Patent Issued for Tokenized healthcare service payments (USPTO 11610201): Capital District Physicians Health Plan Inc.

2023 APR 07 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- From Alexandria, Virginia, NewsRx journalists report that a patent by the inventors Cooley, Brent (Albany, NY, US), Rege, Umesh (Albany, NY, US), filed on September 25, 2019, was published online on March 21, 2023.

The patent’s assignee for patent number 11610201 is Capital District Physicians Health Plan Inc. (Albany, New York, United States).

News editors obtained the following quote from the background information supplied by the inventors: “Healthcare administrative overhead costs may account for a significant portion of healthcare spending. At least part of these overhead costs may be due to the antiquated claims-based retrospective insurance payment model that frequently results in unexpected and/or delayed bills to patients after a healthcare service.

“In a traditional claims-based insurance model, a healthcare provider submits a claim on behalf of a patient to an insurance payer (e.g., a health insurance company) after providing the patient with a healthcare service. After the claim is checked for errors, and after any errors are resolved, the claim goes through an adjudication process to determine the amount to pay the provider for the healthcare service. In some select circumstances, patient clinical encounter data may be shared between the healthcare provider and the healthcare payer in the process of finalizing the payment amount to the healthcare provider. Once the healthcare provider receives payment from the payer, the healthcare provider may submit a bill to the patient for any remaining balance for the healthcare service. As many patients, such as those with a high deductible-based insurance plan, may not know their share of the costs until after claim adjudication and billing. They may be unprepared to meet their payment obligations in a timely manner. A delinquent patient account may require the healthcare provider to send additional statements to the patient to collect unpaid balances. If the bill remains unpaid, the healthcare provider may turn the bill over to a debt collector. Consequently, revenue flow to healthcare providers may be slow, sometimes with months passing before full payments are received for a healthcare service.

“U.S. Pat. No. 10,340,038 describes a healthcare validation system, whereby peers in a healthcare network manage a healthcare historical blockchain associated with stakeholder, such as a patient. The healthcare historical blockchain represents a chronicle or ledger of the stakeholder’s validated healthcare transactions, such as birth, doctor visits, and surgeries.

“However, there is a need for improved payment processing systems that provide more timely revenue flow to healthcare providers for healthcare services, and reduce administrative expenses involved in payment or debt collection. Though accelerated payments is one of the goals, another important objective is to provide full cost (and bill) transparency to members and provide friction-less financial experience to patients and healthcare providers. Additionally, there is a need for systems that improve the transparency of a patient’s cost share for a healthcare service in advance of the healthcare service. Further, there is a need for systems that facilitate the sharing of clinical encounter data and other data between healthcare providers and healthcare payers. The embodiments of the present disclosure attempt to provide a technical solution to address these needs.”

As a supplement to the background information on this patent, NewsRx correspondents also obtained the inventors’ summary information for this patent: “Embodiments disclosed herein apply a blockchain technology-backed health token system to provide a technical solution to the above challenges. In one embodiment, a computer-implemented method for expediting processing of a payment for a patient’s healthcare service with a healthcare provider includes displaying an exact out-of-pocket cost for the patient for the healthcare service at a display interface associated with a computer device of the patient, prior to the healthcare service being rendered. The method further includes issuing the patient a health token as cryptocurrency for future payment of the healthcare service with the healthcare provider. The health token may be stored in a digital wallet on the computer device of the patient. The method further includes receiving the health token from the healthcare provider after the healthcare provider renders the healthcare service, receives the health token from the patient for payment of the healthcare service, and embeds data pertaining to the healthcare service into the health token. Additionally, the method further includes determining if the healthcare service is approved based at least on the data embedded in the health token, and issuing a full payment to the healthcare provider for the healthcare service if the healthcare service is approved.

“In another embodiment, a health token system for expediting processing of a payment for a patient’s healthcare service with a healthcare provider includes a blockchain network including at least a payer computer device associated with a payer, a provider computer device associated with a healthcare provider, and a patient computer device associated with the patient. The health token system further includes a patient interface module associated with the payer computer device configured to issue the patient a health token as cryptocurrency for payment of the healthcare service prior to the healthcare service being rendered. The health token may be stored in a digital wallet on the patient’s computer device. The health token system further includes a provider interface module associated with the payer computer device configured to receive the health token from the provider computer device after the healthcare provider renders the healthcare service and receives the health token from the patient for payment of the healthcare service. Additionally, the health token system further includes an approval module associated with the payer computer device configured to approve the healthcare service and approve issuance of a full payment to the healthcare provider for the healthcare service.”

The claims supplied by the inventors are:

“1. A computer-implemented method for expediting processing of a payment for a patient’s healthcare service with a healthcare provider, comprising: prior to the healthcare service being rendered, displaying an exact out-of-pocket cost for the patient for the healthcare service at a display interface associated with a computer device of the patient; issuing the patient a health token as cryptocurrency for future payment of the healthcare service, the health token being stored in a digital wallet on the computer device of the patient; receiving the health token from the healthcare provider after the healthcare provider: 1) renders the healthcare service, 2) receives the health token from the patient for payment of the healthcare service, and 3) embeds data pertaining to the healthcare service into the health token, the data including clinical encounter data for the healthcare service and approval rules for an approval of the healthcare service; determining, based on the received health token, that the clinical encounter data for the healthcare service meets the approval rules; generating the approval of the healthcare service, and issuing a full payment to the healthcare provider for the healthcare service based on the determining step.

