U.S. patent application number 14/304145 was filed with the patent office on 2014-10-02 for method and system using combined healthcare payment device and web portal for receiving patient medical information.
The applicant listed for this patent is VISA U.S.A. INC.. Invention is credited to Nigel Smith.
Application Number | 20140297332 14/304145 |
Document ID | / |
Family ID | 38791430 |
Filed Date | 2014-10-02 |
United States Patent
Application |
20140297332 |
Kind Code |
A1 |
Smith; Nigel |
October 2, 2014 |
METHOD AND SYSTEM USING COMBINED HEALTHCARE PAYMENT DEVICE AND WEB
PORTAL FOR RECEIVING PATIENT MEDICAL INFORMATION
Abstract
Embodiments of systems and methods in accordance with the
present invention relate to a centralized portal for making
healthcare information of a patient accessible to a plurality of
entities, including but not limited to the patient himself/herself,
healthcare providers authorized by the patient, and healthcare
payers (insurance carriers) authorized by the patient. In one
embodiment, the portal comprises a website associated with a
portable consumer device (such as a HSA magnetic stripe
credit/debit card) of the patient, and hosted on a server
accessible over the world wide web or another computer network. The
patient sets a privacy level associated with his or her medical
record on the host site, the privacy level granting certain
entities (for example healthcare providers or insurance carriers)
access to particular medical records of the patient. Upon
presenting the portable consumer device to an authorized healthcare
provider, medical information previously transmitted through a
payment processing network may be received at the authorized
healthcare provider.
Inventors: |
Smith; Nigel; (Foster City,
CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
VISA U.S.A. INC. |
San Francisco |
CA |
US |
|
|
Family ID: |
38791430 |
Appl. No.: |
14/304145 |
Filed: |
June 13, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11796185 |
Apr 27, 2007 |
8788284 |
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14304145 |
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60809857 |
May 30, 2006 |
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Current U.S.
Class: |
705/3 |
Current CPC
Class: |
G16H 10/60 20180101;
G06Q 10/10 20130101; G06Q 40/02 20130101; G06Q 20/102 20130101;
G06Q 40/08 20130101 |
Class at
Publication: |
705/3 |
International
Class: |
G06F 19/00 20060101
G06F019/00 |
Claims
1. A method comprising: receiving, by a computational apparatus, a
medical service eligibility inquiry message from a first healthcare
provider via a payment processing network, the medical service
eligibility inquiry message indicating a medical record information
access request, the payment processing network being configured to
communicate and process transactions using financial transaction
credit card account originated communication message protocols
having a financial interchange specification; retrieving, by the
computational apparatus, a privacy level associated with a
patient's medical record, wherein the privacy level is designated
to a first healthcare provider via a user interface of a host site;
and granting, by the computational apparatus, the first healthcare
provider access to the patient's medical record, based on the
privacy level, wherein the first healthcare provider has a
different level of access to the patient's medical record than a
second healthcare provider.
2. The method of claim 1, further comprising processing the privacy
level to allow the first healthcare provider to access at least one
of patient eligibility information, patient co-payment information,
patient deductible information, and patient balance owed
post-adjudication.
3. The method of claim 1, further comprising processing the privacy
level to prevent the first healthcare provider from accessing
patient medical information on a medical treatment unrelated to an
area of practice of the first healthcare provider.
4. The method of claim 1, further comprising processing the privacy
level to prevent the first healthcare provider from accessing
patient medical information not pertinent to a specific procedure
performed or to be performed by the first healthcare provider.
5. The method of claim 1, further comprising setting a second
privacy level governing access of a healthcare insurance carrier to
the patient's medical record.
6. The method of claim 1, wherein the medical service eligibility
inquiry message complies with Health Insurance Portability and
Accountability Act (HIPAA) 270.
7. The method of claim 1, further comprising: receiving patient
feedback relating to treatment provided by the first healthcare
provider; and incorporating the feedback into a rating associated
with the first healthcare provider.
