SYSTEM AND METHOD OF ACCELERATED HEALTH CARE CLAIM PAYMENT
A method of accelerating a health care claim payment may include filtering a claim to determine whether the claim is eligible for accelerated claim payment. A payment amount for a claim may be determined by a computing device by retaining a provider level adjustment. The payment amount may be automatically paid via electronic funds transfer. A portion of the provider level adjustment may be distributed via electronic funds transfer.
1 . A method of accelerating a health care claim payment comprising:
filtering a claim to determine whether the claim is eligible for accelerated claim payment;
determining, via a computing device, a payment amount for the claim by retaining a provider level adjustment;
automatically paying the payment amount via electronic funds transfer; and
distributing, via electronic funds transfer, a portion of the provider level adjustment.
2 . The method of claim 1 wherein distributing a portion of the provider level adjustment comprises distributing a portion of the provider level adjustment only if a service level is exceeded.
3 . The method of claim 1 wherein filtering the claim to determine whether the claim is eligible for accelerated claim payment comprises:
obtaining a plurality of provider's parameters;
determining if data from the claim corresponds with the provider's parameters;
obtaining a plurality of payer's parameters;
determining if data from the claim corresponds with the payer's parameters;
processing the claim in an accelerated claim payment group.
4 . The method of claim 3 wherein the plurality of provider's parameters comprise one or more of the following:
a flag to indicate that a threshold total cost was exceeded,
a flag to indicate the claim should be included in the accelerated payment group, and
a provider identifier to indicate a provider wants an accelerated payment.
5 . The method of claim 3 wherein the plurality of payer's parameters comprise one or more of the following:
a flag to indicate that a threshold total cost was exceeded,
a flag to indicate the claim should be included in the accelerated payment group, and
a payer identifier to indicate that a payer will accept an accelerated payment.
6 . The method of claim 1 further comprising:
performing clinical coding verification on the claim.
7 . The method of claim 1 further comprising:
performing eligibility verification on the claim.
8 . The method of claim 1 wherein determining a payment amount comprises:
reconciling the claim based on remittance advice.
9 . The method of claim 1 wherein filtering a claim comprises filtering a claim in real time to determine whether the claim is eligible for accelerated claim payment.
10 . The method of claim 1 , further comprising:
submitting the claim, in real time, to a payer.
11 . The method of claim 1 wherein determining a payment amount for the claim comprises determining a payment amount in real time.
12 . A system for accelerating a health care claim payment, the system comprising:
a processor; and
a processor-readable storage medium in communication with the processor;
wherein the processor-readable storage medium contains one or more programming instructions for performing the following when executed:
filtering a claim to determine whether the claim is eligible for accelerated claim payment,
determining a payment amount for the claim by retaining a provider level adjustment,
automatically paying the payment amount, and
distributing a portion of the provider level adjustment.
13 . The system of claim 12 wherein the processor-readable storage medium is configured to store the claim.
14 . The system of claim 12 wherein the processor-readable storage medium is configured to store one or more valid or invalid combinations of product and service codes.
15 . The system of claim 12 wherein the processor-readable storage medium further contains one or more programming instructions for performing eligibility verification on the claim.
16 . A computer program product, comprising a computer usable medium having a computer readable program code embodied therein, the computer readable program code adapted to be executed to implement a method for accelerating a health care claim payment, the method comprising:
filtering a claim to determine whether the claim is eligible for accelerated claim payment;
determining a payment amount for the claim by retaining a provider level adjustment;
automatically paying the payment amount via electronic funds transfer; and
distributing, via electronic funds transfer, a portion of the provider level adjustment.
17 . The computer program product of claim 16 wherein filtering the claim to determine whether the claim is eligible for accelerated claim payment comprises:
obtaining a plurality of provider's parameters;
determining if data from the claim corresponds with the provider's parameters;
obtaining a plurality of payer's parameters;
determining if data from the claim corresponds with the payer's parameters;
processing the claim in an accelerated claim payment group.
18 . The computer program product of claim 17 wherein the plurality of provider's parameters comprise one or more of the following:
a flag to indicate that a threshold total cost was exceeded,
a flag to indicate the claim should be included in the accelerated payment group, and
a provider identifier to indicate a provider wants an accelerated payment.
19 . The computer program product of claim 17 wherein the plurality of payer's parameters comprise one or more of the following:
a flag to indicate that a threshold total cost was exceeded,
a flag to indicate the claim should be included in the accelerated payment group, and
a payer identifier to indicate that a payer will accept an accelerated payment.
20 . The computer program product of claim 16 wherein distributing a portion of the provider level adjustment comprises distributing a portion of the provider level adjustment only if a service level is exceeded.