“2. The computer-implemented method of claim 1, further comprising collecting from the patient a payment including the out-of-pocket cost for the healthcare service prior to issuing the health token to the patient.

“3. The computer-implemented method of claim 1, wherein issuing the patient the health token comprises activating the health token if the patient does not have an out-of-pocket cost for the healthcare service.

“4. The computer-implemented method of claim 1, wherein the method is at least partially performed using a payer computer device associated with a payer for the healthcare service.

“5. The computer-implemented method of claim 4, wherein the payer is a healthcare insurer with which the patient has a healthcare plan.

“6. The computer-implemented method of claim 5, further comprising providing a computer-downloadable health token application to the healthcare provider that allows the healthcare provider to scan the health token stored in the patient’s digital wallet after rendering the healthcare service, embed the data into the health token, and to submit the health token to the payer for redemption at a provider computer device.

“7. The computer-implemented method of claim 6, further comprising using the health token application at the payer computer device to view the health token received from the healthcare provider, view the data embedded on the health token, and determine if the data embedded in the health token satisfies the approval rules.

“8. The computer-implemented method of claim 7, further comprising providing the patient with the computer-downloadable health token application to allow the patient to view the out-of-pocket cost for the healthcare service, select the healthcare service, pay any out-of-pocket cost for the healthcare service, and obtain the health token for payment of the healthcare service at the patient’s computer device.

“9. A health token system for expediting processing of a payment for a patient’s healthcare service with a healthcare provider, comprising: a blockchain network including at least a payer computer device associated with a payer, a provider computer device associated with the healthcare provider, and a patient computer device associated with the patient; a patient interface module associated with the payer computer device configured to issue the patient a health token as cryptocurrency for payment of the healthcare service prior to the healthcare service being rendered, the health token being stored in a digital wallet on the patient’s computer device; a provider interface module associated with the payer computer device configured to receive the health token from the provider computer device after the healthcare provider renders the healthcare service and receives the health token from the patient for payment of the healthcare service, the health token including clinical encounter data for the healthcare service and approval rules for an approval of the healthcare service; and an approval module associated with the payer computer device configured to determine, based on the health token received by the provider interface, that the clinical encounter data for the healthcare service meets the approval rules, generate an approval of the healthcare service in response to the clinical encounter data of the health token received by the provider interface meeting the approval rules, and to-approve issuance of a full payment to the healthcare provider for the healthcare service in response to the determination based on the health token received by the provider interface.

“10. The health token system of claim 9, wherein the health token is generated and validated using blockchain technology.

“11. The health token system of claim 9, wherein the payer computer device is associated with a healthcare insurer with which the patient has a healthcare plan.

“12. The health token system of claim 9, wherein the provider interface module is configured to submit a request for additional data to the provider computer device if the healthcare service is not approved.

“13. The health token system of claim 9, wherein the patient’s computer device includes a health token application downloaded thereon that allows the patient to view an out-of-pocket cost for the healthcare service, select the healthcare service, pay any out-of-pocket cost for the healthcare service, and obtain the health token for payment of the healthcare service at a display interface.

“14. The health token system of claim 13, wherein the patient interface module is configured to issue the health token to the patient after collecting a payment from the patient that includes the patient’s out-of-pocket cost for the healthcare service.

“15. The health token system of claim 13, wherein the provider computer device includes the health token application downloaded thereon, the health token application allowing the healthcare provider to scan the health token stored in the patient’s digital wallet, embed data pertaining to the healthcare service into the health token, and submit the health token to the payer computer device for redemption.

“16. The health token system of claim 15, wherein the approval module is configured to approve the healthcare service based at least on the data embedded in the health token.

“17. A computer-implemented method for expediting processing of a payment for a patient’s healthcare service with a healthcare provider, comprising: providing the patient with a list of healthcare services at a display interface of a computer device of the patient; presenting the patient with an exact out-of-pocket cost for each of the healthcare services at the display interface; allowing the patient to select a desired healthcare service from the list; collecting from the patient a payment corresponding to the out-of-pocket cost for the selected healthcare service if the selected healthcare service includes an out-of-pocket cost; prior to the healthcare service being rendered, issuing the patient a health token for future payment of the healthcare service, the health token being generated using blockchain technology and being stored in the patient’s computer device; receiving the health token from the healthcare provider after the healthcare provider renders the healthcare service, receives the health token from the patient for payment of the healthcare service, and embeds data pertaining to the healthcare service into the health token, the data including clinical encounter data for the healthcare service and approval rules for an approval of the healthcare service; determining, based on the received health token, that the clinical encounter data for the healthcare service meets the approval rules; generating the approval of the healthcare service, and providing a full payment to the healthcare provider for the healthcare service based on the determining step.”

For additional information on this patent, see: Cooley, Brent. Tokenized healthcare service payments. U.S. Patent Number 11610201, filed September 25, 2019, and published online on March 21, 2023. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(11610201)&db=USPAT&type=ids

(Our reports deliver fact-based news of research and discoveries from around the world.)