8. An apparatus comprising: a processor; and a computer readable
storage medium storing instructions that, when executed by the
processor, cause the apparatus at least to perform: receiving a
medical service eligibility inquiry message from a first healthcare
provider via a payment processing network, the medical service
eligibility inquiry message indicating a medical record information
access request, the payment processing network being configured to
communicate and process transactions using financial transaction
credit card account originated communication message protocols
having a financial interchange specification; retrieving a privacy
level associated with a patient's medical record, wherein the
privacy level is designated to a first healthcare provider via a
user interface of a host site; and granting the first healthcare
provider access to the patient's medical record, based on the
privacy level, wherein the first healthcare provider has a
different level of access to the patient's medical record than a
second healthcare provider.
9. The apparatus of claim 8, wherein the instructions, when
executed, further cause the apparatus to process the privacy level
to allow the first healthcare provider to access at least one of
patient eligibility information, patient co-payment information,
patient deductible information, and patient balance owed
post-adjudication.
10. The apparatus of claim 8, wherein the instructions, when
executed, further cause the apparatus to process the privacy level
to prevent the first healthcare provider from accessing patient
medical information on a medical treatment unrelated to an area of
practice of the first healthcare provider.
11. The apparatus of claim 8, wherein the instructions, when
executed, further cause the apparatus to process the privacy level
to prevent the first healthcare provider from accessing patient
medical information not pertinent to a specific procedure performed
or to be performed by the first healthcare provider.
12. The apparatus of claim 8, wherein the instructions, when
executed, further cause the apparatus to set a second privacy level
governing access of a healthcare insurance carrier to the patient's
medical record.
13. The apparatus of claim 8, wherein the medical service
eligibility inquiry message complies with Health Insurance
Portability and Accountability Act (HIPAA) 270.
14. The apparatus of claim 8, wherein the instructions, when
executed, further cause the apparatus to perform: receiving patient
feedback relating to treatment provided by the first healthcare
provider; and incorporating the feedback into a rating associated
with the first healthcare provider.
15. A non-transitory computer readable medium storing
computer-executable instructions that, when executed, cause an
apparatus at least to perform: receiving a medical service
eligibility inquiry message from a first healthcare provider via a
payment processing network, the medical service eligibility inquiry
message indicating a medical record information access request, the
payment processing network being configured to communicate and
process transactions using financial transaction credit card
account originated communication message protocols having a
financial interchange specification; retrieving a privacy level
associated with a patient's medical record, wherein the privacy
level is designated to a first healthcare provider via a user
interface of a host site; and granting the first healthcare
provider access to the patient's medical record, based on the
privacy level, wherein the first healthcare provider has a
different level of access to the patient's medical record than a
second healthcare provider.
16. The computer readable medium of claim 15, wherein the
instructions, when executed, further cause the apparatus to process
the privacy level to allow the first healthcare provider to access
at least one of patient eligibility information, patient co-payment
information, patient deductible information, and patient balance
owed post-adjudication.
17. The computer readable medium of claim 15, wherein the
instructions, when executed, further cause the apparatus to process
the privacy level to prevent the first healthcare provider from
accessing at least one of: patient medical information on a medical
treatment unrelated to an area of practice of the first healthcare
provider, and patient medical information not pertinent to a
specific procedure performed or to be performed by the first
healthcare provider.
18. The computer readable medium of claim 15, wherein the
instructions, when executed, further cause the apparatus to set a
second privacy level governing access of a healthcare insurance
carrier to the patient's medical record.
19. The computer readable medium of claim 15, wherein the medical
service eligibility inquiry message complies with Health Insurance
Portability and Accountability Act (HIPAA) 270.
20. The computer readable medium of claim 15, wherein the
instructions, when executed, further cause the apparatus to
perform: receiving patient feedback relating to treatment provided
by the first healthcare provider; and incorporating the feedback
into a rating associated with the first healthcare provider.
Description
CROSS-REFERENCES TO RELATED APPLICATIONS
[0001] The instant nonprovisional patent application is a
Continuation of U.S. Utility application Ser. No. 11/796,185, filed
on Apr. 27, 2007 entitled "Method and System Using Combined
Healthcare Payment Device and Web Portal for Receiving Patient
Medical Information", which claims priority to U.S. Provisional
Patent Application No. 60/809,857, filed May 30, 2006 entitled
"Method and System Using Combined Healthcare Payment Device and Web
Portal for Receiving Patient Medical Information." The content of
each of which is incorporated herein by reference in its entirety
for all purposes.
