US 7,792,686 B2
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`MEDICAL BENEFITS PAYMENT SYSTEM
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`FIELD OF INVENTION
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`This inventionrelates to facilitating payments for medical
`benefits, and more specifically to streamline the payment of
`health care providers by administrators and insurancecarriers
`that handle claims adjudication and paymentto these provid-
`ers.
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`BACKGROUNDOF THE INVENTION
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`Paid benefits charged to the associated debit card transac-
`tion may be reconciled via the unique card numbergenerated
`and assignedto a single payment.In addition,the debit card is
`pre-funded only to the authorized benefit amount. Thusis it
`not possible to charge more than the authorized benefit
`amount. Furthermore, the stored-value card account payment
`mayonly be charged through a medical services terminal. The
`terminal may be coupled to a computer-implemented com-
`munications networkas is knownin the art for credit and debit
`card transactions.
`Another embodiment includes a method of facilitating
`payment of health care benefits to a health care provider
`including the steps of identifying the health care providerthat
`renders medical services in anticipation of payment; identi-
`fying a payer that has agreed to pay the health care provider on
`behalf of a patient subject to preselected conditions; identi-
`fying an administrator that determines whether the medical
`services conducted by the service provider meet the prese-
`lected conditions by the payer, generates an explanation of
`benefits, and arranges for paymentofthe service provider if
`appropriate; intercepting the explanation of benefits and pay-
`ment information transmitted from the administrator to the
`health care provider; acquiring a stored-value card account
`numberfor the amount ofthe check; merging the stored-value
`card account numberwith the explanation of benefits into an
`imagefile; and transmitting the imagefile to the health care
`provider. The imagefile may be transmitted by a numberof
`methods including, but not limited to, fax, SMTP, SMS,
`MMS, HTTP, HTTPS, and FTP. The transmission may be
`implemented using a computer coupledto a network connec-
`tion such as knownin the art and required for transmissions
`such as FTP, HTTP, andthelike.
`The charge incurred against the stored-value card account
`numbermaybe reconciled to confirm the health care provider
`has been paid for the services approved by the administrator.
`As an added security precaution,
`the stored-value card
`account number is chargeable only through a medical ser-
`vices terminal.
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`BRIEF DESCRIPTION OF THE DRAWINGS
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`For a fuller understanding of the invention, reference
`should be madeto the following detailed description, taken in
`connection with the accompanying drawings, in which:
`FIG.1 (priorart) is an illustration of the current state-of-
`the-art.
`FIG. 2 is a flow-chart illustration of an embodimentofthe
`invention.
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`FIG. 3 is a diagrammatic view of an embodimentof the
`invention.
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`FIG.4 is an image of a merged EOB andstored-value card
`account payment according to an embodimentof the inven-
`tion.
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`DETAILED DESCRIPTION OF THE PREFERRED
`EMBODIMENT
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`Turning to FIG. 1 (prior art), insured patient 20 consumes
`services from health care provider 30. Health care provider 30
`submits a benefit claim to administrator 40 in orderto receive
`payment. Administrator 40 maybe a third party administra-
`tor, insurance company governmententity, non-profit orga-
`nization or the like. For the purposes of this specification,
`administrator 40 is considered any entity that adjudicates
`claims, compares them to the benefit plan and makes the
`decision to make paymentfor the services. Administrator 40
`evaluates the claim madeby health care provider 30 to deter-
`mine whetherall or a portion of the benefit claim is payable
`underthe terms of the relevant policy issued by payer or plan
`sponsor(herein “payer’). 50. Payer 50 funds funding account
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`Third party administrators, insurance companies, and large
`self-funded corporations (herein “Payers’’) adjudicate claims,
`compare them to the benefit plan and make the decision to
`write checks in paymentfor the claims. Currently, Payers are
`required to print checks and explanation of benefit (EOB)
`formsfor delivery to the health care providers. The EOBlists
`the amountthe health care provider billed the Payer’s com-
`pany and the amount the Payer’s companypaid onthe claim.
`It may also list the contractual discount amount and the
`patient responsibility. If the claim is denied, the EOB will
`explain the reason for denial. It has been estimated that the
`check and EOB formscost Payers approximately $4.50 each.
`The inefficiencies to all Payers that must coordinate pay-
`ment for medicalservices. This includes, butis not limited to,
`insurance carriers, governmententities, and non-profit orga-
`nizations.
`A long-felt but unfulfilled need in the art is a system to
`reduce the transactional costs incurred by the payers and
`speed up the delivery and funding of payments by weeks.
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`SUMMARYOF INVENTION
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`The present invention is a method of facilitating payment
`of health care benefits to a health care provider on behalf ofa
`Payer, often an insurance company, governmentorganization
`or self-insured entity. An embodiment of the invention
`includesthestep of electronically transmitting a stored-value
`card account paymentof the authorized benefit amount con-
`currently with an explanation of benefits. For the purposes of
`this patent specification, stored-value cards and stored-value
`card accounts shall also includefinancial instruments known
`as credit cards, debit cards and EFT cards.
`A credit card system is a type ofretail transaction settle-
`ment and credit system, named after the small plastic card
`issuedto users of the system. A credit card is different from a
`debit card in that it does not remove money from the user’s
`accountafter every transaction.In the case of credit cards, the
`issuer lends money to the consumer(or the user).
`A debit card account provides an alternative payment
`method to cash when making purchases. When issued in
`physical form,the card is a ISO 7810 cardlike a credit card,
`howeverits functionality is more similar to writing a check as
`the funds are withdrawn directly from the cardholder’s bank
`account; some cardsare referred to as check cards.
`A stored-value card represents money on deposit with the
`issuer, and is similar to a debit card. One major difference
`between stored value cards and debit cardsis that debit cards
`are usually issued in the nameof individual account holders,
`while stored value cards are usually anonymous.
`The stored-value card account payment generally includes
`acard numberwith the pre-funded amount,a card verification
`value code and an expiration date. The payment and expla-
`nation ofbenefits may be transmitted by a number ofmethods
`including, but not limited to, fax, SMTP, SMS, MMS, HTTP,
`HTTPS, and FTP. The electronic transmission mayinclude an
`electronically computer-generated image of a physical debit
`card and the unique debit card numberis associated with a
`single benefit payment.
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