US 7,792,686 B2
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`70 in anticipation of benefit claims. If administrator 40 finds
`that a benefit claim is payable,
`it draws the money from
`funding account 70. Administrator 40 then generates an
`explanation of benefits and a check for the benefit payment.
`The explanation of benefits and check are then sent concur-
`rently to health care provider 30. Drawbacks associated with
`the prior art include the cost and time associated with gener-
`ating hardcopy checks and sending them by mail to health
`care provider 30. A long-felt but unfulfilled need exists in the
`art to reduce this transactional cost and speed up paymentof
`benefits to health care provider 30.
`In FIG.2, claim 80 is received. Claim 80 is then evaluated
`to determine whether it is payable under the terms of an
`applicable policy. If claim 80 is not even partially payable,
`then non-payment EOB 90 is generated and transmitted to
`health care provider 30 without payment. However, if claim
`80 is at least partially payable, then stored-value card account
`100 is loaded with funds equal to the amountof the payable
`benefit. Payment EOB 110 is merged with stored-value card
`account 100 to generate image file 120. Image file 120
`includes payment EOB 110 and a computer-generated fac-
`simile of a physical stored-value card complete with the card
`number, expiration date and security verification code. Image
`file 120 is transmittedto health care provider 30 by a suitable
`transmission medium including, but not
`limited to, fax,
`SMTP, SMS, MMS, HTTP, HTTPS, and FTP.
`In FIG.3, insured 20 having coverage provided by payer 50
`consumes services by health care provider 30. Health care
`provider 30 then submits a benefit claim to administrator 40
`which adjudicates the benefit claim in accordance with pre-
`existing guidelines. If payment is appropriate on the benefit
`claim,a transfer of funds is made between payer’s account 60
`and its funding account 70 (to which administrator 40 has
`access). Stored-value card processor 130 then loads funds
`from funding account 70 onto a stored-value card account.
`The stored-value card account is chargeable only on a medi-
`cal services terminal andit cannot be charged over the amount
`loaded ontoit. The card number,the security verification code
`and the expiration date of the debit card account are merged
`with the explanation of benefits generated by administrator
`40 into imagefile 140 whichis then transmitted backto health
`care provider 30.
`FIG.4 illustrates an exemplary embodiment of a merged
`EOBand stored-value card account payment.
`Tt will be seen that the advantages set forth above, and those
`made apparent from the foregoing description,are efficiently
`attained and since certain changes may be madein the above
`construction without departing from the scope of the inven-
`tion, it is intendedthat all matters contained in the foregoing
`description or shownin the accompanying drawingsshall be
`interpreted as illustrative and notin a limiting sense.
`It is also to be understood that the following claims are
`intended to coverall ofthe generic and specific features ofthe
`invention herein described, andall statements of the scope of
`the invention which,as a matter of language, mightbesaid to
`fall therebetween. Now that the invention has been described,
`Whatis claimedis:
`
`1. A methodoffacilitating payment of adjudicated health
`care benefits to a health care provider on behalf of a payer
`comprising the steps of:
`loading a unique, single-use, stored-value card account
`with an amount equal to a single, authorized benefit
`payment, the card account only chargeable through a
`medical services terminal;
`generating an explanation of benefits associated with the
`payment;
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`creating a computer-generated imagefile containing the
`stored-value card account number, the amount, a card
`verification value code, an expiration date, and the
`explanation of benefits;
`transmitting the image file by fax to the health care pro-
`vider; and
`reconciling the charged card account to confirm that the
`health care provider has received payment.
`2. A methodoffacilitating payment of adjudicated health
`care benefits to a health care provider comprising:
`identifying the health care provider that renders medical
`services in anticipation of payment;
`identifying a payer that has agreed to pay the health care
`provider on behalf of a patient subject to preselected
`conditions;
`identifying an administrator that determines whether the
`medical services conducted bythe service provider meet
`the preselected conditions by the payer, generates an
`explanation of benefits, and authorizes payment of the
`service provider for an authorized amount;
`intercepting the explanation ofbenefits and paymentinfor-
`mation transmitted from the administratorto the health
`care provider;
`acquiring a single-use, stored-value card account number
`and loading it with funds equal
`to the authorized
`amount;
`merging the stored-value card account number, the autho-
`rized amount, a card verification value code, and an
`expiration date with the explanation of benefits into a
`computer-generated image file; and
`transmitting the imagefile to the health care provider via a
`computer-implemented transmission.
`3. The method of claim 2 wherein the imagefile is trans-
`mitted by fax.
`4. The method of claim 2 further comprising the step of
`reconciling the charge incurred against the stored-value card
`account numberto confirm the health care provider has been
`paid for the services approved by the administrator.
`5. The method of claim 2 wherein the stored-value card
`account number is chargeable only through a medical ser-
`vices terminal.
`6. A methodoffacilitating payment of adjudicated health
`care benefits to a health care provider on behalf of a payer
`comprising the steps of:
`loading a unique, single-use, stored-value card account
`with an amount equal to a single, authorized benefit
`payment, the card account only chargeable through a
`medical services terminal;
`generating an explanation of benefits associated with the
`payment;
`creating a computer-generated imagefile containing the
`stored-value card account number, the amount, a card
`verification value code, an expiration date, and the
`explanation of benefits;
`transmitting the image file by a computer-implemented
`electronic transmission medium selected from the group
`consisting of fax, SMTP, SMS, MMS, HTTP, HTTPS,
`and FTP to the health care provider wherein the elec-
`tronic transmission includes a computer-generated
`imageof a physical card; and
`reconciling the charged card account to confirm that the
`health care provider has received payment.
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