BACKGROUND
[0002] A recent trend in healthcare insurance is the emergence of
high deductible healthcare plans. Specifically, as employers try to
control year-over-year increases in providing their employees with
a health insurance benefit, many small and medium-size companies
are turning to health plans with higher deductible amounts.
Deductibles of $1,000 for individual coverage and $2,000 for family
coverage are typical of high deductible plans.
[0003] To fill the deductible gap, some employers will fund a
portion of the deductible amount through a Health Reimbursement
Arrangement (HRA) or Health Savings Account (HSA). With HSAs,
employees can also contribute funds up to the amount of their
deductible (if the plan meets IRS requirements for a high
deductible plan). Another source for the payment of high healthcare
coverage deductibles, are Flexible Spending Accounts (FSA) which
allow the allocation of pre-tax dollars toward healthcare
expenses.
[0004] In view of growing responsibility of the individual patient
in monitoring and paying for health care expenses, methods and
systems promoting ease of electronic access to the healthcare
records are desirable, as are systems conferring the ability of the
individual to easily and rapidly control the parties having access
to those healthcare records.
[0005] Another recent development in the healthcare field is the
implementation of the Health Insurance Portability and
Accountability Act (HIPAA). Enacted by Congress in 1996, Title I of
HIPAA sets forth a number of requirements addressing the security
and privacy of healthcare data communicated between different
covered entities, for example a healthcare provider and a
healthcare insurance company.
[0006] In addition, Title II of HIPAA dictates the adoption of
standardized electronic data interchange (EDI) message formats to
exchange information, and the utilization of electronic forms of
payment. For example, a HIPAA message type 270 ("HIPAA 270")
describes a format for an electronic benefit inquiry message sent
from a healthcare provider to an healthcare insurance carrier. In
turn, a HIPAA message type 271 ("HIPAA 271") describes a format for
a response to the benefit inquiry message, that is returned to the
healthcare provider by the health insurance carrier. Examples of
other HIPAA sections describing particular electronic message
formats include a HIPAA message type 837 ("HIPAA 837") which is a
healthcare claim message to insurer, and a HIPAA message type 835
("HIPAA 835") which is an electronic remittance from insurer to
healthcare provider. HIPAA adopts some portions of the above
message formats from standards set by the American National
Standards Institute (ANSI) Accredited Standards Committee (ASC).
Accordingly, the HIPAA message types may refer to various portions
of the ANSI standards. For example, HIPAA 271 may refer to some
portion of ANSI X2N 271, HIPAA 835 may refer to some portion of
ANSI X12N 835, and HIPAA 837 may refer to some portion of ANSI X12N
837.
[0007] In view of the above, banks, healthcare companies, and third
party processing providers have an incentive to bring to the
healthcare marketplace the degrees of reliability,
interoperability, security, and automation that exists in banking
and the traditional payments arena.
SUMMARY
[0008] Embodiments of systems and methods in accordance with the
present invention relate to a centralized portal making healthcare
information of a patient accessible to a various entities,
including but not limited to the patient himself/herself,
healthcare providers authorized by the patient, and healthcare
payers (insurance carriers) authorized by the patient. In one
embodiment, the portal includes a website associated with a
portable consumer device (such as a HSA magnetic stripe
debit/credit card) of the patient, and hosted on a server
accessible over the world wide web or another computer network. The
patient sets a privacy level associated with his or her medical
record on the host site, the privacy level granting certain
entities (for example healthcare providers or insurance carriers)
access to the medical record of the patient. Upon presenting the
portable consumer device to an authorized healthcare provider,
medical information previously transmitted through an electronic
payment processing network may be received at the authorized
healthcare provider.
[0009] An embodiment of a method in accordance with the present
invention comprises setting a privacy level associated with a
patient's medical record on a host site, wherein the host site is
associated with a portable consumer device, and wherein the privacy
level provides certain entities, including healthcare providers
with the ability to access the patient's medical record. The
portable consumer device is presented to a healthcare provider who
has access to the medical record, medical information is received
at the provider, wherein the medical information is transmitted
through a payment processing network.
[0010] An embodiment of an apparatus in accordance with the present
invention, comprises, a host computer including a processor in
electronic communication with a computer readable storage medium.
