System And Method For Payment Of Medical Claims

Abstract

A system allows a health care provider to arrange payment at the time of service for a patient responsibility portion of a health care claim amount, even though the provider may not know what the patient responsibility portion will be until after adjudication. A health care debit card is associated with an account of the patient. At the time of service, the patient presents the card to the provider. The provider uses the card to authorize the system to hold an estimate of the patient responsibility amount in suspense in the patient's account. After adjudication, when the actual patient responsibility amount is known, a transaction set is sent to the system. The system then automatically transfers the actual patient responsibility amount from the patent's account and into the provider's bank account. Any remainder of the suspended funds is left in the patient's account. A trace number is provided so that the provider can reconcile bank statement deposits with transaction set information.

1 - 14 . (canceled) 
     
     
         15 . A health care claim adjudication computer-implemented method, comprising:
 receiving, at a payment processing center, an estimated payment amount for a health care service provided to a patient by a health care provider, the estimated payment amount corresponding to a patient payment portion payable by the patient;   receiving, at the payment processing center, account information corresponding to an account of the patient; and   suspending, by the payment processing center, the estimated payment amount at the account of the patient prior to adjudication of a claim payment for the provided health care service.   
     
     
         16 . The method of  claim 15 , further comprising:
 receiving, at the payment processing center, information associated with processing the claim payment following the adjudication, wherein the processed claim payment includes a determined payment amount corresponding to the patient payment portion;   deducting, by the payment processing center, the determined payment amount from the account of the patient based on the suspended estimated payment amount at the account of the patient; and   sending to an account of the health care provider, from the payment processing center, the determined payment amount deducted from the account of the patient.   
     
     
         17 . The method of  claim 16 , wherein a trace number is assigned to the determined payment amount that is sent to the account of the health care provider. 
     
     
         18 . The method of  claim 17 , wherein the trace number is utilized by the health care provider for identifying a transaction set, the transaction set facilitating a confirmation of a deposited amount shown on a statement corresponding to the account of the health care provider. 
     
     
         19 . The method of  claim 18 , wherein the transaction set information is accessible by the health care provider from a website server. 
     
     
         20 . The method of  claim 16 , wherein the processed claim payment comprises a first transaction set including the claim payment for the health care service provided, a health care payer claim payment, and the determined payment amount corresponding to the patient payment portion. 
     
     
         21 . The method of  claim 20 , wherein the health care payer is a medical insurance company. 
     
     
         22 . The method of  claim 15 , wherein the health care provider is a doctor's office. 
     
     
         23 . The method of  claim 20 , wherein the first transaction set is a portion of a second transaction set, the first transaction set withholding information concerning the health care service provided to the patient by the health care provider. 
     
     
         24 . The method of  claim 23 , wherein the second transaction set comprises the claim payment for the health care service provided, the health care payer claim payment, the determined payment amount corresponding to the patient payment portion, and the health care service provided to the patient by the health care provider. 
     
     
         25 . The method of  claim 16 , wherein:
 when the estimated payment amount is greater than the determined payment amount, a remainder of the estimated payment amount remains in the account of the patient, and   the determined payment amount is transferred from the account of the patient to the account of the health care provider.   
     
     
         26 . The method of  claim 15 , wherein the payment processing center is a VISA electronic payment processing center. 
     
     
         27 . A health care claim adjudication method, comprising:
 sending, from a health care provider, a claim payment to a health care payer;   sending, from the health care provider to a payment processing center, account information corresponding to an account of a patient;   sending, from the health care provider to the payment processing center, an estimated payment amount for a health care service provided to the patient by the health care provider, wherein the estimated payment amount corresponds to a patient payment portion payable by the patient; and   suspending, by the payment processing center, the estimated payment amount at the account of the patient prior to adjudication of the claim payment by the health care payer.   
     
     
         28 . The method of  claim 27 , further comprising:
 sending, from the health care payer to the payment processing center, information associated with processing the claim payment following the adjudication, wherein the processed claim payment includes a determined payment amount corresponding to the patient payment portion;   deducting, by the payment processing center, the determined payment amount from the account of the patient based on the suspended estimated payment amount at the account of the patient; and   sending to an account of the health care provider, from the payment processing center, the determined payment amount deducted from the account of the patient.   
     
     
         29 . The method of  claim 28 , further comprising:
 sending to an account of the health care provider, from the health care payer, a payer responsible payment amount, wherein the payer responsible payment amount is determined as a difference between the claim payment and the determined payment amount deducted from the account of the patient.   
     
     
         30 . The method of  claim 28 , wherein the processed claim payment comprises a first transaction set including the claim payment for the care service provided, a health care payer claim payment, and the determined payment amount corresponding to the patient payment portion. 
     
     
         31 . The method of  claim 30 , wherein the first transaction set is a portion of a second transaction set, the first transaction set withholding information concerning the health care service provided to the patient by the health care provider. 
     
     
         32 . The method of  claim 31 , wherein the second transaction set comprises the claim payment for the health care service provided, the health care payer claim payment, the determined payment amount corresponding to the patient payment portion, and the health care service provided to the patient by the health care provider. 
     
     
         33 . The method of  claim 32 , wherein the second transaction set is sent from the health care payer to the health care provider and the first transaction set is sent from the health care payer to the payment processing center. 
     
     
         34 . The method of  claim 27 , wherein the health care payer is a medical insurance company. 
     
     
         35 . The method of  claim 27 , wherein the account information corresponding to the account of the patient is generated by swiping a health care debit card of the patient at the health care provider. 
     
     
         36 . The method of  claim 27 , wherein the payment processing center is a VISA electronic payment processing center. 
     
     
         37 . A health care claim adjudication system, comprising:
 a memory; and   a processor disposed in communication with the memory and configured to issue processing instructions stored in the memory to:   receive an estimated payment amount for a health care service provided to a patient by a health care provider, the estimated payment amount corresponding to a patient payment portion payable by the patient;   receive account information corresponding to an account of the patient; and   suspend the estimated payment amount at the account of the patient prior to adjudication of a claim payment for the provided health care service.   
     
     
         38 . A processor-readable tangible medium storing processor-issuable health care claim adjudication instructions to:
 receive an estimated payment amount for a health care service provided to a patient by a health care provider, the estimated payment amount corresponding to a patient payment portion payable by the patient;   receive account information corresponding to an account of the patient; and   suspend the estimated payment amount at the account of the patient prior to adjudication of a claim payment for the provided health care service.   
     
     
         39 . A health care claim adjudication system, comprising:
 a memory; and   a processor disposed in communication with the memory and configured to issue processing instructions stored in the memory to:   send, from a health care provider, a claim payment to a health care payer;   send, from the health care provider to a payment processing center, account information corresponding to an account of a patient;   send, from the health care provider to the payment processing center, an estimated payment amount for a health care service provided to the patient by the health care provider, wherein the estimated payment amount corresponds to a patient payment portion payable by the patient; and   suspend, by the payment processing center, the estimated payment amount at the account of the patient prior to adjudication of the claim payment by the health care payer.   
     
     
         40 . A processor-readable tangible medium storing processor-issuable health care claim adjudication instructions to:
 send, from a health care provider, a claim payment to a health care payer;   send, from the health care provider to a payment processing center, account information corresponding to an account of a patient;   send, from the health care provider to the payment processing center, an estimated payment amount for a health care service provided to the patient by the health care provider, wherein the estimated payment amount corresponds to a patient payment portion payable by the patient; and   suspend, by the payment processing center, the estimated payment amount at the account of the patient prior to adjudication of the claim payment by the health care payer.