Process for linked healthcare and financial transaction initiation
Methods and systems for acquiring a pre-approval from a responsible party and receiving funds from a financial account related to the pre-approval in the healthcare field are described herein. A method for collecting payment from an individual for services rendered by a provider is disclosed. The method includes verifying an individual's eligibility for benefits, estimating an individual responsibility amount, acquiring authority from the individual for up to the individual responsibility amount on at least one financial account held by the individual, submitting one or more claims to one or more payer entities requesting compensation for the services rendered by the provider, deducting an amount from the at least one financial account held by the individual, and transferring the deducted amount to the provider.
1. A system for collecting payment from an individual for services rendered by a provider, the system comprising:
a processor; and
a non-transitory, computer-readable storage medium in operable communication with the processor, wherein the storage medium comprises one or more programming instructions, that, when executed, cause the processor to:
acquire eligibility and benefit information from at least one of a payer entity, a financial entity, and a healthcare provider fee schedule, wherein the eligibility and benefit information comprises:
an amount the provider is allowed to charge for the services rendered,
an amount the payer entity will compensate the provider for the services rendered, and
an amount owed by the individual, wherein the amount owed is a difference between the amount the provider is allowed to charge and the amount the payer entity will compensate the provider, a co-pay, or a combination thereof;
determine an estimated amount for which the individual is responsible after the services are rendered by the provider using the acquired eligibility and benefit information;
provide the estimated amount to the individual;
transmit one or more claims for adjudication to one or more third party payer entities requesting compensation for the services rendered by the provider;
automatically determine, without a user input, an amount to be deducted from at least one financial account held by the individual based on an amount not paid by the one or more third party payer entities;
automatically deduct, without a user input, the determined amount from the at least one financial account held by the individual; and
automatically transfer, without a user input, the deducted amount to the provider.
2. The system of claim 1 , wherein the storage medium further comprises one or more programming instructions, that, when executed, cause the processor to route, by a network, information pertaining to a financial transaction or the one or more claims to one or more financial entities housing the at least one financial account held by the individual or one or more payer entities.
3. The system of claim 2 , wherein the storage medium further comprises one or more programming instructions, that, when executed, cause the processor to process, prior to routing, the information in accordance with a Standard Financial Network Authorization Process.
4. The system of claim 1 , wherein the storage medium further comprises one or more programming instructions, that, when executed, cause the processor to route, by a service provider, information pertaining to a financial transaction or claim to one or more of the following: a financial entity and a payer entity.
5. The system of claim 1 , wherein the storage medium further comprises one or more programming instructions, that, when executed, cause the processor to route, by the service provider, the information to a network, wherein the information is routed to one or more of the following: a financial entity and a payer entity.
6. The system of claim 1 , wherein the provider is a healthcare service provider.
7. The system of claim 1 , wherein the financial entity is selected from a financial institution, a bank, a credit card company, a loan company, and combinations thereof.
8. The system of claim 1 , wherein the financial account is selected from a savings account, a checking account, a credit account, a debit account, a credit card account, a debit card account, a health savings account, and combinations thereof.
9. The system of claim 1 , wherein the third party payer entity is selected from a healthcare payer entity, an insurance company, a health savings account, and combinations thereof.
10. A system for collecting payment from an individual for services rendered by a provider, the system comprising:
a processor; and
a non-transitory, computer-readable storage medium in operable communication with the processor, wherein the storage medium comprises one or more programming instructions, that, when executed, cause the processor to:
acquire eligibility and benefit information from one or more of a payer entity, a financial entity, and a healthcare provider fee schedule, wherein the eligibility and benefit information comprises:
an amount the provider is allowed to charge for the services rendered,
an amount the payer entity will compensate the provider for the services rendered, and
an amount owed by the individual, wherein the amount owed is a difference between the amount the provider is allowed to charge and the amount the payer entity will compensate the provider, a co-pay, or a combination thereof;
estimate a defined amount of compensation the individual will owe after the payer entity has provided compensation after the services are rendered by the provider using the acquired eligibility and benefit information;
transmit a claim for adjudication to the one or more payer entities requesting compensation for the services rendered by the provider;
automatically determine, without a user input, an amount to be deducted from at least one financial account held by the individual based on an amount not paid by the one or more payer entities;
automatically deduct, without a user input, the determined amount from the at least one financial account held by the individual wherein the amount deducted is not more than the defined amount; and
automatically transfer, without a user input, the deducted amount to the provider.
11. The system of claim 10 , wherein the storage medium further contains one or more programming instructions, that, when executed, cause the processor to determine a co-pay amount due at a point of service.
12. The system of claim 10 , wherein the provider is a healthcare service provider.
13. The system of claim 10 , wherein the financial entity is selected from a financial institution, a bank, a credit card company, a loan company, and combinations thereof.
14. The system of claim 10 , wherein the financial account is selected from a savings account, a checking account, a credit account, a debit account, a credit card account, a debit card account, a health savings account, and combinations thereof.
15. The system of claim 10 , wherein the payer entity is selected from a healthcare payer entity, an insurance company, a health savings account, and combinations thereof.
16. The system of claim 4 , wherein the storage medium further comprises one or more programming instructions, that, when executed, cause the processor to process the information prior to routing by the service provider.
17. A method of facilitating payment to a provider from an individual comprising:
acquiring, by a processor, eligibility and benefit information from at least one of a payer entity, a financial entity, and a healthcare provider fee schedule, wherein the eligibility and benefit information comprises:
an amount the provider is allowed to charge for the services rendered,
an amount the payer entity will compensate the provider for the services rendered, and
an amount owed by the individual, wherein the amount owed is a difference between the amount the provider is allowed to charge and the amount the payer entity will compensate the provider, a co-pay, or a combination thereof;
determining, by the processor, an estimated amount for which the individual will be responsible after services are rendered by the provider using the acquired eligibility and benefit information;
providing, by the processor, the estimated amount to the individual;
transmitting, by the processor, one or more claims for adjudication to one or more payer entities requesting compensation;
automatically determining, by the processor without a user input, an amount to be deducted from the at least one financial account held by the individual based on an amount not paid by the one or more payer entities;
automatically deducting, by the processor without a user input, the determined amount from the at least one financial account held by the individual; and
automatically transferring, by the processor without a user input, the deducted amount to the provider.
18. The system of claim 1 , wherein the third party payer entity is at least one of a commercial healthcare plan provider, a government healthcare provider, and an employer.
19. The system of claim 1 , wherein the provider is a hospital, a doctor, a chiropractor, a radiologist, or a pharmacy.
20. The system of claim 1 , wherein the eligibility and benefit information further comprises at least one of a plan identification number, an insurance company contact information, an electronic link to the insurance company, insurance eligibility information, insurance eligibility status, a policy limit, a to-date co-pay, a deductible, a co-insurance percentage, an annual out of pocket maximum, and a lifetime out of pocket maximum.
21. The system of claim 2 , wherein the network is a healthcare transaction network.