The computer readable storage medium having code stored thereon to
direct the processor to, set a privacy level associated with a
patient's medical record on a host site, wherein the host site is
associated with a portable consumer device, and wherein the privacy
level provides certain healthcare providers with the ability to
access the patient's medical record, and to send information
pertaining to the patient's medical record to a healthcare provider
who has access to the medical record, after the patient
presents
[0011] An embodiment of a computer readable medium in accordance
with the present invention, comprises, code for setting a privacy
level associated with a patient's medical record on a host site,
wherein the host site is associated with a portable consumer
device, and wherein the privacy level provides certain healthcare
providers with the ability to access the patient's medical record;
and code for sending information pertaining to the patient's
medical record to a healthcare provider who has access to the
medical record, after the patient presents the portable consumer
device to a healthcare provider.
[0012] An embodiment of a method for management of healthcare
information in accordance with the present invention, comprises the
steps of establishing a plurality of access authorization levels
based on the type of healthcare information needed for a patient by
a healthcare provider, authorizing access to the healthcare
information with a portable device, wherein the patient provides
the healthcare provider with access to the healthcare information
using the portable device and wherein the level of access is based
on the established access authorization levels, and providing
payment for the service using the portable device.
[0013] These and other embodiments of the invention are described
in further detail below.
BRIEF DESCRIPTION OF THE DRAWINGS
[0014] FIG. 1 shows a simplified schematic diagram illustrating
interactions between various entities in accordance with the
teachings of the present invention.
[0015] FIG. 1A shows a simplified flow diagram of various steps
illustrated in FIG. 1.
[0016] FIG. 1B is a simplified schematic diagram shown exemplary
screen shots for different privacy settings.
[0017] FIG. 2 shows a simplified schematic diagram of an example of
a processing flow for eligibility requests in accordance with the
teachings of the present invention.
[0018] FIG. 3 shows a simplified schematic diagram of an example of
a processing flow for payment of claims in accordance with the
teachings of the present invention.
[0019] FIG. 4 is a schematic illustration of a computer system for
in accordance with the teachings of the present invention.
[0020] FIG. 4A is an illustration of basic subsystems the computer
system of FIG. 4.
DETAILED DESCRIPTION
[0021] Embodiments of systems and methods in accordance with the
present invention relate to a centralized portal for making
healthcare information of a patient accessible to a plurality of
entities, including but not limited to the patient himself/herself,
healthcare providers authorized by the patient, healthcare payers
(insurance carriers) authorized by the patient, and other entities
authorized by the patient. In one embodiment, the portal comprises
a website (an example of a host site) associated with a portable
consumer device (such as a HSA magnetic stripe debit/credit card)
of the patient, and hosted on a server accessible over the world
wide web or another computer network. The patient sets a privacy
level associated with his or her medical record on the host site,
the privacy level granting certain entities (for example healthcare
providers or insurance carriers) access to the medical record of
the patient. Upon presenting the portable consumer device to an
authorized healthcare provider, medical information previously
transmitted through a payment processing network may be received at
the authorized healthcare provider.
[0022] FIG. 1 shows a simplified schematic diagram illustrating the
interaction between different entities in accordance with an
embodiment of the present invention. FIG. 1A shows a simplified
diagram illustrating flows of information between the entities
shown in FIG. 1. Embodiments of the invention may take place in the
order shown in FIG. 1A, or may take place in any other suitable
order.
[0023] Steps 102-108 of flow 100 take place before healthcare
services have been rendered to a patient by a healthcare provider.
In step 102, before seeking service from a healthcare provider 150
and 151, a patient 152 receives a portable consumer device 153 and
authenticates it.
