Patent Issued for Patient/Member Reconciled Billing And Explanation Of Benefit Statements With Provider Prompt Pay (USPTO 10,346,587)

2019 JUL 24 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- According to news reporting originating from Alexandria, Virginia, by NewsRx journalists, a patent by the inventors Stamper, Jeanne (Lexington, KY); Hartley, Paul Alan (New Canaan, CT); Morrison, Mike (Lexington, KY), filed on July 31, 2012, was published online on July 22, 2019.

The assignee for this patent, patent number 10,346,587, is Conduent Business Services LLC.

Reporters obtained the following quote from the background information supplied by the inventors: “Health plan members or patients often receive multiple communications from healthcare payers (e.g., health insurance companies) and providers (e.g., doctors, hospitals, care centers/clinics). The communications may include bills, invoices, and statements regarding episodes of care to providers (e.g., clinical visits, treatments). For example, the same care visit or treatment for a patient may result in multiple explanations of benefits (EOBs) according to payer(s) and multiple billing statements for different providers (e.g., physicians, nurse practitioners, labs). Reconciling the billing statements against the EOBs and the various EOB components (deductibles, coverage percentage) to determine what is really owed by the member/patient can be often challenging. Further, this reconciliation is typically done in the context of health spending accounts (HSAs), flexible spending accounts (FSAs), high deductible plans, provider network discounts, and/or other guidelines, where indicated figures and values are not easily mapped or understood. As a result, patients may delay or choose not to pay providers, which causes significant underpayment of providers. The underpaid providers may also choose not to pursue payment due to the relatively high administrative cost associated with reconciliation and collections. The underpayment of providers is one aspect that contributes to overall healthcare cost.”

In addition to obtaining background information on this patent, NewsRx editors also obtained the inventors’ summary information for this patent: “In an embodiment, the disclosure includes a healthcare payment management system comprising a payment consolidation server configured to receive billing information from a provider for an episode of care for a member, receive benefit information from a payer for the episode of care, consolidate the billing information and the benefit information into a payment reconciliation statement, and send the payment reconciliation statement to a member.

“In another embodiment, the disclosure includes an apparatus comprising an apparatus for healthcare payment management comprising a processor configured to receive one or more billing statements from one or more providers for an episode of care for a member, receive one or more EOB statements from one or more payers for the episode of care, and consolidate the billing statements and the EOB statements to provide a total balance owed by the member to each of the providers for the episode of care, wherein the total balance includes any payments the payer will make or has made on behalf of the member for the episode of care.

“In yet another embodiment, the disclosure includes a healthcare payment management method comprising receiving billing information from one or more providers for one or more healthcare services to a member, receiving healthcare insurance benefits information from one or more payers for the one or more healthcare services, generating a payment reconciliation statement for the member by consolidating and mapping between the billing information and the healthcare insurance benefits information, sending the payment reconciliation statement and the one or more payment options to the member, and presenting one or more payment options to the member including a multiple payments option.

“These and other features will be more clearly understood from the following detailed description taken in conjunction with the accompanying drawings and claims.”

The claims supplied by the inventors are:

“What is claimed is:

“1. A payment consolidation server for completing an online transaction, the payment consolidation server comprising: a communications interface configured to: communicate electronically with a plurality of provider servers and a payer server; receive billing information from the plurality of provider servers for a single episode of care for a member; and receive benefit information from the payer server for the single episode of care; a computer processor coupled to the communication interface and configured to: consolidate the billing information and the benefit information into a payment reconciliation statement by mapping the billing information and the benefit information; and combine payment links for a plurality of payment options with the billing information and the benefit information to form a website that comprises information from a provider web portal of the plurality of provider servers and from a payer web portal of the payer server, the website presenting the payment reconciliation statement with the plurality of payment options on a user interface to increase payments to a plurality of providers from the member for the single episode of care based at least in part by allowing the member to make payments to the plurality of providers using multiple ones of the plurality of payment options, the payment reconciliation statement indicating for the single episode of care a total payment balance owed by the member to each of the plurality of providers, the total payment balance owed to each of the plurality of providers being calculated as a difference between total charges for the provider in the billing information and a total covered by a payer in the benefit information, the payment reconciliation statement comprising the plurality of payment options for each of the plurality of providers, the plurality of payment options including a healthcare account option and a partial payment option, the payment reconciliation statement being provided to the member on the user interface, the payment reconciliation statement listing each of the plurality of providers for the single episode of care and the total payment balance owed to each of the plurality of providers, the payment reconciliation statement presenting the plurality of payment options for each of the plurality of providers on the user interface, the plurality of payment options including the healthcare account option, the partial payment option, and a pay-in-full option, the payment options including an option to pay by credit card and an option to pay by a check from a banking account, and the partial payment option allowing the member to use a pre-established healthcare account to pay a percentage of the total payment balance owed to each of the plurality of providers as a down payment and pay a remainder of the total payment balance owed to each of the plurality of providers over a scheduled amount of time; the communications interface being further configured to: send the payment reconciliation statement electronically to the member; and send an electronic payment confirmation to the plurality of providers based on receiving an indication of a payment made from the member to a third-party payment transaction system, the electronic payment confirmation indicating a charging of an account associated with the member and a crediting of an account associated with the plurality of providers; and the computer processor being further configured to complete the online transaction by performing a validation process with an Explanation of Benefits (EOB) statement, the validation process comprising the payment consolidation server validating that the total payment balance owed to each of the plurality of providers matches a total payment balance on the EOB statement, that the member has paid an insurance amount specified on the EOB statement, and that the member has paid an insurer amount specified on the EOB statement.

