PRACTICE MANAGEMENT SYSTEM (PMS) INTEGRATION METHOD
A method 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 method 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 resulted 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 method for verifying eligibility information and authorizing payment for a card member comprising:
validating account information related to the card member;
determining the card member's eligibility for one or more services requested by the card member, based on the validation step results;
billing the card member for the one or more services availed;
communicating with a processor for authorization of payment to a service provider after the billing step; and
executing an automatic payment to the service provider based on the processor's response.
2 . The method of claim 1 , wherein the steps of validating, determining the card member's eligibility and billing are all performed in a single step.
3 . The method of claim 2 , wherein said single step is a card swipe on a wedge reader.
4 . The method of claim 1 , wherein the step of validating comprises:
(a) reading information stored in a card associated with the card member;
(b) sending the information to a card company;
(c) requesting card member eligibility information from an insurer;
(d) contacting an eligibility gateway for retrieving data to be used for determining the card member's eligibility for one or more services;
(e) transmitting the retrieved data to the card company and to an office of the service provider via a practice management system; and
(f) holding financial information related to the card member until the card member eligibility information is verified.
5 . The method of claim 1 , wherein the step of determining the card member's eligibility further comprises:
(a) encoding basic card member eligibility information on a region of a data storage device; and
(b) providing services to the card member based on whether or not the card member is eligible for said services.
6 . The method of claim 5 , wherein step (a) occurs on one or more of a plurality of tracks.
7 . The method of claim 1 , wherein the step of billing further comprises:
(a) reading card data; and
(b) sending read data to a card company.
8 . The method of claim 1 , further comprising:
displaying results of the validating and determining steps on a web-based a web-based portal.