[0024] In accordance with one particular embodiment, the portable
consumer device 153 is a magnetic stripe credit, debit, prepaid, or
stored value card. In accordance with alternative embodiments,
however, the portable consumer device 153 may take other forms. For
example, the portable consumer devices can be hand-held and compact
so that they can fit into a consumer's wallet and/or pocket (e.g.,
pocket-sized). The portable consumer devices may include smart
cards (with a microprocessor), a keychain device, etc. Other
examples of portable consumer devices include cellular phones,
personal digital assistants (PDAs), pagers, payment cards, security
cards, access cards, smart media, transponders, and the like. The
portable consumer devices 153 can also be debit devices (e.g., a
debit card), credit devices (e.g., a credit card), or stored value
devices (e.g., a stored value card). In some embodiments, the
portable consumer devices 153 may be re-writeable so that values
associated with the portable consumer devices 153 are stored on
them. In other embodiments, the values associated with the portable
consumer devices may be stored at a server operated by or at an
issuer. An "issuer" is typically a financial institution, such as a
bank, that issues the portable consumer device to the patient. In
some embodiments, the portable consumer devices may function as
payment devices that can be used to access both payment accounts
(e.g., credit card accounts) and healthcare spending accounts
(e.g., flexible spending accounts or health savings accounts).
[0025] In step 104, patient 152 uses a personal computer or client
computer 155 and logs on to a secure website 154 hosted at a server
161 and sets privacy settings for his or her account. The existence
of the account on the secure website 154 grants one or more
healthcare providers, such as providers 150 and 151, with the
ability to access the patient's medical records. The patient can
control the privacy settings that are established, such that
various levels of information may be accessed by other
entities.
[0026] For example, FIG. 1B is a simplified schematic diagram shown
exemplary screen shots for different privacy settings. One privacy
setting may confer an outside entity unrestricted access to
information on the website (e.g. primary care physician or hospital
emergency room). A different privacy setting may confer an outside
entity only with a listing of prior medications and treatments
related to the specialist being see, but may exclude access to
non-directly relevant medical information (e.g., dermatologist).
Still another privacy setting may confer an outside entity only
with a listing of prescribed medications and treatments, but may
exclude access to all other medical information (e.g., pharmacist
view).
[0027] The server 161 may be embodied by one or more computational
apparatuses, which can service the requests of one or more client
computers. Typically, the server 161 is a powerful computer or
cluster of computers that behave as a single computer. For example,
the server 161 can be a mainframe computer, a minicomputer, or a
minicomputer cluster. In another example, the server 161 may
include one or more database servers and one or more Web servers.
The server 161 may service the requests of one or more client
computers.
[0028] After the patient 152 uses a client computer or personal
computer 155 and sets his or her privacy settings on the website
154, the server 161 may send notification messages to the providers
150 and/or 151 indicating that they are able to access the
patient's medical information.
[0029] At some point in time, in step 106 patient 152 feels ill and
logs onto the secure website 154 in order to research his or her
symptoms. Uncertain of the exact diagnosis, in step 108 patient 152
calls a medical hotline at the healthcare information provider 155
for guidance. In response, a list of consumer rated (such as
five-star) healthcare providers in user's geographic area is
generated and shared with the patient to allow the patient to
further explore and/or attend for treatment of symptoms. If the
patient has not already set privacy settings, the patient may
thereafter set privacy settings thereby allowing specific providers
with the ability to access their medical information. Prompts such
as popup windows, drop down menus, etc. may be used to prompt the
patient to provide desired privacy settings.
[0030] Steps 110-116 of process flow 100 take place at the point of
care, prior to treatment. In step 110, the patient 152 goes to a
particular provider, such as provider 150, which may be a doctor,
to seek treatment. Other examples of providers include hospitals,
dentists, eye care specialists, etc. The provider 150 is a
healthcare provider to whom the patient 152 has previously granted
access to his or her medical records on the secure website 154.
[0031] In step 112, the patient 152 presents his portable consumer
device 153 to the provider 150 upon arrival at the doctor's office.
If the portable consumer device 153 is a payment card, such as a
magnetic stripe credit card or combined payment-healthcare spending
account card, then the portable consumer device 153 is swiped at a
computer terminal (not shown) at the office of the provider 150,
and information therefrom is communicated across an payment
processing network 166 to a payer 170. Within a short time (e.g.,
less than 30 seconds), in step 114 an eligibility response,
co-payment confirmation, and basic medical record may be
communicated to the provider 150 over the payment processing
network 166, which may be a closed system inaccessible to the
general public. An exemplary payment processing network may be
VisaNet operated by Visa.RTM.. Payment processing networks have
capabilities for communications via private telecommunication
network facilities, as well as the ability to process transactions
in Internet Protocol (IP) formats to facilitate the exchange of
transactions between and amongst private networks and open
networks, such as the Internet.