“2. The payment consolidation server of claim 1, wherein the healthcare account option comprises providing the member an option to pay with a health savings account (HSA) and an option to pay with a flexible spending account (FSA).

“3. The payment consolidation server of claim 1, wherein the payment consolidation server is configured to receive the billing information from the plurality of provider servers and the benefit information from the payer server automatically in real-time as the billing information and the benefit information become available.

“4. The payment consolidation server of claim 1, wherein the payment consolidation server is configured to receive the billing information from the plurality of provider servers and the benefit information from the payer server at regularly scheduled time intervals.

“5. The payment consolidation server of claim 1, wherein the billing information, the benefit information, and the payment reconciliation statement are exchanged electronically.

“6. The payment consolidation server of claim 1, wherein the healthcare payment management system comprises multiple members, and each of the multiple members having a login and a password to access the healthcare payment management system.

“7. The payment consolidation server of claim 1, further comprising a database coupled to the computer processor, the database configured to store the billing information from the plurality of provider servers and the benefit information from the payer server, and the computer processor being further configured to retrieve the billing information from the plurality of provider servers and the benefit information from the payer server to complete the online transaction.

“8. An apparatus for completing an online transaction in a healthcare payment management system, the apparatus comprising: a computer processor; and a communications interface coupled to the computer processor, the computer processor being configured to: receive through the communications interface multiple billing statements from multiple provider servers for a single episode of care for a member; receive through the communications interface multiple explanation of benefit (EOB) statements from one or more payer servers for the single episode of care; consolidate the multiple billing statements and the multiple EOB statements by mapping billing information and benefit information using the computer processor to provide a total payment balance owed by the member to each one of a plurality providers for the single episode of care; combine payment links for a plurality of payment options with the multiple billing statements and the multiple EOB statements to form a website that comprises information from a provider web portal of the multiple provider servers and from a payer web portal of the one or more payer servers, the website presenting a payment reconciliation statement with the plurality of payment options on a user interface to increase payments to a plurality of providers from the member for the single episode of care based at least in part by allowing the member to make payments to the plurality of providers using multiple ones of the plurality of payment options, the total payment balance owed by the member to each one of the plurality of providers being calculated as a difference between total charges for the provider in the multiple billing statements and a total covered by a payer in the multiple EOB statements, the payment reconciliation statement comprising the plurality of payment options for each of the plurality of providers, the plurality of payment options including a healthcare account option and a partial payment option, the payment reconciliation statement being provided to the member on the user interface, the payment reconciliation statement listing each of the plurality of providers for the single episode of care and the total payment balance owed to each of the plurality of providers, the payment reconciliation statement presenting the plurality of payment options for each of the plurality of providers on the user interface, the plurality of payment options including the healthcare account option, the partial payment option, and a pay-in-full option, the payment options including an option to pay by credit card and an option to pay by a check from a banking account, the partial payment option allowing the member to use a pre-established healthcare account to pay a percentage of the total payment balance owed to each of the plurality of providers as a down payment and pay a remainder of the total payment balance owed to each of the plurality of providers over a scheduled amount of time; send an electronic payment confirmation to the plurality of providers based on receiving an indication of a payment made from the member to a third-party payment transaction system, the electronic payment confirmation indicating a charging of an account associated with the member and a crediting of an account associated with the plurality of providers; and complete the online transaction by performing a validation process with the multiple EOB statements, the validation process comprising validating that the total payment balance owed to each of the plurality of providers matches a total payment balance on the multiple EOB statements, that the member has paid an insurance amount specified on the multiple EOB statements, and that the member has paid an insurer amount specified on the multiple EOB statements.

