Healthcare eligibility and benefits data system
View Patent ↗A healthcare eligibility and benefits system provides efficient processing and exchanging of eligibility and benefits data with clearinghouses and payers, such as insurance companies, federal and state health plans, and the such. Certain data from responses is stored and used by future requests. As such, the system captures member data such that the member data does not have to be keyed in a second time.
1. A healthcare eligibility and benefits data system, the system comprising:
a provider computer configured to:
receive patient information for a patient;
communicate an eligibility request to a payer computer, wherein the eligibility request is based on the received patient information;
receive an eligibility response from the payer computer in response to the eligibility request, wherein the eligibility response includes data associated with the patient in a format that is acceptable to the payer computer;
obtain the data associated with the patient and capture the format for the data associated with the patient from the eligibility response received from the payer computer, wherein the data associated with the patient includes identification data of the patient;
store the data associated with the patient and the format from the eligibility response;
populate a subsequent eligibility request for the patient with the data associated with the patient and format the data associated with the patient according to the format captured from the eligibility response; and
send the subsequent eligibility request to the payer computer.
2. The system of claim 1 , wherein the stored data comprises a patient member number and a patient date of birth.
3. The system of claim 1 , wherein the eligibility request includes a completed HIPAA 270 form and the eligibility response includes a completed HIPAA 271 form.
4. The system of claim 1 , wherein the provider computer is further configured to present a list of patients for whom identification data is stored.
5. The system of claim 4 , wherein the provider computer is further configured to present the list of patients in an interface in a pop up window.
6. The system of claim 1 , wherein the provider computer is further configured to check format validity locally before the eligibility request is communicated.
7. The system of claim 6 , wherein the provider computer is configured to determine the format validity based on stored rules associated with a plurality of payer computers.
8. The system of claim 1 , wherein the provider computer is further configured to couple the stored data with a request for electronic funds transfer.
9. The system of claim 1 , wherein the provider computer is further configured to use the stored data to reconcile outstanding patient account balances.
10. A non-transitory computer-readable medium having instructions stored thereon that, in response to execution by a computing device, cause the computing device to perform operations comprising:
receiving patient information for a patient;
communicating an eligibility request to a payer computer, wherein the eligibility request is based on the received patient information;
receiving an eligibility response from the payer computer for the patient in response to the eligibility request, wherein the eligibility response includes data associated with the patient in a format that is acceptable to the payer computer;
obtaining the data associated with the patient and capturing the format for the data associated with the patient from the eligibility response received from the payer computer, wherein the data associated with the patient includes identification data of the patient;
storing the data associated with the patient and the format from the eligibility response;
populating a subsequent eligibility request for the patient with the data associated with the patient and formatting the data associated with the patient according to the format captured from the eligibility response; and
send the subsequent eligibility request to the payer computer.
11. The product of claim 10 , wherein the stored data comprises a patient member number and a patient date of birth.
12. The product of claim 10 , wherein the eligibility request includes a completed HIPAA 270 form and the eligibility response includes a completed HIPAA 271 form.
13. The product of claim 10 , wherein the instructions further cause the computing device to present a list of patients for whom identification data is stored.
14. The product of claim 10 , wherein the instructions further cause the computing device to couple the stored data with a request for an electronic funds transfer.
15. The product of claim 10 , wherein the instructions further cause the computing device to use the stored data to reconcile outstanding patient account balances.
16. A method comprising:
receiving, by a provider computer, patient information for a patient;
communicating, by the provider computer, an eligibility request to a payer computer, wherein the eligibility request is based on the received patient information;
receiving, by the provider computer, an eligibility response from the payer computer for the patient in response to the eligibility request, wherein the eligibility response includes data associated with the patient in a format that is acceptable to the payer computer;
obtaining, by the provider computer, the data associated with the patient and capturing the format for the data associated with the patient from the eligibility response received from the payer computer, wherein the data associated with the patient includes identification data of the patient;
storing the data associated with the patient and the format from the eligibility response using the provider computer;
populating, by the provider computer, a subsequent eligibility request for the patient with the data associated with the patient and formatting the data associated with the patient according to the format captured from the eligibility response; and
sending the subsequent eligibility request from the provider computer to the payer computer.
17. The method of claim 16 , wherein the stored data comprises a patient member number and a patient date of birth.
18. The method of claim 16 , wherein the eligibility request includes a completed HIPAA 270 form and the eligibility response includes a completed HIPAA 271 form.
19. The method of claim 16 , further comprising presenting a list of patients for whom identification data is stored using the provider computer.
20. The method of claim 19 , wherein said presenting a list of patients for whom identification is stored comprises presenting the list of patients in an interface in a pop up window.
21. The method of claim 16 , communicating the eligibility request to the payer computer using the provider computer.
22. The method of claim 21 , further comprising checking, using the provider computer, format validity locally before the eligibility request is communicated.
23. The method of claim 22 , wherein said checking format validity comprises determining the format validity based on stored rules associated with a plurality of payer computers.
24. The method of claim 16 , further comprising coupling the stored data with a request for electronic funds transfer using the provider computer.
25. The method of claim 24 , further comprising reconciling, using the provider computer, outstanding patient account balances based on the stored data.