System and method for managing payments for health care services
The health care payment techniques include a system, and/or a machine-readable storage media. In some embodiments of these techniques, the system includes a processor that executes instructions. The system further includes machine-readable storage media having the instructions stored therein, the instructions when executed by the computer system causing the computer system to implement a health care claim payment method. The method includes receiving a plurality of claims for a plurality of health care services provided by a plurality of health care service providers to a patient. The method further includes remitting payment for each claim in the plurality of claims in a single payment. The remitting step is performed before the participant has acknowledged the participant's obligation to pay for the health care service. The method further includes combining the claim from the health care provider and a plurality of additional health care providers into a master bill. The method further includes sending the master bill to the participant. This Abstract is provided for the sole purpose of complying with the Abstract requirement rules. This Abstract is submitted with the explicit understanding that it will not be used to interpret or to limit the scope or the meaning of the claims.
1. A computer-implemented method, the method comprising:
receiving a plurality of claims for a plurality of health care services provided by a 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 instructions stored in the machine-readable storage media, for each claim in the plurality of claims, payment of the entire claim in a single payment, including (i) remitting the portion of the claim payable by the third party payor, and (ii) remitting the portion of the claim payable by the participant, wherein the remitting step is initiated and performed by a payment services manager, the remitting step being performed before the participant has acknowledged the participant's obligation to pay for the health care service; and
combining the claim from the health care provider and a plurality of additional health care providers into a master bill, and sending the master bill to the participant.
2. The method of claim 1 , further comprising tracking receipt of payment from the participant for the participant's portion of the plurality of claims.
3. The method of claim 1 , wherein the sending step is performed by the payment services manager.
4. The method of claim 1 , wherein the participant is the patient on whom the health care service is performed.
5. The method of claim 1 , wherein the patient on whom the health care service is performed is a family member of the participant or other person covered by the participant's benefits plan.
6. The method of claim 1 , wherein remitting payment further includes (iii) accepting risk of delinquency and/or non-payment by the participant.
7. The method of claim 1 , wherein the third party payor is an employer of the participant.
8. The method of claim 1 , wherein the third party payor is an insurer associated with the benefits plan.
9. The method of claim 1 , wherein the payment services manager and the third party payor are different entities.
10. The method of claim 1 , wherein the payment services manager and the third party payor are the same entity.
11. The method of claim 10 , wherein the third party payor is an insurer associated with the benefits plan.
12. Machine-readable storage media having stored therein instructions that when executed cause a computer system to implement a method for managing health care claims for health care services received by a patient from a health care service provider, the method comprising:
establishing a predetermined amount of funds for payment of at least one claim, the claim having a participant portion and a third party payor portion;
receiving notification of the claim;
in response to the receiving step, transferring funds, in a single payment, through a disbursement system to the health care service provider in payment of the participant portion of the claim and the third party payor portion, the transferring of funds step being performed before the participant has acknowledged the participant's obligation to pay for the health care service;
combining, by a payment services system logic implemented by the instructions stored in the machine-readable storage media, claim information from the health care provider and a plurality of additional health care providers into a master bill to be sent to a participant enrolled in a benefits plan, the master bill containing claim information for the health care provider and the plurality of additional health care providers;
itemizing, by the payment services system logic, claim information for each of the health care services provided to the patient by the health care provider and the plurality of additional health care providers; and
tracking, by the payment services system logic, payment of the master bill by the participant.
13. The machine-readable storage media of claim 12 , wherein the funds are equal to the sum of the third party payor portion and the participant portion of the claim.
14. The machine-readable storage media of claim 13 , wherein the instructions when executed cause the computer system to:
issue a report periodically accounting for funds received and distributed to the third party payor.
15. The machine-readable storage media of claim 12 , wherein the instructions when executed cause the computer system to:
produce an electronic transaction with an expected amount for monitoring funds, wherein the producing occurs periodically.
16. The machine-readable storage media of claim 12 , wherein the instructions when executed cause the computer system to:
issue a report on any delinquency.
17. A computer system comprising:
a processor that executes instructions; and
machine-readable storage media having the instructions stored therein, the instructions when executed by the computer system causing the computer system to implement a health care claim payment method comprising
receiving a plurality of claims for a plurality of health care services provided by a 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; and
remitting payment, by a payment services system logic implemented by the instructions stored in the machine-readable storage media, for each claim in the plurality of claims, payment of the entire claim in a single payment, including (i) remitting the portion of the claim payable by the third party payor, and (ii) remitting the portion of the claim payable by the participant, wherein the remitting step is initiated and performed by a payment services manager, the remitting step being performed before the participant has acknowledged the participant's obligation to pay for the health care service.
18. The computer system of claim 17 , wherein the participant is the patient on whom the health care service is performed.
19. The computer system of claim 17 , wherein the patient on whom the health care service is performed is a family member of the participant.
20. The computer system of claim 17 , wherein the third party payor is an employer of the participant.
21. The computer system of claim 17 , wherein the third party payor is an insurer or other associated party associated with the benefits plan.