“9. The apparatus of claim 8, wherein the healthcare account option comprises providing the member with an option to pay with a health savings account (HSA) and an option to pay with a flexible spending account (FSA).

“10. The apparatus of claim 8, wherein the plurality of payment options include an option that is provided as an Internet link that enables the member to make a payment for the total payment balance, a first partial payment, and/or subsequent payments electronically.

“11. The apparatus of claim 8, wherein the apparatus comprises multiple members, and each of the multiple members having a login and a password to access a healthcare payment management system.

“12. The apparatus of claim 8, further comprising a database coupled to the computer processor, the database configured to store the billing information from the plurality of provider servers and the benefit information from the payer server, and the computer processor being further configured to retrieve the billing information from the plurality of provider servers and the benefit information from the payer server to complete the online transaction.

“13. A payment consolidation server for completing an online transaction, the payment consolidation server comprising: a computer processor; and a communications interface coupled to the computer processor, the computer processor being configured to: receive through the communications interface billing information from a plurality of providers for a single episode of care for a member; receive through the communications interface benefit information from a payer for the single episode of care; consolidate the billing information and the benefit information into a payment reconciliation statement by mapping the billing information and the benefit information; combine payment links for a plurality of payment options with the billing information and the benefit information to form a website that comprises information from a provider web portal of the plurality of providers and from a payer web portal of the payer, the website presenting the payment reconciliation statement with the plurality of payment options on a user interface to increase payments to the plurality of providers from the member for the single episode of care based at least in part by allowing the member to make payments to the plurality of providers using multiple ones of the plurality payment options, the payment reconciliation statement indicating for the single episode of care a total payment balance owed by the member to each of the plurality of providers, the total payment balance owed to each of the plurality of providers being calculated as a difference between total charges for the provider in the billing information and a total covered by the payer in the benefit information, the payment reconciliation statement comprising the plurality of payment options for each of the plurality of providers, the plurality of payment options including a healthcare account option and a partial payment option, the payment reconciliation statement being provided to the member on the user interface, the payment reconciliation statement listing each of the plurality of providers for the single episode of care and the total payment balance owed to each of the plurality of providers, the payment reconciliation statement presenting the plurality of payment options for each of the plurality of providers on the user interface, the plurality of payment options including the healthcare account option, the partial payment option, and a pay-in-full option, the payment options including an option to pay by credit card and an option to pay by a check from a banking account, and the partial payment option allowing the member to use a pre-established healthcare account to pay a percentage of the total payment balance owed to each of the plurality of providers as a down payment and pay a remainder of the total payment balance owed to each of the plurality of providers over a scheduled amount of time; send the payment reconciliation statement electronically to the member; send an electronic payment confirmation to the plurality of providers based on receiving an indication of a payment made from the member to a third-party payment transaction system, the electronic payment confirmation indicating a charging of an account associated with the member and a crediting of an account associated with the plurality of providers; and complete the online transaction by performing a validation process with an Explanation of Benefits (EOB) statement, the validation process comprising the payment consolidation server validating that the total payment balance owed to each of the plurality of providers matches a total payment balance on the EOB statement, that the member has paid an insurance amount specified on the EOB statement, and that the member has paid an insurer amount specified on the EOB statement.

“14. The payment consolidation server of claim 13, wherein the account associated with the member comprises a medical account associated with the member.

“15. The payment consolidation server of claim 13, wherein the single episode of care involves a plurality of clinical and treatment visits of the member to the plurality of providers, and the billing information being issued from the plurality of providers for the different clinical and treatment visits of the member.

“16. The payment consolidation server of claim 13, further comprising a database coupled to the computer processor, the database configured to store the billing information from the plurality of provider servers and the benefit information from the payer server, and the computer processor being further configured to retrieve the billing information from the plurality of provider servers and the benefit information from the payer server to complete the online transaction.”

For more information, see this patent: Stamper, Jeanne; Hartley, Paul Alan; Morrison, Mike. Patient/Member Reconciled Billing And Explanation Of Benefit Statements With Provider Prompt Pay. U.S. Patent Number 10,346,587, filed July 31, 2012, and published online on July 22, 2019. Patent URL: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=10,346,587.PN.&OS=PN/10,346,587RS=PN/10,346,587

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