Healthcare point of service adjudication and payment system

Abstract

Systems and methods are described that facilitate providing an online, automated payment architecture that aggregates funds from multiple health-related accounts (e.g., a member's HSA, an employer's advance account, etc.) and automatically transfers the aggregated funds to a healthcare provider's account to pay a bill or invoice. According to other aspects, healthcare fraud is prevented by storing electronic images of members and their dependents, wherein the images can be recalled by a healthcare provider at the point of service to verify that the member or dependent is actually a covered member. In other aspects, the described systems and methods permit members to negotiate reduced invoice payments in exchange for prompt delivery of payment funds.

1 . A system that facilitates online healthcare fund aggregation for payment of healthcare provider invoices, comprising:
 a processor that executes computer-executable instructions for aggregating funds from multiple healthcare-related accounts for payment to a healthcare provider;   a memory that stores the computer-executable instructions; and   a server comprising the processor and the memory and providing Internet access to the processor for fund aggregation and healthcare invoice payment;   wherein the instructions comprise:
 receiving an electronic invoice from a healthcare provider; 
 accessing a member account belonging to a member of a healthcare plan; 
 withdrawing funds to pay the invoice amount from the member account, if funds are available in the member account; 
 accessing an employer account maintained by an employer providing the healthcare plan to the member; 
 withdrawing additional funds from the employer account to satisfy the invoice amount when the member account does not have sufficient funds to satisfy the invoice amount; 
 aggregating the funds from the member account and the additional funds from the employer account in an aggregating account (AA); and 
 transferring the aggregated funds from the aggregating account to a healthcare provider account to pay the invoice amount. 
   
     
     
         2 . The system of  claim 1 , wherein:
 the member account comprises at least one of a health savings account (HSA) belonging to a member of a healthcare plan and a health reimbursement account (HRA) maintained by the employer of the member; and   the employer account comprises at least one of an employer advance account (EAA), an employer bank account (EBA), and an employer line of credit.   
     
     
         3 . The system of  claim 2 , wherein the instructions further comprise assigning a unique identification number (UIDN) to each withdrawal and transfer of funds. 
     
     
         4 . The system of  claim 3 , wherein the instructions further comprise using the UIDNs to track deposits into the member HSA, and, when funds subsequently are deposited into the HSA, transferring funds from the HSA to the EAA until the additional funds withdrawn respectively therefrom to satisfy the invoice amount are repaid. 
     
     
         5 . The system of  claim 1 , further comprising photographic data for each member of the healthcare plan, stored in the memory and retrievable at a point of service for verifying member identity. 
     
     
         6 . The system of  claim 1 , the instructions further comprising offering the healthcare provider a predetermined percentage of the invoice amount in return for the healthcare provider accepting the predetermined percentage within a predetermined time period. 
     
     
         7 . The system of  claim 6 , wherein the predetermined percentage increases as a function of time, and wherein the healthcare provider is offered a lower percentage in exchange for prompt payment from the aggregating account and a higher percentage in exchange for delayed payment from the aggregating account. 
     
     
         8 . The system of  claim 1 , the instructions further comprising receiving a member personal identification number (PIN) at a point of service, wherein the member PIN identifies the member as being covered by the healthcare plan, and receiving a healthcare provider PIN at the time of invoice generation by which the healthcare provider verifies that the invoice is accurate. 
     
     
         9 . The system of  claim 1 , the instructions further comprising triggering a review of the invoice upon a determination that one or more items listed therein are inconsistent with a predetermined set of approved items consistent with a diagnosis listed in the invoice. 
     
     
         10 . The system of  claim 9 , wherein the healthcare provider is permitted to append to the invoice documentation in support of the items listed in the invoice. 
     
     
         11 . A computer-executable method of online healthcare fund aggregation for payment of healthcare provider invoices, comprising:
 receiving an electronic invoice from a healthcare provider;   accessing a member account comprising at least one of a health savings account (HSA) belonging to a member of a healthcare plan and a health reimbursement account (HRA) maintained by the employer of the member;   withdrawing funds to pay the invoice amount from the member account, if funds are available in the member account;   accessing an employer account comprising at least one of an employer advance account (EAA), an employer bank account (EBA), and an employer line of credit maintained by an employer providing the healthcare plan to the member;   withdrawing additional funds from the employer account to satisfy the invoice amount when the member account does not have sufficient funds to satisfy the invoice amount or when the employer plan is required to pay the invoice;   aggregating the funds from the member account and the additional from the employer account in an aggregating account (AA); and   transferring the aggregated funds from the aggregating account to a healthcare provider account to pay the invoice amount.   
     
     
         12 . The method of  claim 11 , wherein:
 the member account comprises at least one of a health savings account (HSA) belonging to a member of a healthcare plan and a health reimbursement account (HRA) maintained by the employer of the member; and   the employer account comprises at least one of an employer advance account (EAA), an employer bank account (EBA), and an employer line of credit.   
     
     
         13 . The method of  claim 12 , further comprising assigning a unique identification number (UIDN) to each withdrawal and each transfer of funds. 
     
     
         14 . The method of  claim 13 , further comprising using the UIDNs to track deposits into the member HSA, and, when funds subsequently are available in the HSA, transferring funds from the HSA to the EAA until the additional funds withdrawn therefrom to satisfy the invoice amount are repaid to the EAA. 
     
     
         15 . The method of  claim 11 , further comprising storing photographic data for each member of the healthcare plan, and electronically retrieving a digital photograph of the member at the point of service in order to verify member identity. 
     
     
         16 . The method of  claim 11 , further comprising offering the healthcare provider a predetermined percentage of the invoice amount in return for the healthcare provider accepting the predetermined percentage within a predetermined time period. 
     
     
         17 . The method of  claim 16 , wherein the predetermined percentage increases as a function of time, and wherein the healthcare provider is offered a lower percentage in exchange for prompt payment from the aggregating account and a higher percentage in exchange for delayed payment from the aggregating account. 
     
     
         18 . The method of  claim 11 , further comprising receiving a member personal identification number (PIN) at a point of service, wherein the member PIN identifies the member as being covered by the healthcare plan, and receiving a healthcare provider PIN at the time of invoice generation by which the healthcare provider verifies that the invoice is accurate. 
     
     
         19 . The method of  claim 11 , further comprising triggering a review of the invoice upon a determination that one or more items listed therein are inconsistent with a predetermined set of approved items consistent with a diagnosis listed in the invoice. 
     
     
         20 . The method of  claim 19 , further comprising permitting the healthcare provider to append to the invoice documentation in support of the items listed in the invoice.