[0032] Specifically, FIG. 2 shows a simplified schematic diagram of
an example of a processing flow 200 for eligibility requests in
accordance with an embodiment of the present invention. In step
202, a point of service (POS) terminal 902 associated with provider
150 submits a HIPAA 270 eligibility request message to an insurance
carrier 910. In step 204, the HIPAA 270 eligibility request message
is received by a third party interface 904, or directly by an
acquirer 908 (e.g., through a virtual POS connection). The acquirer
908 may be a financial institution such as a bank that is
associated with the healthcare provider 150. In step 206, the HIPAA
270 eligibility request message is routed from the third party
interface 904 or the acquirer 906 to the appropriate insurance
carrier 910 (Payer) through the previously described payment
processing network (not shown), which may (or may not) involve
additional third party processors 908. The insurance carrier 910
may access a database 912, which may contain information about the
patient's eligibility. As shown by the solid arrows going from the
insurance carrier database 912 back to the POS terminal 902,
insurance carrier 910 validates patient eligibility, and routes a
HIPAA 271 eligibility status message 208 back to healthcare
provider's POS terminal 902.
[0033] Returning to the process flow of FIG. 1, once eligibility
has been determined, in step 116 the patient 152 then reviews the
medical record with the provider 150 (or the doctor's staff), for
accuracy and completeness. The reason for the visit is entered into
patient's medical records on the secure website 154. A client
computer terminal (not shown) at the office of the provider 150 may
be used for this purpose.
[0034] Steps 118-124 of process flow 100 take place at the point of
care, post-treatment. In step 118, the provider 150 treats the
patient 152, taking into account the patient's medical history and
current medications. In step 120, the portable consumer device 153
is again swiped at the computer terminal in the office of the
provider 150, and information such as actual treatment, referrals,
follow-ups, and prescribed medications are uploaded to the
patient's medical records stored using the secure website 154. Such
transactions may be transmitted either via private network
communications, or over an open network in IP format by a payment
processing network, like VisaNet.TM..
[0035] Again within a short time (i.e. 30 seconds), in step 122 and
in response to the second swipe of the portable consumer device
153, the doctor (provider 150) receives from the payer 170 over the
payment processing network 166, adjudicated claims information
based upon contracted rates. The doctor then bills the patient 152
for any remaining deductible. If desired, in step 124, the patient
152 authorizes the provider 150 to pay the bill in-full with the
portable consumer device 153 (e.g. with a HSA payment card).
[0036] Steps 126-132 take place after the doctor's service has been
performed. In step 126 patient 152 may go to a second healthcare
provider, such as provider 151 (for example a pharmacy or
laboratory) and may present the portable consumer device 153 to the
provider 151. For example, when the provider 151 is a pharmacy, the
prescription is automatically accessed and filled, with the
pharmacist having access to the information portal of website 154
in order to double check the appropriateness of the medication for
the treatment that has been performed. The patient 152 then makes a
co-payment at the provider 151.
[0037] Once at home, in step 128 the patient 152 may again call the
medical hotline of the healthcare information provider 155, this
time to provide feedback upon the care that has been provided, such
as to provide comments on the service. For example, the patient 152
may provide information about bad service at the office of the
provider 150. The comments of the patient 150 then incorporated
into the rating of the provider 150 on the secure website 154,
resulting in the provider 150 being re-rated, which in this
specific example would be to change the rating from 5-star to a
4.5-star provider. By facilitating ongoing rating of the
performance of the provider, readily accessible at the centralized
healthcare portal, embodiments of methods and systems in accordance
with the present invention help ensure a high quality of
service.
[0038] In step 130, a payment processing organization, such as
Visa.RTM., that administers the payment processing network 166 may
then facilitate the payment of claims from payer 170 to the
provider 150. The payment processing network 166 may be operatively
connected to various acquirers and issuers. Account reconciliation
information may be provided through the secure website 154. Of
course, the scope of the present invention is not limited to
payments over a network administered by Visa.RTM., and other
payment methods such as automated clearing house transactions or
payment processing networks could alternatively be used.
