Patent ID: 11244767

Abstract:
Computerized method requiring claim adjudication to receive patient payment for a product or service provided by a healthcare provider to a patient with full financial responsibility, including receiving a patient claim; re-pricing the claim, automatically initiating a real-time payment authorization request through a payment gateway; receiving a real-time notification that the patient's funding source has verified funds availability, with the funds to be deposited in a designated account for subsequent provider payment; sending the healthcare provider the copay and plan pay pricing edits; and concurrently, sending the patient a payment e-receipt electronically, indicating the total amount due and the amount debited from the patient's funding source, the plan payment, with any difference the copay to be paid directly to the provider. Automatic real-time patient audit enabling payment e-receipts indicate claim adjudications and claim reversals as well as adjudicated copay and plan pay amounts, with the plan payment eliminating adjudication circumvention.