Patent ID: 8214233
Filing Date: 2012-07-03
Classification: G06Q

Abstract:
1. A data management system for managing services rendered within a network of one or more medical service entities that provide medical services and one or more insurance entities that provide insurance coverage for medical services, wherein the medical service entities and insurance entities communicate with one another via standardized transactions, wherein a first format is used in transactions from the medical service entities to the insurance entities in relation to charges for one or more patient-rendered medical services performed by the one or more medical service entities, and wherein a second format is used in transactions from the insurance entities to the medical service entities in relation to payments for the one or more patient-rendered medical services performed by the one or more medical service entities, the data management system comprising: a provider interface in communication with the one or more medical service entities, the provider interface configured to communicate with the one or more medical service entities via the standardized transactions, so that transactions from the one or more medical service entities to the provider interface are in the first format and transactions from the provider interface to the medical service entities are in the second format, wherein the format of communications between the one or more medical service entities and the provider interface is similar to the format of communications between the one or more medical service entities and the one or more insurance entities, since the same format is used for transactions with the one or more medical service entities, the provider interface being configured to transmit information to the one or more insurance entities as to a patient and one or more medical services for the patient performed or to be performed by the one or more medical service entities, the provider interface further configured to receive an eligibility-benefits transaction from the one or more insurance entities for the patient containing information related to patient eligibility and coverage for the one or more medical services; wherein the provider interface is further configured to communicate with one or more payment services for payment of at least a portion of the charges for the one or more medical services; a payment interface in communication with the one or more payment services and configured to request payment of a designated amount in connection with any charges for the one or more medical services; a processing engine configured to apply any payments from the one or more insurance entities and any payments from the one or more payment services, in connection with any charges for the one or more medical services, wherein any payments from the one or more insurance entities are applied first, followed by applying any payments from the one or more payment services, so that the one or more payment services are the last to pay; wherein the processing engine is further configured to identify (i) any remaining amount due after any payments from the one or more insurance entities and one or more payment services have been applied, in connection with the charges for the one or more medical services or (ii) any credit due after any payments from the one or more insurance entities and one or more payment services have been applied, in connection with any charges for the one or more medical services; the payment interface being in communication with the one or more payment services and further configured to request payment of any remaining amount due or a refund of any credit due; and wherein information related to the payment processing of any remaining amount due and any credit due is populated in a payment transaction and communicated via the provider interface to the one or more medical service entities.