[0039] Specifically, FIG. 3 shows a simplified schematic diagram of
an example of a processing flow 300 for payment of claims utilizing
the payment processing network 166. In step 302, the payer 170
(e.g., an insurance company) remits a HIPAA-compliant .sctn.835
claim payment message to the payment processing network 166 for
healthcare services rendered. In step 304, the payment processing
network 166 creates a file containing payer payments to the
provider 150, and makes health care claim advice data available to
the provider 150. In step 306, the payment processing network 166
transfers funds from the bank account of the payer 170 at a payer
bank 172 to the bank account of the provider 150 at a provider bank
160 via the payment processing network 166. The payment processing
network 166 also routes appropriate files to the provider bank 160
to pay for services rendered by the provider 150. The provider 150
may thereafter access funds that are deposited in the account of
the provider 150 at the provider bank 160. Although in this
specific embodiment, two different banks are shown, alternative
embodiment are contemplated, where the provider bank and the payer
bank are the same bank and, hence, funds are transferred between
two accounts within the same banking organization.
[0040] As described above, one aspect of methods and systems in
accordance with embodiments of the present invention, is the use of
a single portal for providing access to healthcare information for
multiple entities. In certain embodiments, this portal includes a
website hosted by a server device configured to be in electronic
communication with a computer network, for example the world wide
web. FIG. 4 shows a simplified schematic diagram of an embodiment
of a computer system for use in hosting such a healthcare
information website portal. Alternatively or additionally, FIG. 4,
and FIG. 4A may show parts of a client computer that is used by the
patient to access the website.
[0041] A computer system 410 of FIG. 4 includes a monitor or
display device 420, a display screen 430, a cabinet 440, a keyboard
450, and a mouse 470. The mouse 470 and the keyboard 450 are
representative "user input devices." The mouse 470 includes buttons
480 for selection of buttons on a graphical user interface device.
Other examples of user input devices are a touch screen, light pen,
track ball, data glove, microphone, and so forth. FIG. 4 is
representative of but one type of system for embodying the present
invention. It will be readily apparent to one of ordinary skill in
the art that many system types and configurations are suitable for
use in conjunction with the present invention. In one embodiment,
the computer system 410 includes an Intel class based computer,
running a Windows.RTM. based operating system by Microsoft
Corporation. However, the system is easily adapted to other
operating systems and architectures by those of ordinary skill in
the art without departing from the scope of the present
invention.
[0042] As noted, the mouse 470 can have one or more buttons such as
the buttons 480. The cabinet 440 houses familiar computer
components such as disk drives, a processor, storage device, etc.
Storage devices include, but are not limited to, disk drives,
magnetic tape, solid state memory, bubble memory, etc. The cabinet
440 can include additional hardware such as input/output (I/O)
interface cards for connecting the computer system 410 to external
devices external storage, other computers or additional
peripherals, further described below.
[0043] FIG. 4A is an illustration of basic subsystems in the
computer system 410 of FIG. 4. This diagram is merely an
illustration and should not limit the scope of the claims herein.
One of ordinary skill in the art will recognize other variations,
modifications, and alternatives. In certain embodiments, the
subsystems are interconnected via a system bus 475. Additional
subsystems such as a printer 474, a keyboard 478, a fixed disk 479,
a monitor or display device 476, which is coupled to a display
adapter 482, and others are shown. Peripherals and input/output
(I/O) devices, which couple to I/O controller 471, can be connected
to the computer system 410 by any number of means known in the art,
such as a serial port 477. For example, the serial port 477 can be
used to connect the computer system to an external interface device
48 (for example a modem), which in turn connects to a wide area
network such as the Internet. The interconnection via the system
bus 475 allows central processor 473 to communicate with each
subsystem and to control the execution of instructions from system
memory 472 or the fixed disk 479, as well as the exchange of
information between subsystems. Other arrangements of subsystems
and interconnections are readily achievable by those of ordinary
skill in the art. System memory, and the fixed disk are examples of
tangible media for storage of computer programs, other types of
tangible media include floppy disks, removable hard disks, optical
storage media such as CD-ROMS and bar codes, and semiconductor
memories such as flash memory, read-only-memories (ROM), and
battery backed memory.
