System and method for managing payments for health care services
The health care payment techniques include a method. The method includes receiving, by a payment services manager computer system, from a plurality of computer systems of a plurality of health care providers via a communication network, notification of a plurality of claims for a plurality of health care services provided to a patient by the plurality of health care service providers. At least a portion of the claims are being payable by a participant in a benefits plan and at least a portion of the claims are being payable by a third party payor. The method further comprises remitting, by a payment services system logic implemented by the payment services manager computer system, for each claim in the plurality of claims, payment of the entire claim within a predetermined time period of receiving the notification of the claim.
1. A computer-implemented health care claim payment method, the method comprising:
receiving, by a payment services manager computer system comprising a processor and machine readable media having instructions stored therein that are executed by the processor, from a plurality of computer systems of a plurality of health care providers via a communication network, notification of a plurality of claims for a plurality of health care services provided to a patient by the plurality of health care service providers, at least a portion of the claims being payable by a participant in a benefits plan and at least a portion of the claims being payable by a third party payor;
remitting, by a payment services system logic implemented by the payment services manager computer system, for each claim in the plurality of claims, payment of the entire claim within a predetermined time period of receiving the notification of the claim, including (i) remitting payment of the portion of the claim payable by the third party payor, and (ii) remitting payment of the portion of the claim payable by the participant;
combining, by the payment services system logic, claim information from the plurality of health care service providers into a master bill, the master bill containing claim information for the plurality of health care service providers;
itemizing, on the master bill, by the payment services system logic, claim information for each of the health care services provided to the patient by the plurality of health care service providers, and wherein the patient did not directly interact with at least some of the health care service providers;
providing the participant the master bill, including the claim information for the plurality of health care service providers; and
tracking, by the payment services system logic, payment of the master bill by the participant.
2. The computer-implemented method of claim 1 , wherein the predetermined time period within which the remitting payment of the entire claim is performed is 30 days.
3. The computer-implemented method of claim 1 , wherein the predetermined time period within which the remitting payment of the entire claim is performed is 20 days.
4. The computer-implemented method of claim 1 , wherein the predetermined time period within which the remitting payment of the entire claim is performed is 10 days.
5. The computer-implemented method of claim 1 , wherein the remitting step is performed by the payment services manager computer system.
6. The computer-implemented method of claim 1 , wherein the sending step is performed by the payment services manager computer system.
7. The computer-implemented method of claim 1 , wherein the participant is the patient on whom the health care service is performed.
8. The computer-implemented method of claim 1 , wherein the patient on whom the health care service is performed is a family member of the participant.
9. The computer-implemented method of claim 1 , wherein remitting further includes
(iii) accepting risk of delinquency and/or non-payment by the participant.
10. A computer-implemented method, the method comprising:
receiving, by a payment services manager computer system comprising a processor and machine readable media having instructions stored therein that are executed by the processor, from a plurality of computer systems of a plurality of health care providers via a communication network, notification of a plurality of claims for a plurality of health care services provided by the plurality of health care service providers to a patient, at least a portion of the claims being payable by a participant enrolled in a benefits plan;
maintaining, by a payment services system logic implemented by the payment services manager computer system, funds to pay the portion of the claims payable by the participant;
remitting, for each claim in the plurality of claims, payment of the claim, including (i) remitting, on behalf of the participant, payment of the portion of the claim payable by the participant, and (ii) accepting risk of delinquency and/or non-payment by the participant on the funds used to pay the portion of the claims payable by the participant;
combining, by the payment services system logic, claim information from the plurality of health care service providers into a master bill, the master bill containing claim information for the plurality of health care service providers;
itemizing, on the master bill, by the payment services system logic, claim information for each of the health care services provided to the patient by the plurality of health care service providers, and wherein the patient did not directly interact with at least some of the health care service providers;
sending the participant the master bill, including the claim information for the plurality of health care service providers; and
tracking, by the payment services system logic, payment of the master bill by the participant.
11. The computer-implemented method of claim 10 , wherein the instructions when executed cause the computer system to receive payment from the participant for the participant's portion of the plurality of claims.
12. The computer-implemented method of claim 10 , wherein the remitting step is performed by the payment services manager computer system.
13. The computer-implemented method of claim 10 , wherein the sending step is performed by the payment services manager computer system.
14. The computer-implemented method of claim 10 , wherein the participant is the patient on whom the health care service is performed.
15. The computer-implemented method of claim 10 , wherein the patient on whom the health care service is performed is a family member of the participant.
16. A computer-implemented method, the method comprising:
receiving, by a payment services manager computer system comprising a processor and machine readable media having instructions stored therein that are executed by the processor, from a plurality of computer systems of a plurality of health care providers via a communication network, a plurality of claims for a plurality of health care services provided by the plurality of health care service providers to a patient, the receiving being performed by program logic implemented by the instructions stored in the machine-readable storage media, at least a portion of the claims being payable by a participant in a benefits plan and at least a portion of the claims being payable by a third party payor;
remitting payment, by a payment services system logic implemented by the payment services manager computer system, for each claim in the plurality of claims, payment of the entire claim in a single payment, including (i) remitting payment of the portion of the claim payable by the third party payor, and (ii) remitting payment of the portion of the claim payable by the participant;
combining, by the payment services system logic, claim information from the plurality of health care service providers into a master bill, the master bill containing claim information for the plurality of health care service providers;
itemizing, on the master bill, by the payment services system logic, claim information for each of the health care services provided to the patient by the plurality of health care service providers, and wherein the patient did not directly interact with at least some of the health care service providers;
sending the participant the master bill, including the claim information for the plurality of health care service providers; and
tracking, by the payment services system logic, payment of the master bill by the participant.
17. The computer-implemented method of claim 16 , wherein the sending step is performed by the payment services manager computer system.
18. The computer-implemented method of claim 16 , wherein the participant is the patient on whom the health care service is performed.
19. The computer-implemented method of claim 16 , wherein the patient on whom the health care service is performed is a family member of the participant.
20. The computer-implemented method of claim 16 , wherein remitting further includes
(iii) accepting risk of delinquency and/or non-payment by the participant.