METHOD FOR PROVIDING REAL TIME CLAIMS PAYMENT

摘要

A system for real time payment of insurance claims is disclosed. As an initial step, patients provide their insurance information to a service provider. The service provider transmits the patient's information and the insurance information to a benefits administrator. The benefits administrator determines whether the patient is participating in a plan provided by the insurance provider that provides for real time payment of the insurance claim. If the patient is participating in an eligible plan, the benefits administrator informs the service provider. The service provider submits a claim describing the services provided to the patient. The benefits administrator identifies the services for which payment may be made in real-time. The benefits administrator coordinates payment from the insurance provider to the service provider and sends a confirmation of the payment to the service provider. The benefits administrator may additionally provide an explanation of benefits in real time to the patient.

主权项

1. A method for real-time claims payment, comprising the steps of:
generating a claim submission with a practice management system executing on a computer at a service provider, wherein the claim submission identifies at least one service provided; transmitting the claim submission from the computer at the service provider to a remote server at a benefits administrator via a network; verifying that the claim submission is a clean claim with a claim processing system executing on the remote server; initiating a payment in real-time from the claim processing system for the at least one service provided, wherein the payment is credited to an account for the service provider; and transmitting a payment acknowledgement from the claim processing system on the remote server to the claim management module executing on the computer at the service provider via the network in real-time.