[0044] Embodiments in accordance with the present invention offer a
number of potential benefits over conventional systems for
processing healthcare information. One advantage is the allowance
for real-time access to the healthcare information. For the
healthcare provider, this means that important information such as
patient eligibility, the value of claims adjudicated by the
healthcare insure, and medical records of the patient are readily
accessible. For the healthcare insurance carrier, the availability
of administered treatment and result information can lead to
increased accuracy and fewer mistakes. Also, in embodiments of the
invention, a patient may choose the privacy level associated with
his or her medical information and can control access to that
information by various providers.
[0045] Utilization of methods and embodiments in accordance with
the present invention can also lead to greater efficiency in
payments. Such payments executed with greater efficiency include
Payer-to-Provider claims payments/accelerated payments, and
Consumer-to-Provider co-payments and deductibles.
[0046] Utilization of methods and embodiments in accordance with
the present invention can also lead to improved risk management.
For example, the single portal provided for accessing healthcare
information helps insure the accuracy and reliability of that
information. Another source of improved risk management is the
benefit of utilizing security and fraud controls associated with an
payment processing network such as VisaNet.TM..
[0047] Utilization of methods and embodiments in accordance with
the present invention can also function to improve the quality of
the healthcare received. For example, the function of the
healthcare portal to provide basic health information (portal),
provider ratings, supplemental information, concierge services, and
healthcare financial advice can allow for the maximum efficient
utilization of the healthcare dollar, and ensure access to quality
healthcare services.
[0048] It should be understood that the present invention as
described above can be implemented in the form of control logic
using computer software in a modular or integrated manner. Based on
the disclosure and teachings provided herein, a person of ordinary
skill in the art will know and appreciate other ways and/or methods
to implement the present invention using hardware and a combination
of hardware and software.
[0049] Any of the software components or functions described in
this application, may be implemented as software code to be
executed by a processor using any suitable computer language such
as, for example, Java, C++ or Perl using, for example, conventional
or object-oriented techniques. The software code may be stored as a
series of instructions, or commands on a computer readable medium,
such as a random access memory (RAM), a read only memory (ROM), a
magnetic medium such as a hard-drive or a floppy disk, or an
optical medium such as a CD-ROM. Any such computer readable medium
may reside on or within a single computational apparatus, and may
be present on or within different computational apparatuses within
a system or network.
[0050] The above description is illustrative and is not
restrictive. Many variations of the invention will become apparent
to those skilled in the art upon review of the disclosure. The
scope of the invention should, therefore, be determined not with
reference to the above description, but instead should be
determined with reference to the pending claims along with their
full scope or equivalents.
[0051] Incorporated by reference herein for all purposes are the
following U.S. Nonprovisional Patent Applications: Ser. No.
10/418,989, filed Apr. 18, 2003 and entitled "SYSTEM AND METHOD FOR
PAYMENT OF MEDICAL CLAIMS"; Ser. No. 11/231,026, filed Sep. 20,
2005 and entitled "METHOD FOR ENCODING MESSAGES BETWEEN TWO DEVICES
FOR TRANSMISSION OVER STANDARD ONLINE PAYMENT NETWORKS"; Ser. No.
11/230,761, filed Sep. 20, 2005 and entitled "AUTO SUBSTANTIATION
FOR OVER-THE-COUNTER TRANSACTIONS"; and Ser. No. 11/230,743, filed
Sep. 20, 2005 and entitled "METHOD AND SYSTEM FOR DETERMINING
HEALTHCARE ELIGIBILITY".
[0052] Other details of embodiments of the invention can be found
in the following U.S. provisional patent applications, each of
which are incorporated herein by reference in their entirety for
all purposes: 60/641,483, filed on Jan. 4, 2005; 60/641,597, filed
on Jan. 4, 2005; 60/641,464 filed on Jan. 4, 2005; 60/834,584,
filed on Jul. 31, 2006; and 60/812,266, filed on Jun. 8, 2006.
[0053] One or more features from any embodiment may be combined
with one or more features of any other embodiment without departing
from the scope of the invention.
[0054] A recitation of "a", "an" or "the" is intended to mean "one
or more" unless specifically indicated to the contrary.
[0055] All patents, patent applications, publications, and
descriptions mentioned above are herein incorporated by reference
in their entirety for all purposes and none is admitted to be prior
art.
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