PRACTICE MANAGEMENT SYSTEM (PMS) INTEGRATION
A system and computer program product for integrating verification of eligibility information of a card member enrolled in a health plan with a payment account required to pay for the services used according to the health plan is described. The present invention integrates card member information to a Practice Management System which provides payment capabilities for services used by the card member. The invention encodes basic patient eligibility information onto a card magnetic stripe. This helps in overcoming any manual data entry errors that can result from a paper-based or paperless electronic process. The invention provides the ability to complete a transaction involving a medical service provider, a patient and a payer in a single swipe of card.
1 . A practice management system for payment and eligibility verification, comprising:
(a) a card associated with a card member to provide payment;
(b) an office management system coupled with a service provider to provide one or more services and accept payments for said one or more services;
(c) a card company with an associated database comprising an account associated with the card;
(d) an insurance database providing data for validation requests from the associated database; and
(e) a processor constructed and arranged to process data from the insurance database and provide authorization for the service provider to bill the card member for said one or more services availed, and cause the service provider to automatically receive at least one of a first portion of a total amount of the payment from the card member and a second portion of the total amount of the payment from an insurance company associated with the insurance database, in a single card reading operation.
2 . The system of claim 1 , wherein the card member is a medical patient.
3 . The system of claim 1 , wherein the card comprises:
a magnetic tape having a first track including encoded patient medical information and a second and a third track contain encoded patient financial information.
4 . The practice management system of claim 1 , further comprising an eligibility gateway having means for verifying whether or not the card member is eligible to use said one or more services wherein the insurance database is coupled to the eligibility gateway.
5 . The practice management system of claim 1 , wherein the card company comprises means for processing payment information and authorization instructions from the processor.
6 . A computer program product comprising a computer usable medium having control logic stored therein for causing a computer to integrate a patient's eligibility and payment information, said control logic comprising:
a set of instructions for processing data related to a card member with an associated account;
a first computer readable program code means for causing the computer to verify whether or not the card member is eligible for one or more services offered;
a second computer readable program code means for causing the computer to provide data for authorization to a service provider for a payment related to one or more services, and cause the service provider to automatically receive at least one of a first portion of a total amount of the payment from the card member and a second portion of the total amount of the payment from an insurance company associated with the insurance database, in a single card reading operation; and
a third computer readable code means for causing the computer to provide data to bill the card member to a card company database.
7 . The practice management system of claim 1 , further comprising:
(f) a web-based portal to perform the payment and eligibility verification.
8 . The practice management system of claim 1 , wherein the payment and eligibility verification occur in a single swipe of the card on a card reader.
9 . The computer program product of claim 6 , wherein the first computer readable program code means for causing the computer to verify comprises at least one rule engine.