy may be improved, but the complexity and administrative cost increase significantly
Solution Approach 1:
The patent introduces an intermediary system (billing consolidation platform) that automatically reconciles billing statements with EOBs. This intermediary performs the complex matching and calculation tasks between providers, payers, and patients, eliminating the need for patients to manually reconcile documents while ensuring payment accuracy.
Solution Approach 2:
The system enables self-service by automatically generating consolidated billing statements and payment options for patients. The reconciliation process occurs automatically in the background without requiring patient intervention, while still providing accurate payment information and multiple payment options to the patient.
2Productivity
If providers pursue underpaid bills, then revenue collection may be improved, but administrative costs increase due to high reconciliation complexity
Solution Approach 1:
The billing consolidation platform acts as an intermediary that handles the complex reconciliation and collection processes automatically. Providers can initiate the process and receive consolidated statements without dealing with the administrative burden of manual reconciliation, while still achieving improved collection rates through systematic follow-up.
Solution Approach 2:
The patent replaces manual mechanical reconciliation processes with automated electronic systems. The platform automatically matches billing data with EOB information, calculates patient responsibilities, and generates consolidated statements, eliminating the need for manual administrative work while improving collection efficiency.
3Measurement precision
If multiple separate billing statements are sent to patients, then provider-specific billing accuracy is maintained, but patient understanding and payment timeliness deteriorate
Solution Approach 1:
The patent merges multiple separate billing statements and EOBs into a single consolidated billing statement that presents all charges, payments, and patient responsibilities in one clear document. This consolidation maintains the accuracy of individual provider bills while improving patient understanding by showing the complete financial picture in context.
Solution Approach 2:
While consolidating information, the system segments the billing data by provider and service type within the single statement. This allows patients to understand each provider's specific charges while seeing how they fit into the overall episode of care, maintaining billing accuracy while improving comprehensibility.
4Speed
If electronic payment options are provided, then payment speed is improved, but system complexity increases
Solution Approach 1:
The billing consolidation platform serves as an intermediary that integrates multiple electronic payment options into the consolidated statement delivery process. The system handles the complexity of connecting with different payment processors, bank accounts, and credit card systems in the background, while presenting simple payment options to patients.
Solution Approach 2:
The platform provides universal access to multiple payment methods (electronic funds transfer, credit card, debit card) through a single consolidated statement system. This multi-functional approach allows patients to choose their preferred payment method while the system handles all the technical complexity of processing different payment types through a unified interface.
Data Source
AI summary
A healthcare payment management system comprising a payment consolidation server configured to receive billing information from a provider for an episode of care for a member, receive benefit information from a payer for the episode of care, consolidate the billing information and the benefit information into a payment reconciliation statement, and send the payment reconciliation statement to a member.