Point of service third party financial management vehicle for the healthcare industry
A method for point of service third party adjudicated payment, which includes providing payment system access information to a point of service provider, receiving from the point of service provider purchase transaction data and the payment system access information, adjudicating the transaction substantially in real-time to determine the portion payable by the customer and the portion payable by a third party, sending an adjudicated settlement transaction to the point of service provider substantially in real-time, and initiating a request to transfer funds substantially in real-time in accordance with the adjudicated settlement transaction to an account of the service provider.
1. A method of providing adjudicated payment of reimbursable healthcare costs to a healthcare provider at a point of service of a patient, comprising the steps of:
receiving payment system access information at said point of service for payment for a purchase of at least one of healthcare products and services by the patient, at least part of said purchase being reimbursable by a third party payor;
transmitting a purchase transaction to an adjudication engine for processing, wherein said purchase is adjudicated substantially in real-time so as to determine a first portion of said purchase to be paid by said third party payor and a second portion of said purchase to be paid by said patient;
receiving from said adjudication engine an adjudicated settlement transaction at said point of service designating obligations for payment of at least said first portion and said second portion; and
sending an indication of said completed purchase transaction to initiate a funds transfer in accordance with said obligations for payment of said adjudicated settlement transaction.
2. The method as in claim 1 , wherein the step of sending an indication of said completed purchase transaction occurs substantially in real-time during said purchase.
3. The method as in claim 1 , wherein said payment system access information includes an account number for a credit card network and a healthcare policy between an employer of the patient and the third party payor, and said sending an indication of said completed purchase transaction step comprises the steps of formatting said adjudicated settlement transaction as a credit card transaction and processing said adjudicated settlement transaction in said credit card network.
4. The method as in claim 1 , wherein said payment system access information is provided to the healthcare provider in said providing step prior to provision of healthcare services, said method further comprising the step of:
accessing said adjudication engine to verify patient eligibility for payment for services by the third party payor prior to provision of healthcare services by the healthcare provider.
5. The method of claim 4 , further comprising the step of:
receiving a coverage profile for the patient by the healthcare provider; and comparing a preliminary diagnosis for healthcare services to be provided to the
patient to said coverage profile prior to providing healthcare services to the patient.
6. The method of claim 1 , further comprising the step of:
receiving an interactive response from said adjudication engine to facilitate said adjudication process.
7. The method of claim 6 , further comprising the step of:
receiving an indication of a discrepancy affecting payment for said purchase;
sending corrected information to facilitate the adjudication process;
wherein said corrected information is provided prior to completion of said purchase transaction.
8. The method of claim 1 , wherein said payment system access information is obtained from a payment system access card.